Deadly Exposures

Summary

Vickie Flaherty, a well-educated, industrious healthcare risk manager, sees her institution get hit with a $2.3 million uninsured loss because of gaps in her insurance coverage after a hospital-acquired infection outbreak exposes environmental pollution exclusions in her general liability and property policies.

Video Insights: Matthew Kahn sat down with Marcel Ricciardelli, Senior Vice President, Environmental at Allied World who is the sponsor of this scenario, for an in-depth discussion of “Deadly Exposures”. Highlights of their conversation are integrated into the summary below.

1. Build staff-wide awareness of hospital-acquired infections: Healthcare-associated deaths are now one of the top 10 leading causes of death in the U.S., accounting for nearly two million infections and 100,000 deaths annually. An outbreak of Legionella at a hospital in Atlanta resulted in cleanup costs alone of approximately $1 million.

 2. Be ready: Have a crisis response plan in place to contain infection outbreaks. That plan should include details of how your organization handles sterilization of rooms, clothing, bathrooms, sinks, equipment and eating utensils. The plan should also include guidance on how to communicate not only with the families of victims but with other concerned patients and the media.

3. Be adaptable: Be aware that your response plan might look good on paper but not work so well in execution. Vickie had a detailed response plan, but the hospital still found itself dealing with angry patients and families. Don’t get stuck reading a script if the situation demands flexibility.

4. Manage your message: Emotions can run high when there is a death or a serious medical outcome from a hospital-acquired infection. Vickie’s meeting with the deceased patient’s family to promote transparency and disclosure was the right approach but Dr. Graves’ outburst put the hospital in danger of losing coverage and being damaged by potential litigation. Be sure to meet with all providers before holding a similar meeting to ensure that everyone is on the same page and will communicate a consistent message.

5. Focus on exposures, not policies: In an effort to keep costs down, agents frequently focus on policies rather than the exposures that exist. Too often, they try to write the existing coverage cheaper rather than writing the right coverage at a fair price. That could leave a company exposed.

6. Review your coverages: A MRSA outbreak could be categorized as an environmental pollutant and excluded from the standard E&O (Med Mal), Property and General Liability policies. These policies should be thoroughly vetted for such exclusions.

Related Articles and Resources

An Infectious Condition  (Risk & Insurance®)

Here’s an article about how risk management in health care has changed over the years. It used to focus primarily on reducing medical mistakes. Now, health care providers are coming to realize that errors affecting patient safety are not necessarily the fault of one person who makes a mistake.

Unnoticed Infection Turns Unstoppable (New York Times)

Here’s an example of how other infections — not just MRSA — can turn deadly very quickly. Rory Staunton, 12, went to the emergency room with a sick stomach and fever one day in March; he was sent home. Three days later, he died of septic shock.

Dealing With Nasty Staphs (Risk & Insurance®)

What are the experts saying? The American Society of Safety Engineers says that hospitals and other facilities can take steps to prevent MRSA infections. Among the suggestions are good medical screenings, frequent hand and equipment washing, using gloves to treat cuts and infections and encouraging ill staff members to stay home.

‘Superbug’ Stalked Hospital, Killing Six (Washington Post)

As a deadly infection, untreatable by nearly every antibiotic, spread through the National Institutes of Health’s Clinical Center last year, the staff resorted to extreme measures. They built a wall to isolate patients, gassed rooms with vaporized disinfectant and even ripped out plumbing. They eventually used rectal swabs to test every patient in the 234-bed hospital.

After He Fell Off a Ladder, One Medical Error Led to Another (The Washington Post News Service with Bloomberg News)

In this gripping first-person account, Kerry O’Connell describes how an already complex arm injury became even worse when he acquired methicillin-resistant Staphylococcus epidermidis (MRSE) from the surgical drain tube at the hospital.

Video: MRSA Infection Truths and Myths

This video offers insight from doctors about how the infection is spread as well as how it is treated.

How is the frequency of instances of hospital-acquired infections like MRSA trending in the healthcare institution you provide risk management services for?

• They are running about the same as three years ago.
• They have decreased from three years ago.
• They have increased compared to three years ago.

When was the last time the hospital you provide risk management services for took part in infectious disease control planning in conjunction with the institution’s infection control committee?

• Within the past 12 months.
• Beyond the past 12 months.
• I don’t know the answer to this question

Were you aware that MRSA can be considered an environmental pollutant under general liability and property policies and that cleanup costs and business interruption losses wouldn’t be covered?

• I was not at all aware of this potential coverage gap.
• I was somewhat conversant on this issue but this scenario opened my eyes a bit to the potential losses.
• I was very comfortable with my knowledgeable on this issue before I read this scenario and the scenario didn’t add to my awareness of the risk.

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