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The Clinician's Handbook
on FTCA is a descriptive document, not a legal
one. It is intended to provide frontline
Health Center clinicians with a basic understanding
of FTCA malpractice immunity protection, the claim
process, and its impact on clinicians. It should not
be considered a comprehensive legal analysis of either
FTCA or of medical malpractice. It is an interpretive
reference, and should not be used as a guide for clinicians
to contract or work directly with federal employees
or agencies on FTCA matters - a role more appropriate
for the Clinical Director or the Executive Director.
Introduction
- Background
Over the course of a clinician's career it is likely
that several patients will feel that they have been
injured through acts of omission or negligence. The
patient, or the patient's attorney, may decide to
file a claim based on the alleged injury. Consequently,
most clinicians eventually deal with a malpractice
claim. Certain actions and omissions of some clinicians
at federally funded Health Centers, however, are financially
protected from medical malpractice claims.
In 1992 and 1995, Congress passed legislation that
created a program designed to help certain United
States government-funded clinics save money. The laws
were titled the Federally Supported Health Centers
Assistance Acts (FSHCAA) of 1992 and of 1995 (Pub.L.
102-501 and Pub.L.104-73, respectively). This program
is more commonly called the Federal Tort Claims Act,
or FTCA program. FSHCAA of 1992, and the subsequent
1995 reauthorization, make malpractice protection
available for employees and certain contractors of
clinics funded under Section 330 of the Public Health
Service Act. These clinics must apply in order to
be deemed a FTCA covered Health Center and receive
the consequent protection for their employees. FTCA
is the same protection that has been available for
employees of the Federal Government (such as those
employed in the Indian Health Service) for decades.
As of August 2001, there were over 585 Health Centers
that had applied and received approval for FTCA protection.
Approximately 7,000 clinicians provide care through
Bureau of Primary Health Care-funded organizations.
They treat approximately 9 million patients who visit
the Health Centers more than 35 million times per
year.
A Question/Answer section forms
the main body of this handbook. It is composed of
those questions that are most commonly asked by clinicians.
Appendices include a case study, a glossary of FTCA
and Public Health Service terms, and various contacts
and sources of information. Appendix I contains a
self-test for clinicians who may wish to perform a
cursory review of their FTCA protection status on
alleged or potential claims.
The Clinician's Handbook on FTCA
is written for those Health Center clinicians who
are (or will be) receiving Federal Tort Claims Act
malpractice protection. The handbook is intended to
provide you with a fundamental understanding of the
Federal Tort Claims Act. It should be saved as a source
for answering questions and identifying basic documents.
Should further questions arise, talk to your Clinical
Director, or Executive Director. Should a claim be
made against you, immediately consult your Clinical
Director or Executive Director.
Introduction - Basic FTCA Definitions
The Federal Tort Claims Act (FTCA)
is the federal legislation that allows parties claiming
to have been injured by negligent actions of employees
of the United States to file claims against the federal
government for the harm they suffered. The FTCA also
provides authority for the federal government to defend
against such claims. Amendments to the Public Health
Service Act in 1992 and 1995 provide that employees
at deemed Health Centers are to be treated as employees
of the United States for purposes of medical malpractice.
These "employees" include board members, officers,
employees and certain contractors of deemed Health
Centers. "Employees" are given malpractice protection
for actions within their scope of employment, and
within the scope of project of a deemed Health Center.
Health Centers eligible for FTCA
protection are those funded by the Department of Health
and Human Services, Health Resources and Services
Administration, Bureau of Primary Health Care under
Section 330 of the Public Health Service Act. These
grantees submit periodic applications to the Bureau
of Primary Health Care as a condition of their funding.
These periodic applications are called project period
renewal grant applications.
Deeming is an application process
that an eligible Health Center must undertake in order
to activate and maintain its FTCA malpractice protection.
The law allows only organizations funded through section
330 of the Public Health Service Act, to be deemed.
The deeming process, while not onerous, does have
some basic requirements. Health Centers that wish
to participate must assure the Bureau of Primary Health
Care that they conduct complete and thorough credentialing
of their providers including a query of the National
Practitioner Data Bank. Participating Health Centers
must maintain clinical protocols, tracking systems,
medical record reviews, and active quality assurance
programs. Once deemed, participation is maintained
through project period renewal grant applications
and indicated on the Health Center's Notice of Grant
Award.
A Health Center's Scope of Project
is the domain described in certain segments of its
grant application and approved by the Bureau of Primary
Health Care. Those segments include a description
of the Health Center's populations served, the list
of services provided, list of service delivery sites,
Health Center affiliations and work plan. A Health
Center can change its scope of project throughout
its project period by adjusting those fundamental
documents and seeking approval for such change from
the Bureau of Primary Health Care.
An individual's Scope of Employment
is defined by the duties and responsibilities of an
employee or contractor as identified by a written
job description or contract, along with other related
performance responsibility documents.
Credentialing - A process for verifying
that a provider is appropriately licensed or certified,
and for evaluating the quality of that provider's
work history. Most health plans and hospitals credential
providers that practice with or for their organization.
The Federally Supported Health Centers Assistance
Act of 1992 requires, and PIN
2001-16 reiterates, that each deemed Health
Center that participates in the FTCA must credential
all its physicians and all other licensed or certified
health care practitioners, set up a periodic privileging
policies and procedures for those practitioners, and
follow those policies and procedures.
A glossary of additional definitions and terms is
presented at the end of this document in Appendix
B.
Questions
and Answers
How is FTCA different from my individual malpractice
policy?
Under FTCA you do not have an individual malpractice
policy.
If you have FTCA protection, you have financial protection
from a malpractice lawsuit. The United States government
would be substituted as the defendant in any malpractice
claim for your activities, which are within your scope
of employment and within the scope of project of a
deemed Health Center.
I am a dentist (radiologist, psychiatrist,
pediatrician, neurologist, nurse, family physician,
physician assistant, etc.). Does FTCA cover my profession?
Yes. FTCA malpractice protection applies to you and
all other employees (and certain contractors) of appropriately
deemed Health Centers.
Malpractice claims protection is available for your
discipline and all other disciplines. All types of
clinicians, administrators, directors, nurses, and
other personnel, who could be named partners to your
Health Center-related clinical actions can receive
malpractice protection. Malpractice protection is
not available for Health Center volunteers. Malpractice
protection is not available for students or residents
training in a Health Center. Malpractice protection
for these individuals should be provided through a
means other than FTCA.
How would I know if my service to the Health
Center would be considered employment?
If you receive a W-2 from the Health Center, you are
probably an employee.
Determination of employment status of contractors
can be complex. The Center for Risk Management and
the Department of Health and Human Services Office
of General Counsel may utilize the Internal Revenue
Service definition (a 23-part test) to determine if
you are an employee (see Appendix D "Organization
Chart"). If you receive a W-2 income reporting form
from the Health Center, you are likely to be considered
an employee. If you receive a 1099 income reporting
form from the Health Center, you are more likely to
be considered a contractor.
As an employee you should have a job description and
policies and procedures that clearly delineate your
role, duties, responsibilities and tasks. These types
of documents define your scope of employment or those
actions that you can undertake on behalf of the Health
Center and under FTCA malpractice claims immunity.
What if I am a part-time employee?
You are protected.
All employees of a deemed Health Center are eligible
for FTCA malpractice protection. This includes employees
hired for part time service and employees hired for
short periods of time, such as locum tenens. This
applies only to employees (including employed locum
tenens). For information on independent contractors,
see the following question.
Can I come under FTCA malpractice claims protection
through a contract instead of as an employee?
Yes - in many instances.
You must be appropriately credentialed, licensed and/or
certified according to the standards of your profession
and according to national, regional and local requirements
in order to be eligible to come under FTCA protection
through an independent contract.
All appropriately credentialed, licensed and/or certified
full-time individual contractors are eligible for
FTCA malpractice protection. You are protected if
you are contracted for more than 32.5 hours per week
and the Health Center is the entity that receives
payer compensation for the services you provide. If
contracted for less than 32.5 hours per week, protection
eligibility will depend on the services you provide.
If you provide family practice, obstetrics/gynecology,
pediatrics, or general internal medicine services,
you can come under FTCA as either a full-time or a
part-time contracted provider. The Health
Center, however, must be the entity that receives
payer compensation for the services you provide (except
in those cases where the exceptions listed in PIN
2001-11 are met.) This usually means that the
Health Center receives the compensation directly.
In certain circumstances, however, FTCA malpractice
claims protection is applicable when compensation
is passed through you to the Health Center. If each
of the following conditions are met, FTCA malpractice
claims protection can remain intact when the Health
Center does not receive direct compensation for the
services you provide: 1) You report all of your billings
to the Health Center. 2) The funds you receive for
your billings are transferred directly to the Health
Center within a reasonable period of time. 3) Your
employment contract authorizes the billing arrangements
described in steps 1 and 2.
If you are not providing family practice, obstetrics/gynecology,
pediatrics, or general internal medicine services
you must be a full time contractor (at least 32.5
hours per week) in order to be eligible for FTCA protection.
If you are a part time employed dentist, for example,
you are eligible for FTCA malpractice claims protection.
If you are a part time contract dentist, however,
you are not eligible for FTCA malpractice protection.
In either case, the Health Center must be the entity
that receives payer compensation, directly or indirectly
(see previous paragraph) for the services you provide.
As a contractor, you should have a formal and written
contract that clearly delineates your role, duties,
responsibilities, tasks, and mechanisms for your compensation,
and which identifies the Health Center as the reimbursement
payee. This contract and the organization's policies
and procedures define your scope of contracted services
or those actions that you can undertake on behalf
of the Health Center and under FTCA malpractice claims
immunity.
Can I come under FTCA malpractice claims protection
through a contract with my group, or my professional
corporation?
No.
Health Center contracts must be with individual clinicians
in order for them to receive malpractice protection.
If a Health Center contracts with your group, then
your group assumes its own liability. If a Health
Center contracts with your professional, personal
or private corporation, or any other entity, then
that corporation or entity assumes its own liability.
If you receive direct compensation from payers for
the services you provide at the Health Center, you
may not be eligible for malpractice claims immunity
and protection for those services.
Can I retain malpractice protection at any
clinic that meets underserved community needs?
No.
FTCA malpractice protection is only available to you
as an employee or independent contractor of a deemed
Health Center, acting within your scope of employment
and within the scope of project of your deemed Health
Center.
What is my coverage limit?
There is no monetary limit.
If you come under FTCA malpractice protection, the
Federal Government is the defendant for claims made
against your Health Center-related actions or omissions.
You have complete financial protection from malpractice
related claims. FTCA settlements are the responsibility
of the United States government.
Which of my Health Center and community-affiliated
activities fall under FTCA malpractice claims protection?
All activities within your scope of employment, and
which your Health Center has built into its approved
scope of project - are covered.
Your activities are covered if they are within the
scope of your employment, and if they are within the
approved scope of project of a deemed Health Center.
These activities could include (but are not limited
to) clinical patient care, inpatient care, patient
education, Health Center triage, clinical trials (where
the patients are Health Center patients) and oversight
of the Health Center-based clinical medical education
of students, interns and residents.
Activities protected under FTCA include emergency
room coverage or community call participation that
are required in order to maintain admitting priviledges
---if these are requirements placed on all community
physicians, when these activities are within your
scope of employment, and when admitting privileges
are within your Health Center's scope of project.
Your activities are covered for services provided
in all of your Health Center's sites, as long as the
activities fall within your scope of employment and
within your deemed Health Center's scope of project.
This could include activities provided at a school-based
clinic, in a mobile van, in a family planning clinic,
or at a location that your Health Center has contracted
to provide care for. Appendix J contains a simple
self-test to help review FTCA protection status. You
may wish to perform this cursory review with regard
to alleged or potential claims.
Which of my activities may not be protected?
Those activities of yours that are not associated
with a deemed Health Center, are not within the scope
of project of a deemed Health Center, are not within
your scope of employment, or are not clinical malpractice
related - are not protected.
- FTCA malpractice protection does not apply to
your actions undertaken while outside of United
States borders.
- FTCA malpractice protection does not apply to
your activities to supervise non-Health Center employees
and staff - such as serving as Medical Director
for a Health Center contracted nursing home, or
as Medical Director for the local emergency medical
system.
- FTCA malpractice protection does not cover your
supervision of care provided by students or residents
to non-Health Center patients, unless the patient
is part of your required on-call scope of employment.
- If you are unfamiliar with the terminology presented
in this answer, review the Basic FTCA Definitions
section at the beginning of this handbook.
FTCA malpractice protection does not apply to moonlighting
or any other of your activities that are outside
of your scope of employment or outside of the scope
of project of your deemed Health Center.
- FTCA malpractice protection may not apply to
any of your activities for which you charge payers
directly (see
PIN 2001-11).
- FTCA does not provide protection like general
liability coverage, director's and officer's liability
coverage, automobile and collision coverage, fire
coverage, theft coverage, or any other non - malpractice
coverage.
It would be prudent for your Health Center to obtain
activity specific insurance products if you or the
Health Center participate in the above activities,
or other activities that do not come under FTCA
malpractice protection. Your Health Center's Primary
Care Association may offer advice on activity specific
insurance carriers (see Appendix C).
- FTCA malpractice protection does not provide
coverage for non-Health Center related individuals
or entities who might also be named in a malpractice
claim against you (see "indemnification" in Glossary,
Appendix B). FTCA protects only the employees and
certain contracted clinicians of deemed Health Centers.
Other organizations working with Health Centers,
such as HMOs and hospitals, should obtain separate
malpractice coverage. Indemnification can be addressed
with specific insurance products.
- FTCA does not provide malpractice protection
for your acts that are considered criminal or illegal
-such as sexual misconduct or willful physical abuse.
- FTCA malpractice protection may not apply to
community activities. These activities could include
(but are not limited to); community call, hospital
call, emergency room coverage, and services such
as medical care for local events, or serving as
a football sideline physician. If you are involved
in community activities, it would be prudent for
your Health Center to either work to make your community
activities available for FTCA malpractice protection
(see the following question), or purchase "gap"
insurance protection. The National Association of
Community Health Centers, and/or your Primary Care
Association can offer advice on "gap" insurance
(see Appendix C).
- FTCA is a financial malpractice protection. FTCA
does not protect you from the normal licensing,
credentialing or peer review requirements or professional
consequences in your state.
What must be done for my community activities
to be covered?
Most activities can be covered. Discuss your community
activities and obligations with your Clinical Director
so that your Health Center can decide whether they
should be brought under FTCA or covered with gap insurance.
Community obligations and services are covered only
if they fit within the Health Center's scope of project,
and within your scope of employment.
Changes to your Health Center's scope of project,
can be requested throughout the year. Have your Clinical
Director contact the Field Office FTCA Coordinator
(Appendix C) for information on changing your Health
Center's scope of project. Changes to your scope of
employment should be reflected in your contract with
your Health Center, and in the job description for
your position.
In addition, it is suggested that an identifiable
relationship with the community entity/event be developed.
Written affiliation agreements can serve to indicate
and solidify the Health Center's relationship with
the community entity/event. A sample affiliation agreement
can be found in Appendix H. Indication of Health Center
sponsorship of the community entity/event on event
publications can also serve as proof of a relationship.
It is a good idea to insist that entities/events note
your Health Center's participation and use its logo
in all of their event-related publications and advertisements.
When does my coverage start and end?
You are protected permanently - regarding those acts
that occurred while you were under the cover of FTCA.
This is similar to the kind of assurance that you
might receive with an "occurrence" type individual
malpractice policy. If you are under the cover of
FTCA, you are protected from malpractice liability
for those acts that occurred while you were under
that cover - regardless of when a claim is made.
The FTCA has been made a permanent program with no
sunset component, so the program is very unlikely
to be discontinued. If it were discontinued, however,
you would retain permanent protection for those acts
that occurred while you were under the protection
of FTCA.
Occasionally, Health Centers lose their eligibility
status for federal funding due to lack of community
need, or for some other reason. It is possible (although
unlikely) that an organization would decide to abandon
its registration as a deemed Health Center. If the
Health Center were to lose its federal funding status
or lose its deemed status, you would still retain
permanent protection for those acts that occurred
while the Health Center was funded and deemed by the
Bureau of Primary Health Care, and you were under
the protection of FTCA.
How will FTCA impact my credentialing by outside
organizations?
Your FTCA malpractice protection WILL be accepted
by those credentialing organizations that wish to
avoid federal penalty.
Some credentialing organizations may inappropriately
question the adequacy of your "coverage" if they are
unaware of FTCA malpractice protection. Legislation
from 1992, however, requires hospitals to accept FTCA
as adequate for their coverage limits - or face the
possibility of losing the privilege of doing business
with Medicaid and Medicare. Legislation from 1995
extends that requirement and comparable sanctions
to HMOs and other managed care organizations (section
224 of the Public Health Service Act).
Appendix E is a Sample Verification Letter. A similar
letter should be typed onto your Health Center's letterhead
and shared with credentialing organizations in response
to inquiries about your coverage. If this does not
satisfy the organization, have them contact the FTCA
Coordinator at your Field Office (listed on Appendix
C) with both your name, and that of your Health Center.
What is the process if a malpractice claim
is filed against me?
The federal government will assume responsibility.
A malpractice claim is likely to start out naming
you and your Health Center as defendants in state
court. This is probably because the claimant is unaware
that you have immunity protection, or because he/she
believes that your conduct was not covered by FTCA.
You will not remain the defendant for an FTCA-related
malpractice claim.
Those controversies that fall under the jurisdiction
of federal courts instead of state courts are defined
in Article III, Section 2 of the Constitution. They
include cases in which the United States government
or one of its officers is being sued. FTCA makes you
(as an employee or agent of a deemed Health Center,
who is acting within your scope of employment and
within the organization's scope of project) an "officer"
of the federal government for issues of malpractice
protection. Before a trial takes place, your case
will be moved out of state court for lack of appropriate
jurisdiction and the defendant will become the United
States government.
United States Attorneys are the federal government's
principal litigators under the direction of the Attorney
General. There are US Attorney Offices located in
the district of each federal District Court. One role
of US Attorneys, according to Title 28, Section 507
of the US Code, is the defense of civil cases in which
the United States is a party. The United States Attorney's
Office is directed to appear in a state court for
FTCA related malpractice actions within 15 days of
being notified of the action.
The United States Attorney's Office will move the
claim to Federal District Court (see Appendix D).
Plaintiffs are required to seek administrative remedy
before they can sue for malpractice. If no administrative
tort claim has been filed, the Federal District Court
is likely to dismiss the claim. The plaintiff may
then file an administrative claim with the Public
Health Service Claims Office.
If an administrative claim is pursued, the Department
of Health and Human Services will contact your Health
Center requesting additional specific information.
This information will be reviewed by a physician of
appropriate specialty and by a claims panel composed
of clinicians representing the Public Health Service.
A recommendation will then be made to the Health and
Human Services Office of the General Counsel on whether
the standard of care has been met. If the claim is
denied or a settlement is not reached, the plaintiff
has up to six months to file suit in federal District
Court.
If a satisfactory resolution to the claim is not reached
and a lawsuit is filed, a Department of Justice US
Attorney will defend the case. The Department of Justice
defends all claims against the federal government.
The Justice Department has experience defending malpractice
claims filed against the Department of Defense, Veterans
Administration, National Health Service Corps, and
other federal departments and agencies
Your Health Center will receive a risk management
quality improvement report based on an evaluation
conducted by the Princeton Insurance Company. The
report will be forwarded to your Health Center by
the Bureau of Primary Health Care, and the Health
Center will be expected to develop a work-plan, and
organize a written response to the report.
Appendix A contains an example of a Health Center
clinician's FTCA claims process experience. Reviewing
this example may provide you with additional insight
into the FTCA malpractice claims process.
What should I do if a malpractice claim is
filed against me?
Inform your clinical director.
If a suit is filed in state court, confer with your
Health Center Clinical Director and ask him/her to
inform your Executive Director (Appendix J contains
a simple self-test to help you understand how Health
and Human Services will review your FTCA protection
status). Providing malpractice claim information to
your Clinical Director should trigger a variety of
activities that your Health Center administration
will need to oversee:
A. Your Health Center administration must immediately
send the Summons and Complaint via overnight mail
to:
Chief, Litigation Branch Business and Administrative
Law
Division Office of General Counsel Department of Health
& Human Services
300 Independence Ave., S.W., Room 5362
Washington, D.C. 20201
Phone, 202-619-2155
B. Your Health Center administration should call your
Field Office FTCA Coordinator (Appendix C). It is
important that your field Office FTCA Coordinator
is contacted shortly after you have been summoned,
in order to facilitate the process that protects you.
If an allegation is made against you, do not communicate
with the US Attorney until the Department of Health
and Human Services Office of the General Counsel has
determined that your actions were protected by FTCA.
Because you are either; 1) not the defendant, or 2)
are the defendant and it is not a federal case, you
may have no attorney-client privilege with the US
Attorney. Information you provide the US Attorney
prior to determination of your FTCA status could be
disclosed to the plaintiff.
C. Your Health Center administration should document
the details of the alleged incident, and prepare the
following list of documents as required by the Department
of Health and Human Services:
- Two (2) copies of the complaint and summons.
- Two (2) copies of a narrative summary regarding
the facts of the alleged incident from the practitioner,
the medical director and witnesses. Include the
names, addresses and phone numbers of those contributing
to the narrative summary, and follow the format
provided by the Office of the General Council
- Copies of your job description, employment contract
and wage statements for the period when the incident
was alleged to have occurred. If you were an employee
at the time of the alleged incident, send a W-2
wage statement. If you were a contractor at the
time of the alleged incident, send a 1099 statement.
- An affidavit verifying your employment at your
Health Center (see Appendix G sample "Affidavit
of Employment").
- A copy of your professional license and DEA Certificate.
- Two (2) copies of your Health Center's (or your
own) insurance policies.
- Four (4) copies of the relevant sections of the
plaintiff's medical chart.
- Two (2) copies of your Health Center's original
deeming letter from the Department of Health and
Human Services.
- Two (2) copies of the section of the notice of
grant award that verifies that your Health Center
has been re-deemed.
A request for representation by the Department of
Justice, and consequent removal of the case to federal
jurisdiction (see Appendix F sample "Request for Representation").
D. Your Health Center administration should actively
track progress of the claim by communicating with
the Field Office FTCA Coordinator (Field Office contacts
are identified in Appendix C).[3]
The Federal malpractice defense process is not likely
to match your traditional malpractice defense expectations.
Since you would not be the defendant, you could feel
out of touch with the process. Asking your Health
Center administration to actively track progress can
help you stay in touch with the process.
E. The Bureau of Primary Health Care will forward
a risk management quality improvement report, prepared
by the Princeton Insurance Company, to your Health
Center. Your Health Center will be expected to develop
a work-plan, and organize a written response to the
report.
If an allegation is made against you, do not communicate
with the US Attorney until the Department of Health
and Human Services Office of the General Counsel has
determined that your actions were protected by FTCA.
Because you are either; 1) not the defendant, or 2)
are the defendant and it is not a federal case, you
have no attorney-client privilege with the US Attorney.
Information you provide the US Attorney prior to determination
of your FTCA status could be disclosed to the plaintiff.
Would I have final approval over whether or
not my case was settled out of court?
No.
An FTCA claim, after being removed from state court,
would not be your case; the Federal government becomes
the defendant. While United States Attorneys may discuss
plans to settle cases with the treating provider,
they would not be compelled to seek your opinion.
A claim, however, should not be settled without authorization
from the Bureau of Primary Health Care's Center for
Risk Management.
Traditional malpractice insurance programs may seek
proxy from providers to settle when negotiated terms
become favorable. Settlements can then occur for reasons
that are not germane to the claim - such as the insurance
program's desire to clear out a backlog of cases.
There is no inherent reason, however, for the Bureau
to settle cases they believe are defendable. They
have not settled nuisance, or other cases, for medically
trivial reasons, such as a desire to clear up a backlog.
When would my name be required to be placed
in the National Practitioner Data Bank?
If and when a payment is made.
Clinicians must be reported to the National Practitioner
Data Bank whenever a payment is made, and the Public
Health Service Quality Review Panel has determined
that the standard of care was not met. The Health
Resources and Services Administration is interested
in promoting equitable quality care through Health
Centers and their clinicians. The National Practitioner
Data Bank, Health Centers and FTCA are all administered
within the Health Resources and Services Administration.
The Health Resources and Services Administration,
the Bureau of Primary Health Care and all their divisions
follow National Practitioner Data Bank requirements.
How can I reduce the likelihood of malpractice
claims being made against me?
You can reduce the likelihood of malpractice claims,
and improve the federal government's ability to defend
against them, through careful risk management planning
and implementation.
You can manage and minimize malpractice risk by encouraging
and assisting your Health Center in undertaking appropriate
risk management, quality assurance and quality improvement
programs. The likelihood of malpractice claims can
be reduced, and the ability to defend them can be
enhanced with carefully designed and implemented programs.
Health Centers have historically utilized various
risk management strategies. The Bureau of Primary
Health Care required quality assurance measure reporting
for several years prior to the enactment of FTCA law.
The Bureau also typically performed (and still does)
periodic Health Center reviews that considered certain
risk management criteria.
The Bureau of Primary Health Care has promoted an
increased emphasis on risk management, quality assurance
and quality improvement programs in the past few years.
A "Quality Center" has been developed to facilitate
the measurement and improvement of quality in Health
Centers. The Quality Center has formed a joint venture
with the National Association of Community Health
Centers to improve risk management quality in Health
Centers. The venture has adopted three main strategies
to help Health Centers improve risk management:
- Risk management training offerings. These are
typically offered at state primary care association,
clinician's network and NACHC meetings. For information
on upcoming risk management training, contact your
primary care association (see appendix B), or Freida
Mitchem at NACHC, 1-202-659-8008
- Advice offered through a NACHC/ProNational risk
management hotline. The hotline can be accessed
by calling 1-888-800-3772 (toll free).
- An on-site risk management evaluation conducted
by ProNational Insurance. BPHC/NACHC pay the ProNational's
consulting fees for the evaluation, but the Health
Center must cover logistical expenses. For further
information on a BPHC/NACHC risk management evaluation,
contact Freida Mitchem, NACHC, 1-202-659-8008.
The Bureau of Primary Health Care Quality Center,
State Primary Care Associations, State Primary Care
Offices, your Health Center's Field Office, and the
National Association of Community Health Centers are
all resources for developing formal qua lity assurance
and risk management programs. For further information
contact those entities identified in Appendix C, or
call BPHC's FTCA help line at 1-800-FTCA.
Appendices
Appendix A - "Dr. James"
FTCA Case Example
Most people in my Health Center know me as Dr. James[4].
I received an unpleasant surprise from a man who came
into my office on January 28th, 1998. The courier
handed me a document, and asked that I sign for receipt
of a summons and complaint.
The complaint alleged that I had practiced outside
of the community standard of care, and had failed
to diagnose a cancerous skin lesion during a routine
physical exam of a female patient in 1995. The patient
had recently had the lesion removed by another physician.
The summons and complaint said that the claimant suffered
physically and emotionally from a facial scar, and
from fear of further complications.
After the courier departed, I left a message on my
Medical Director's answering machine, and went to
pull the former patient's chart. The chart showed
that the patient had come in for stomach cramps on
the day in question. Health Center policy is to suggest
a full physical exam for all patients over thirty
years of age who have not been examined in the previous
18 months. The patient had refused the exam due to
time constraints, but agreed to make an appointment
to be seen in a subsequent week. The patient did not
make an appointment and had not been seen in the Health
Center since.
Later that day, our Medical Director dropped by -
apparently to reassure me. The Director said that
she had notified the Executive Director and the Regional
Office FTCA Coordinator of the summons, and had asked
her secretary to prepare several appropriate documents.
The documents, she said, would be sent to the Office
of the General Counsel of the Health and Human Services
Department. The Medical Director asked that I write
a description of the patient encounter, which would
be included in that documentation.
The following day, January 29th, 1998, the Medical
Director's secretary interviewed some people in my
department. On February 17, 1998, a representative
from the Office of the General Counsel called and
asked me if a nurse had been present for the duration
of the exam. I told the representative that a nurse
had not been present.
On February 24th, 1998 an Assistant U.S. Attorney
General from the local jurisdiction called and asked
me some further questions. The attorney also corroborated
information with others in the Health Center. Our
billing department sent the attorney a record indicating
that the patient had no further visits.
The U.S. Attorney told me it was not necessary to
attend the hearing on March 11th, since the federal
government was rightfully the defendant, but I attended
anyway. The hearing lasted for just a few minutes.
The federal government presented proof that I had
malpractice immunity under FTCA and asked to have
the case moved to federal court since the state court
had no jurisdiction over the matter. The judge had
the case moved to federal court.
I did not attend any further hearings, but was later
informed that after the case was moved to federal
court, it was dismissed because the plaintiff had
not followed procedure. Alleged claims of malpractice,
I am told, must be presented to the Public Health
Service for an administrative review before they can
go to litigation.
The Health Center received a risk management quality
improvement report that had been prepared by Princeton
Insurance. After word of the claim, Princeton did
a risk management evaluation of my Health Center,
and prepared suggestions for improvement. The report
was apparently passed on to the Bureau of Primary
Health Care, who forwarded it to our center. The Health
Center is expected to respond to suggestions from
Princeton. The suggestions make pretty good sense,
and my Health Center is adopting the prescribed precautionary
actions.
I have heard nothing of this case since, but have
been told that this is not unusual. Sometimes cases
that are moved to federal court and then dismissed
for not following procedure are no longer pursued.
It has been a great comfort to know that our Health
Center's quality standards take such high priority
in this organization. It has also been comforting
to know that I am financially protected from medical
malpractice liability because of the Federal Tort
Claims Act. No cases, I am told, have been settled
in administrative review where the undisputed standard
of care has been met, and most cases do not even go
as far as litigation in federal court.
[4] This case study utilizes fictitious
names and events to describe a provider's role in
the FTCA claims process.
Appendix B - Glossary of Terms
Agent - A person or organization that is authorized
to act on behalf of, or represent, another person
or organization.
BPHC - The Bureau of Primary Health Care is the entity
under which Community and Migrant Health Centers,
and other programs are organized. The Bureau's mission
is "to increase access to comprehensive primary and
preventive health care and to improve the health status
of underserved and vulnerable populations." BPHC is
organized under the Health Resources and Services
Administration, Public Health Service, Department
of Health and Human Services (see Appendix D Organization
Chart).
CHC - Community Health Centers are non-profit, community
based primary care centers in Medically Underserved
Areas, which receive some of their funding from the
Bureau of Primary Health Care. Community Health Centers
have community/user based governing boards, sliding
discounts for the uninsured, community needs-based
service mixes, and strategies to improve community
health measures through increased access to family
practice, internal medicine, obstetrical, gynecological,
pediatric, dental and mental health providers. Community
governing boards are expected to consider the needs
in their community and focus on primary care, prevention,
education and public health strategies to improve
the community's health. CHCs submit periodic applications
as a condition of their funding, which are called
project period renewal grant applications. These applications
identify the needs of the community and propose a
strategy and business plan to address those needs.
Claims Made Policy - A malpractice insurance policy
that only covers the individual for those claims that
are filed during the term of the policy. This is in
contrast to an occurrence policy that covers acts
and omissions that occur during the term of a policy
regardless of when they are filed. Clinicians who
were covered by a claims made policy prior to protection
under FTCA should obtain "tail" coverage, because
FTCA only covers those acts and omissions that occur
while under the protection of the Act.
Contractor - An individual who performs work for a
Health Center but is not an employee of that organization.
Health and Human Services Office of the General Counsel
may use the IRS (23 - part test) definition to differentiate
contractors and employees. Essentially, if a Health
Center issues a 1099 to an individual, then that individual
is probably a contractor.
Credentialing - A process for verifying that a provider
is appropriately licensed or certified, and for evaluating
the quality of that provider's work history. Most
health plans and hospitals credential providers that
practice with or for their organization. The Federally
Supported Health Centers Assistance Act of 1992 requires,
and PIN 2001-16 reiterates that each deemed Health
Center that participates in the FTCA must credential
all its physicians and all other licensed or certified
health care practitioners. Specifically "A Health
Center must verify that its licensed or certified
health care practitioners possess the requisite skills
and expertise to manage and treat patients and to
perform the medical procedures that are required to
provide the authorized services. It is incumbent on
the Health Centers to assure their users that Health
Center practitioners have met standards of practice
and training that enable them to manage and treat
patients and/or perform procedures and practices with
a level of proficiency which minimizes the risk of
causing harm. The organization must adopt its own
policy that outlines specific privileging requirements
and the periodicity of the review of privileges for
all licensed or certified health care practitioners."
For further information see PIN
2001-16, contact your Primary Care Association
or your Field Office FTCA
Coordinator.
Deeming Process - An application process that an eligible
Health Center must undertake in order to activate
and maintain its FTCA malpractice protection. The
law allows only organizations funded under section
330 of the Public Health Service Act to be deemed.
The deeming process, while not onerous, does have
some basic requirements. Health Centers that wish
to participate must assure the Bureau of Primary Health
Care that they conduct complete and thorough credentialing
of their providers, including a query of the National
Practitioner Data Bank. Participating Health Centers
must maintain clinical protocols, tracking systems,
medical record reviews and active quality assurance
programs. Once deemed, eligibility is maintained through
project period renewal grant applications.
Employee - FTCA Administration utilizes the IRS definition
(23-part test) of an employee. Essentially, if a Health
Center issues a W-2 to an individual and pays all
withholding taxes, then that individual is an employee.
Field Office - One of 10 regionally located offices
of the Health Resources and Services Administration.
Each of these offices has an individual who acts as
a regional FTCA Coordinator.
FTCA -The Federal Tort Claims Act (FTCA) can be defined
as the federal law that, among other things, enables
malpractice protection for individuals who are acting
within their scope of employment, and within the scope
of project of a deemed Health Center.
Gap Coverage - In this handbook, gap coverage refers
to a malpractice insurance policy that covers those
clinical activities that are not provided malpractice
immunity under FTCA (sometimes called wrap-around
insurance).
Health Center - The term utilized in this book to
identify an entity eligible for FTCA Protection. "Health
Centers" are funded by the Department of Health and
Human Services, Health Resources and Services Administration,
Bureau of Primary Health Care, under Section 330 of
the Public Health Service Act. These grantees submit
a periodic application as a condition of their funding
which is called the project period renewal grant application.
Indemnification - Legal exemption, for a third party,
from attachment to a malpractice claim. FTCA does
not provide a statutory basis for entities affiliated
with Health Centers to be indemnified or "held harmless".
Malpractice -A dereliction of professional duty through
reprehensible ignorance or negligence - especially
when injury or loss follows (Webster). The Public
Health Service booklet "Medical Malpractice Claims",
states that negligence is the predominant theory of
liability in medical malpractice litigation. Professional
negligence occurs when a practitioner's care falls
below the standard of care established by the medical
community. To meet the standard of care the provider
must exercise the knowledge and skills that a reasonable
practitioner would use under similar circumstances.
National standards have become the benchmark.
The mere assertion of a claim or the fact that an
injury or adverse complication resulted from a medical,
surgical, nursing or dental procedure does not in
and of itself constitute malpractice. The facts must
prove that there was a deviation from the established
standard of care required under the circumstances
and that this departure directly caused the alleged
injury.
Malpractice Claim - An assertion that a provider has
not followed the standard for care, and that the claimant
is therefore due compensation.
Medically Underserved Areas - An area that meets federal
standards designed to indicate a need for primary
care services. The complex index is a mix of morbidity,
mortality, and primary care access measures.
NACHC - The National Association of Community Health
Centers. NACHC is a membership organization that provides
communication, education, training, consulting, networking,
group purchasing and advocacy services at a national
level for community based and Bureau of Primary Health
Care supported clinics.
National Practitioner Data Bank (NPDB) -A federal
clearinghouse to collect and release information concerning
payments made on behalf of physicians, dentists and
other licensed health care practitioners as a result
of malpractice actions and claims and to maintain
information concerning certain adverse actions regarding
their licenses and clinical privileges. Information
is released only to those organizations legally entitled
to receive it. Information in the NPDB is not released
to the public.
Occurrence Policy - An insurance policy that provides
coverage for actions and omissions that took place
during the time of the policy - regardless of when
the claim is made. This is in contrast to a claims
made policy that covers the individual for those claims
that are filed during the term of the policy.
FTCA malpractice immunity is similar to an occurrence
policy. Those protected under FTCA are immune from
malpractice liability for those acts that occurred
while they were under protection - regardless of when
a claim is made.
PCA - Primary Care Associations are state and regional
membership organizations, which are supported, in
part, by the Bureau of Primary Health Care. PCAs provide
communication, education, training, networking, consulting,
group purchasing and advocacy services at a state
level for primary care, community based, Bureau of
Primary Health Care supported clinics, organizations
and clinicians.
PCO - Primary Care Offices are state government based
cooperative agreements that receive funding from the
Bureau of Primary Health Care. PCOs typically serve
a variety of functions that promote primary care,
community-based care and public health in their state.
PCO functions could include (but are not limited to)
liaison with federal offices, needs assessments, clinical
recruiting, collection and reporting of morbidity
and mortality data, oversight of state funding of
primary care and administration of local National
Health Service Corps programs.
Peer Review - A process where a Health Center's provider
staff review the qualifications, outcomes and professional
conduct of individual providers and provider applicants
to that Health Center to determine whether the individuals
reviewed should practice there, and to determine the
parameters for doing so. Most states have givensome
form of immunity to participants in a peer review
process and protect discussions, findings, decisions
and reports of such reviews as information privileged
from judicial disclosure. This protection can vary
significantly from state to state.
Privileging - A process for authorizing a provider
for a defined scope of clinical services based on
an analysis of that provider's credentials, experience
and performance. Most health plans and hospitals privilege
providers that practice with or for their organization.
The Federally Supported Health Centers Assistance
Act of 1992 requires, and PIN 2001-16 reiterates that
each deemed Health Center that participates in the
FTCA must credential, and subsequently privilege,
all its physicians and all other licensed or certified
health care practitioners. In addition to credentialing,
the Health Center "must adopt its own policy that
outlines specific privileging requirements and the
periodicity of the review of privileges for all licensed
or certified health care practitioners." For further
information see PIN 2001-16, contact your Primary
Care Association, or your Field Office FTCA Coordinator.
Scope of Employment -The duties and responsibilities
of an employee or contractor as identified by a job
description or contract and other related performance
responsibility documents.
Scope of Project - A Health Center's scope of project
is the Bureau of Primary Health Care approved domain
described in certain segments of its grant application.
Those segments include a description of the Health
Center's populations served, the list of services
provided, list of service delivery sites, Health Center
affiliations, and work-plan. A Health Center can update
its scope of project by adjusting those fundamental
documents and seeking approval for such change from
the Bureau of Primary Health Care.
Statute of Limitations - The statute of limitations
for filing a FTCA claim is two years.
Sunset Provisions - Scheduled periodic review for
consideration of continuation of certain government
programs, without which the program is discontinued.
FTCA is an abiding program without a sunset provision.
Tail Coverage - A medical malpractice insurance product
designed to cover individuals who move from a claims
made policy to an occurrence policy. Clinicians who
move from a claims made type of policy to FTCA should
obtain tail coverage.
Vicarious Liability - Indirect legal responsibility
that an entity has, concerning the acts of agents.
Hospitals and HMOs, for example, may insure themselves
against the vicarious liability that might result
from a provider's actions.
Work Plan - A section of the federal grant application
on which Health Centers describe goals, objective,
tasks, responsibilities and timetables for improving
the health of their community.
Wrap Around Policy - A malpractice insurance policy
that covers those activities of an employee (or agent)
of a Health Center which are not provided malpractice
immunity under FTCA. Also called gap insurance.
Appendix C - Contacts & Sources for Additional
Information
- Bureau of Primary Health Care's FTCA Help Line
- 1-800-FTCA-HELP.
- Triton Group, 227 Hamburg Turnpike,
Pompton Lakes, NJ 07442.
1-973-831-8395 FAX,
tritongp@optionline.net.
- Bureau of Primary Health
Care's Policy Information Notices and Policy Assistance
Letters
- Mike Chellis, Federal Torts Claims Act Program
Office of Quality and Data
Bureau of Primary Health Care
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
Phone: 301-594-1302
Fax: 301-594-5224
NACHC Information, Training and Workshops - Freida
Mitchem, NACHC's Director of Systems Development.
1330 New Hampshire Ave. NW, Washington, D.C. 20036.
Ph. 202-659-8008 ex. 133. FAX 202-659-8519.
NACHC/ProNational Risk Management Consultation Line
(a free service for non-FTCA risk management questions)
- 888-800-3772. Risk management training is also
available with this group (contact NACHC's Freida
Mitchem at 202-659-8008 ex 133).
NACHC Publications and Issue Briefs - Sharon Lowman,
1330 New Hampshire Ave. NW, Washington, D.C. 20036.
Ph. 202-659-8008 ex. 129. FAX 202-659-8519.
Office of the General Counsel, Litigation Branch,
Business & Administrative Law Division, Health
and Human Services, Cohen Building, Room 5362, 330
Independence Avenue, SW, Washington, D.C. 2020.
Ph. 202-619-2155.
Appendix D
Federal Entities Involved in the Health Center FTCA
Claims Process
- HHS Office of the General Counsel
- U.S. Attorney's Offices
- Judicial Branch District Courts
- PHS Claims Offices
- HRSA/BPHC Office of Quality and Data
Appendix E - Sample FTCA Malpractice Protection
Verification Letter
October 12, 1999
Community Hospital & Health Plan Credentialing
Department 950 E. Irvine Phoenix, Arizona 85027
To whom it may concern:
Dr. Goodoc M.D., is an employee of Clinical Quality
Health Center. As of 12:01 a.m., March 30, 1993, all
clinicians employed by Clinical Quality Health Center
are, for the purposes of malpractice protection, considered
employees of the Public Health Service.
The Federally Supported Health Centers Assistance
Acts of 1992 (P.L. 102-501) and 1995 (P.L. 104-73)
specify that all employees of eligible Health Centers
are covered for malpractice liability under the Federal
Tort Claims Act (FTCA) as per Section 224 of the Public
Health Service Act (42 U.S.C. 233). According to this
Act, the US. Department of Justice will provide defense
of malpractice claims concerning damage or personal
injury resulting from the performance of medical,
dental or surgical activities while acting within
the scope of employment. Our scope of employment includes
patient care services provided in the hospital as
required by our federally supported Health Center.
In addition, FTCA coverage includes payment to a plaintiff
of any damages awarded as a result of a malpractice
judgment or as a result of a settlement approved by
the Attorney General of his/her designee. All organizations
that receive funding from Medicare or Medicaid must
accept this coverage or lose the privilege of participating
in Medicare or Medicaid programs.
One malpractice claim has been filed against Dr. Goodoc,
M.D., during the time of his FTCA coverage with Clinical
Quality Health Center.
If you should have any questions regarding this coverage,
please feel free to contact me at 602-253-0090.
Sincerely,
/s
Cindy Sawit, M.D.
Medical Director
Appendix F - Sample Notice of Complaint &
Summons
July 21st, 1999
Department of Health & Human Services Office of
the General Counsel Business and Administrative Law
Room 5362, Cohen Building 330 Independence Avenue,
SW Washington, DC 20201
RE: Shawnee Gothurt vs. Cody Goodoc, M.D.
The above referenced complaint and summons (previously
sent to you by overnight mail) was served in Maricopa
County, Arizona on October 12, 1999. The following
documents are enclosed:
- Two (2) copies of the complaint and summons.
- Two (2) copies of a narrative summary regarding
the facts of the alleged incident as provided by
our practitioner, medical director and witnesses
. The summary includes the names, addresses and
phone number of those contributing to the narrative,
and is in the format supplied by the Office of the
General Council.
- A copy of Dr. Goodoc's job description, employment
contract and wage statements.
- An affidavit verifying Dr. Goodoc's employment
at Clinical Quality Health Center.
- A copy of Dr. Goodoc's Arizona License and DEA
Certificate.
- Two (2) copies of our Health Center's other insurance
policies.
- Two (2) copies of the relevant sections of Shawnee
Gothurt's medical chart.
- Two (2) copies of Clinical Quality Health Center's
deeming letter from the Department of Health and
Human Services.
- Two (2) copies of the section of Clinical Quality
Health Center's latest notice of grant award signifying
that we have been re-deemed for FTCA.
- A request for representation by the Department
of Justice and consequent removal of the case to
Federal jurisdiction.
I have called the plaintiff's attorney and explained
that this is a FTCA matter, and that some time may
be required for the US Attorney General to respond.
I have told the attorney that you will follow up,
so please call him at 602-589-1000 as soon as you
have received this notice. Should you require further
information or need additional assistance, please
do not hesitate to contact me at 602-253-0090.
Sincerely,
/s
Cindy Sawit, M.D.
Medical Director
Cc. w/o attachments Director of the Center for Risk
Management
San Francisco Field Office FTCA Coordinator
Appendix G - Sample Affidavit of Employment
Form
AFFIDAVIT OF EMPLOYMENT
UNITED STATES DISTRICT COURT
ARIZONA
)
Shawnee Gothurt (Plaintiff) ) Civil Action # 3
)
v. )
) AFFIDAVIT
Cody Goodoc, M.D. (Defendant) ) RE: Cindy Sawit, M.D.
(supervisor)
I, Cindy Sawit, am employed by the Clinical Quality
Health Center as a Medical Director.
I have administrative and professional supervision
over Cody Goodoc M.D., who was named in the above
action brought in the Arizona Superior Court, Maricopa
County.
The summons and complaint were personally served on
Dr. Goodoc on October 12, 1999. Cody Goodoc, M.D.,
is an employee of Clinical Quality Health Center of
Phoenix Arizona, a 330-e grantee of the Bureau of
Primary Health Care. He has been employed here at
Clinical Quality Health Center since November 1, 1990.
During the period of time relevant to the incident
that is the subject of this suit, Dr. Goodoc was acting
within the scope of his employment in the capacity
of contracted employee. Dr. Goodoc was not the recipient
of reimbursement for services he provided to the plaintiff.
He is a Family Physician who normally performs an
average of at least 38 hours per week for our Health
Center.
__________________
Cindy Sawit (supervisor)
Medical Director (title)
Clinical Quality Health Center 3
20 E. McDowell
Phoenix, AZ 12345
Subscribed and sworn to before me, a Notary Public,
this 15th day of October 2000.
___________________
Logan Swears (Notary Public)
My Commission Expires 1/28/01
Appendix H - Sample Affiliation Statement
Affiliation Statement
Newark High is the primary high school serving the
needs of some 1,500 students in the underserved North
Central Neighborhood of Phoenix, Arizona. Newark High's
mission is to prepare North Central Neighborhood students
to improve themselves, their community, their country
and the world. Many of these students are patients
of Clinical Quality Health Center, and the school
and clinic cooperate to serve their health care needs.
Newark High competes in the Arizona High School Athletic
Association Football League. The Arizona league requires
that home teams provide a physician to oversee each
football game.
Clinical Quality Health Center is a federally supported
Community Health Center located in the underserved
North Central Neighborhood of Phoenix, Arizona. Clinical
Quality Health Center's mission is to improve the
health of the North Central Neighborhood by spreading
health information, providing health coordination,
and improving access to primary care services. The
Health Center employs three Board Certified, properly
credentialed physicians.
Newark High School and Clinical Quality Health Center
have missions which overlap and believe that certain
affiliations could help both to become better partners
in serving their communities:
Clinical Quality Health Center agrees to provide an
on-site physician to oversee each Newark High School
home football game.
Newark High School agrees to compensate Clinical Quality
Health Center the set sum of $100 for on-site physician
services provided at each home game. Newark High School
also agrees to recognize Clinical Quality Health Center
at each home game, at awards banquets and on all printed
public materials that are related to football, including
game programs and the yearbook.
Date: _____________
______________________
Principal of Newark High
______________________
Executive Director of CQHC
Appendix I - FTCA Clinician Protection Self-Test
This self-test is designed by the Bureau of Primary
Health Care to help you perform a cursory FTCA protection
evaluation. You can use this simple test to reassure
yourself about FTCA protection for alleged incidents,
or potential future alleged incidents.
To perform a cursory test of alleged or potential
alleged incidents, review in sequence the statements
listed below. If all five statements were true for
you, then your Health Center activity would be protected
under FTCA. If any statement is not true for you,
then your activity might not be protected by FTCA.
This is only a cursory test. For specific information
review this Handbook, and talk with your Clinical
Director.
- The allegation against me is one of medical malpractice.
__ False. Then, your activity would not be protected.
__ True. Go to question #2.
- I am: 1) an employee of a deemed Health Center,
or 2) a licensed or certified contractor working
at least 32.5 hours per week for a deemed Health
Center, or 3) a licensed/certified contractor providing
family practice, general internal medicine, general
obstetrics/gynecology or pediatric services for
a deemed Health Center.
__False. Then, your activity would not be protected.
__True. Go to question #3.
- I have not directly billed the patient, or the
patient's health coverage payer, for my activity
that led to the allegation, or if I have, the billing
meets requirements of PIN 1001-11.
__ False. Then, your activity would not be protected.
__ True. Go to question #4.
- The incident giving rise to the claim occurred
while I was acting within the scope of my employment
with a deemed Health Center.
__ False. Then, your activity would not be protected.
__ True. Go to question #5.
- The activity that led to the allegation against
me was within the approved scope of project of my
deemed Health Center.
__ False. Then, your activity would not be protected.
__ True. If 1-5 are true, your activity would be
protected under FTCA.
Source Documents & Sessions
- HRSA Bureau of Primary Health Care Web site, 1999.
- Federal Judicial
Web site, 1999.
- 'FTCA and Your Clinic's Wrap-Around Policy,' Stephanie
Levin-Gervase.
- Community Health Center Management, Pp18-22,
Jan/Feb 1999.
- 'Federal Tort Claims Act,' Martin Bree.
- Presentation for NACHC's 32nd Annual Convention
& Community Health Institute. August 22, 2001.
- 'Federal Tort Claims Act: Preserving a Valuable
Benefit and Making It Work For You.' Weiner, R.
Jayne. Presentation for NACHC's 32nd Annual Convention
& Community Health Institute. August 27, 2001.
- Forms and documents from El Rio Family Health
Center, Tucson Arizona, 1999.
- Department of Justice
Web site, 1999.
Health Resources and Services Administration Web
site, 1999.
- Handbook of Federal Tort Claims Act Policy Guidance
and Technical Assistance Information.
- National Association of Community Health Centers,
September 1997. Medical Malpractice Claims: A Guide
for PHS Health Professionals.
- U.S. government Printing Office: 1993 - 715-025/88002.
- 'Program Assistance
Letter 99-15', Bureau of Primary Health Care,
April 12, 1999.
- 'Policy Information
Notice 99-08', Bureau of Primary Health Care,
April 12, 1999.
- 'Policy Information
Notice 01-11', Bureau of Primary Health Care,
April 24, 2001.
- 'Policy Information
Notice 01-16', Bureau of Primary Health Care,
July 17, 2001.
- Scheutzow, Susan O. "State Medical Peer Review:
High Cost But No Benefit-Is it Time for a Change?"
American Journal of Law & Medicine. 1999. V.14.
n.4. p.7-60.
- Various Mutual Insurance Company of Arizona newsletter
articles. Risk Advisor. 1998, and 1999.
- Webster's College Dictionary. 1996. Random House,
Ind. New York.
Acknowledegments
Authorship of this handbook was commissioned by the
Arizona Association of Community Health Centers, utilizing
grant funds provided by the United Stated Public Health
Service, Health Resources and Services Administration,
Bureau of Primary Health Care's Quality Center. The
Western Clinician's Network, an association of clinicians
who are dedicated to community based care, provided
project oversight and editorial guidance. The handbook
was compiled in the winter of 1998 and spring of 1999,
and updated in 2001. Many individuals from several
organizations provided oversight, information, guidance,
help, feedback, advice, coaching and editorial comment.
These include:
Western Clinician's Network:
Arthur Martinez MD, Medical Director of El Rio Health
Center, President Western Clinicians Network, Eladio
Pereira MD, Medical Director of Mariposa Community
Health Center,Rodolfo Jimenez DO, Medical Director
of Sun Life Family Health Center, Gregory Waite DDS,
Dental Director of Sun Life Family Health Center,Carl
Heard MD, Medical Director of Nevada Rural Health
Centers, Joe Block MD, clinician at Mariposa Community
Health Center,Dan White, MD, Medical Director of Marin
Community Clinic, Ben Kuhn & Betty Gomez, Western
Clinician's Network, Andy Rinde, Executive Director
of the AACHC
Federal Employees:
Winston Wong MD, Clinical Director of the San Francisco
Field Office,
Marty Bree, Director of the BPHC Center for Risk Management,
Barbara Lee, FTCA Coordinator, San Francisco Field
Office,
Deborah Watkins, PHS Claims Office
Others:
Freida Mitchem, Director of Systems Development, National
Association of Community Health Centers,Tom Curtin
MD, Asst. VP Clinical Affairs, National Association
of Community Health Centers,Clinic operations workgroup
(COPS), Arizona Association of Community Health Centers,Pat
Anderson, Credentialing Coordinator at El Rio Health
Center, Kristi VanStechelman, Arizona School of Health
Sciences,William C Wahl, Jr. Attorney, O'conner &
Cavanaugh, James Dearing DO, FACOFP, Tapatio Consulting,
Debra Gelbart, format editing consultant.
Writer: Gary Cloud
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