Malpractice Insurance: We Talkin' About Practice?

Malpractice Insurance: We Talkin' About Practice?

Chances are you've been advised to carry malpractice insurance at some point during your career. In a litigious society such as ours (presuming you're in the U.S.), this is probably good advice for us all (#AAAE).

However, just because you're a pharmacist doesn't necessarily mean you need to run out there and get the cadillac of insurances. That is, unless you didn't pay attention during class, or buzzed through pharmacy school on a binge of amphetamines and can't remember a thing. 

If that's the case please go get the Ferrari of insurances. And maybe consider a line of work that doesn't entail holding the life of another human in your counting tray.

"Judgmental" language aside, the question of whether to get pharmacy malpractice insurance is one of those "not really covered" areas of pharmacy school. It deserves some looking in to. 

Your employer may be already providing some sort of coverage for you. But you already knew that from reading that contract you signed, right? Right?!

Coverage? Like LTE?

First things first: if you work for the VA, don't worry. Be happy. You're golden. If someone sues you, they sue the United States of America. How's that for protection? That's double-barrier status.

This also applies if you're employed by other government-run facilities. The FTCA is what provides this protection, and it really is pretty sweet unless you were acting with ill-intent. So just don't go postal.

If you're curious, the legal definition of "acting with ill-intent" is working in close proximity to another person while listening to your Nickelback Pandora station. 

If you don't have comprehensive coverage through your employer, there are a number of options out there. ASHP and APhA both have endorsed different companies. And a cursory Google search also provides plenty of options for coverage. 

We did some digging and found one site with an FAQ that lists the top three claims against pharmacists, so let's explore:

  1. Wrong Drug
  2. Wrong Strength
  3. Wrong Directions

Sounds strangely like an omission-commission exam, doesn't it?

 

Wrong Drug

You've probably heard plenty of jokes about doctors' handwriting in your lifetime. And you've probably been introduced to those fun ISMP terms like tall-man lettering and SALA. What's it all for? 

It's to clue you in that you should pay attention to the name of the drug on the prescription.

True story: My residency director once showed me a prescription that was filled and given to the patient for Metronidazole 500mg BID #180.

Now, if that doesn't set off a string of alarms in your head, stop reading this post right now. Go get the highest coverage plan you can find.

The prescription was supposed to be for Metformin, and I'll let you fill in the rest of the story. Joking aside, this stuff happens. And it's on us to prevent it.

 

Wrong Strength

If you follow the pharmacy news, you'll probably remember a few stories in the past of dosing errors that killed children. You were also probably told about these as a scare tactic during pharmacy school. There are also reports of how even electronic records can contribute to this issue.

The computers won't save you in this case. Sometimes you have to rely on your own judgment and pay attention to significant figures (no, not the Kardashians).

If you see a dose that's outside of the range you're familiar with, you need to question it. The patient may actually need 20 mg of warfarin per day, but you better make sure it wasn't supposed to be 2.0 mg. If you are processing a prescription for a drug you're unfamiliar with, it is your professional obligation to make sure the dose (and indication) is appropriate. 

There is no shame in looking it up. 

 

Wrong Directions

Again, this is a well known reading comprehension and chicken scratch issue. The Joint Commission has a list of best practices to prevent this in hospitals. But that doesn't do you much good in the community setting. Again here, you have to rely on your judgement (or google). 

If you see something like Atripla TID, Atenolol Per Rectum, or Ergocalciferol 50,000 IU QDaily #30, question it. There may be a good reason that the provider wanted the directions that way. But probably not.

Fun Fact: This song is actually about a doctor trying to order a loading dose for digoxin (Image)

Fun Fact: This song is actually about a doctor trying to order a loading dose for digoxin (Image)

I've Got 99 Problems But EHR Ain't One?

These problems are still an issue these days. Even with Electronic Health Records (EHR) taking over. With EHRs, you get less of the doctors' chicken scratch error. But there are newer sources of errors that keep cropping up. Wrong info, missing info, system or user error are common. Sometimes it's literally just a matter of selecting the wrong product from a drop down menu box.

These new EHR errors lead to problems that often fall on the pharmacist's shoulders. Again, the computers can't do your job for you. That lovely (and expensive) little brain of yours is vital to keeping patients safe. And to preventing you from getting sued.

So, is this meant to scare you into purchasing insurance?

We don't work for the insurance companies, and they're not paying us to say this (unless they want to start... *hint hint*).

We'll give some general recommendations below. But honestly this article is meant to be an exploration into a topic that impacts us all, but isn't ever talked about. Seriously, you wouldn't believe how much we had to ask around to find someone that had a good understanding of the malpractice insurance landscape. 

 

So, What Do We Recommend?

Let me preface with this. We are not lawyers. We are not qualified to give you legal advice on this matter. The following recommendation is for informational purposes only. Please read our site disclaimer for more information. 

If you're a student, do not get anything. Your available cash flow is low, and you're technically acting under the supervision of a licensed pharmacist. 

If you're not in direct patient care, you probably don't need coverage. 

If you're a practicing pharmacist and you work in a patient care role, you've got more research to do. The most important thing is to find out what your current coverage (if any) entails. Harass your HR department. Demand details. You're entitled to know your coverage. You need to know your coverage.

After that, you generally want a plan that will cover to the allowable maximum. The cost is not that high compared to the peace of mind that you'll get. The plan will usually provide coverage per incident/per year, and the upper limit depends on your state of practice.

If the plan through your workplace has pretty solid coverage that includes bells and whistles (lost wages, defense costs, non-workplace incidents, coverage after separation), then you probably don't need to consider a supplemental plan. If anything is lacking in the bell and whistle category, however, a supplemental plan is worth looking at.

If you're an independent contractor or consultant, you definitely want to look into plans that cater to your needs. Again, look for whatever your jurisdiction max is. You also want to make sure it covers a variety of situations (volunteer work, part-time work, at-home incidents, etc). Get the plan that is best suited for what you do on a daily basis.

You don't want to be on the wrong end of a lawsuit that empties your coffers because you're not covered. We're not going to recommend anything specifically (ASHP and APhA already did), so check your current coverage and determine whether you need something additional. 

tl;dr: if you're not already covered, get covered. Practice safe sex pharmacy.

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