The Risks of Providing Care

One of the most frequently asked legal questions in EMS is, how do you limit the potential financial consequences that any ambulance-based business faces?

Assess the Risks
In order to minimize risks and resulting liabilities, you must first recognize what the risks are and where they come from. First, think of your patients. Injuries to patients resulting from negligence or medical malpractice are always a source of potential liability. Also look at the other individuals your crews come into contact with on the road. Vehicle accidents are another area where we often see liability in EMS.

Look at your own employees. Injuries, worker's compensation claims and allegations of sexual harassment or discrimination can all lead to possible liability for an EMS service.

Finally, consider your business. Liability for business issues, such as proper billing practices, failure to obtain proper licenses and permits, and illegal discounts or incentives in contracting, can lead to enormous financial consequences.

Manage the Risks
Now that you see the areas of potential liability, what can you do about them? First, decide who is the best person to assess, address, monitor and train on these issues. Keep in mind it probably will not be one person. For example, the best person to review trip reports and write protocols and policies for patient care may be your medical director. The best person to address vehicle liability, conduct pre-employment driving tests and write policies on lights, sirens and fatigue may be a paramedic with your service who has a lot of experience and a good driving record. The person you want in charge of employee issues may be a human resource manager who is familiar with worker's compensation requirements and devices used to prevent workplace injuries, as well as how to prevent or deal with claims of sexual harassment or discrimination. Finally, a business office manager who knows state licensing and renewal requirements, billing regulations and contract laws would probably be the best person to deal with those issues.

Stay on Top of the Risks
Once you have decided who should be responsible for each area of potential liability, make sure they know that part of their job is to learn all they can about these issues and stay on top of them, including keeping abreast of changes in laws, rules, requirements or industry standards. Then you can finally get down to the job of actually finding potential liabilities (through quality assurance reports or complaint procedures), training your staff on how to avoid liabilities (with the assistance of written policies and actual classroom or field exercises as pointed out above), and addressing the issues before they turn into actual liabilities.

There is no sure-fire method to prevent all liabilities. The risk of being assessed financial damages due to something you did (or should have done) is a fact of providing prehospital care. However, if you follow the steps above, you will be doing the best you can to prevent these potential areas for loss from becoming actual damages that come out of your budget.

Let me address one other point. Sometimes we don't see potential liabilities for what they are because they are hidden behind insurance, or, in some states, immunity. Just because damages don't come directly from your pocket does not mean that the underlying issue should not be avoided at all costs. For example, insurance may cover injuries to patients (medical malpractice policies), third parties (automobile coverage) or your employees (workers' compensation programs), but claims cause increased premiums, so, in the long run, it comes back to cost the company. In states that have immunity, you may not have liability to an injured patient, but the same care needs to be taken to prevent harming patients, whether or not they may be able to sue you later.

G. Christopher Kelly is an attorney who focuses on federal laws and regulations as they relate to the healthcare industry and specifically to the ambulance industry. Chris lectures and advises EMS clients across the U.S. This article is not intended to be construed as legal advice. For more information or questions, reach Chris at ckelly@emscltd.com or by contacting EMS Consultants, Ltd., 800/342-5460.