This document provides tips for managing the risk of lawsuits related to bariatric surgery practices. It discusses the importance of thorough patient screening, both medically and psychosocially, as well as documenting decision making processes. It emphasizes aligning patient expectations through comprehensive education and informed consent procedures. The document also addresses issues like disclosing financial relationships, managing patient dissatisfaction, tracking complaints, conducting crucial conversations with difficult patients, and dismissing patients when needed. The overall message is that careful screening, education, documentation, and communication can help reduce the risk of legal claims.

1. Protect Your Team From Lawsuits:
Tips for Managing Your
Risk of Claims

2. Overview
• Patient Selection & Screening
• Risks of Emerging Technologies
• Patient Education & Informed Consent
• Surgery & Post Operative Care
• Dissatisfaction & Complaint Management
• Angry, Non-Compliant Patients &
Threats to Sue

3. Medical Screening
• Documentation of Actual Patient
Screening (Medical & Psychological) often
key to defending cases
• Take extra care to document your decision
making process and consultations
whenever you “push the envelop” beyond
published guidelines

4. Psychosocial Screening
• Patient Screening – identify severe
psychosocial problems that may disqualify
• Difficult Patients – Need triage, better to
discharge before surgery. Psychosocial
problems may interfere with post-op care;
may disrupt support group
• Family & Support Systems – involve in
assessment

5. It’s All About Aligning
Expectations:
Patient Education &
Informed Consent

6. Education & Informed Consent
• Mismatched expectations often leads to
lawsuits: 78% lawsuits, no bariatric
specific consent forms
• Education begins with marketing materials
& psychological screening
• Well documented, team based training
reduces the risk of lawsuit

7. Education & Informed Consent
• Mismatched expectations often leads to
lawsuits: 78% lawsuits, no bariatric
specific consent forms
• Education begins with marketing materials
& psychological screening
• Team based education that is well
documented is effective risk management
tool, basis for informed consent

8. Informed Consent
• Bariatric informed consent process
follows mandatory patient education
sessions
• Forms should have checkboxes that
certain key points were reviewed
• Recommend spouse & family attend
classes & sign education form

9. On-line Education & Consent Tools
Improve patient compliance
Increase patient satisfaction
Document informed consent
process

10. Disclosure of Financial Relationships
• The Patient’s Rights Issue: absence of bias in
surgical decision making
• The Relationships:
–Consulting
–Research
–Education support
–Investment
• Organizations starting to require disclosure
• Lawyers starting to use as tactic

11. Evolving Standard on Patient
Disclosure
• If a physician has a material financial
relationship with company that manufactures
permanently implantable medical devices, the
physician must disclose to his/her patients this
financial relationship before obtaining the
patient’s consent. Such disclosure shall be
documented in the patient’s medical record.

12. Care Coordination
• Equal to Patient Education/Informed
Consent as an Effective Risk Management
Strategy
• Making Teams of Experts into
Expert Teams
• Big Impact on Decreasing Dissatisfaction,
Even When Outcome Less Than Expected

13. Managing Individual Patient
Dissatisfaction & Complaints
• Individual dissatisfaction should be
managed by team, recommend use of
patient advocate, follow through is critical
• May include apology, written response and
bill write offs when appropriate

14. Aggregate Complaint
Tracking/Trending
• Patterns of patient complaints may be
predictors of suit
• Facility should have a reliable complaint
tracking system & regularly review
aggregate complaint data to fix delivery
systems
• Complaint review committee

15. Conversations & Interventions
with Angry, Non-Compliant or
Disruptive Patients

16. Crucial Conversations Training
• Resolving “stuck”
complaints through
dialogue, active
listening
• Move to actionable
solutions

17. Crucial Conversations
• Often, dissatisfied patients feel like they
are not being heard, personal issues not
being addressed
• Recommend selected team members
receive conflict resolution or mediation
training. Active listening (what does the
patient/family really want)

18. Behavioral “Contracts”
• Not true contract, a tool for aligning
expectations/behavior when conversation
fails
• For disruptive or non-compliant patients
• Lay out surgeon’s and team’s behavioral
expectations
• Sets up ground work for dismissal

19. Threats to Sue
• When interventions, crucial conversations,
patient advocate have failed
• Damage physician/patient/team
relationship enough that most programs
will dismiss
• May need to comply with insurer’s rules on
dismissal
• IF continue to treat, assure no
disengagement

20. Dismissal From Practice
• To avoid charge of patient abandonment, notify
patient, in writing when surgeon wishes to
discontinue care
– Last day surgical care will be available
– Provide at 15-30 days of emergency
treatment & prescriptions
– How to get copies of medical records
• May need to comply with insurer’s rules on
dismissal

21. Thank you
Questions?