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Liability for house calls


House calls shouldn't increase your liability if you follow proper procedures.

Q. I make frequent house calls to patients in my family practice who aren't able to come to my office. In fact, I visit some on a regular basis. Do these house calls increase my liability? And if so, do I need additional malpractice coverage?

First, make it clear to your patients that house calls have specific purposes and certain limitations. As a family physician, you shouldn't be managing medical conditions that are usually treated by a specialist or treating potentially acute problems like chest pain that would be more appropriately evaluated in your office or in the ED, where stat labs, ECGs, or X-rays are available. Nor should you prescribe or refill medications for conditions you're not treating yourself. Even with conditions you are handling, explain to the patient that some treatment or tests should be done in your office rather than in their homes.

Although you're not responsible for treating conditions being managed by another physician, you may recognize a problem that you should inform him about in a timely manner. If you told the patient on a previous visit to contact the other physician about such a problem, ask the patient if she actually followed through. Document the advice you gave her, and her response.

Back up any medical advice you give the patient with written instructions for continued self care. If possible, give patients handouts with clear advice about common conditions like flu, respiratory infections, hypertension, diabetes, asthma, UTIs, and allergies. On your next visit, ask the patient if she read them; if not, try again. These handouts can improve patient compliance and reduce unnecessary phone calls to your office.

Take a moment to survey the patient's home environment. If you notice unsafe or unsanitary conditions that put her at risk, ask the patient or a family member to correct them. If you're concerned about the patient's diet, check the kitchen to see if it's equipped to prepare cooked meals. If it's not, contact the family and encourage them or the patient to arrange for Meals on Wheels.

Finally, for your own protection and patient privacy, don't leave medical records, supplies, or your medical bag in your car.

Most liability insurance carriers won't deny coverage or charge additional premiums for physicians who make house calls as part of their normal practice. (Still, it's worth checking with your carrier.) But they may ask questions: What percentage of your practice is devoted to home care? What type of care will you be providing? Is that care outside your specialty? What type of medications will you administer? What kind of record-keeping do you do? Are any unusual liability risks involved?

The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at lossprevention@earthlink.net

This department answers common professional liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 973-847-5390 or e-mail it to memalp@advanstar.com

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