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Sport Team gathered around injured player with trainer with first aid kit.

What! My malpractice insurance doesn’t cover that?

January 1, 2025

You perform sports physicals at a small private school in your community as a service to the parents. Several months later, a young athlete you had examined collapses on the field. He is resuscitated but has residual neurologic deficits and subsequently is identified with severe aortic stenosis. The child’s parents file a malpractice suit against you.

Would your malpractice coverage protect you in this scenario? The answer for many pediatricians is “no.”

When pediatricians provide medical services within the scope of routine duties, they presume that care will be covered under their liability insurance. They need to be aware, however, that malpractice coverage may not be provided for care outside their scope of practice or in some locations and circumstances.

Location, location, location

If you choose to practice away from your clinic or hospital setting, it is important to know whether your coverage will extend to that location.

Common volunteer activities that may fall outside your malpractice coverage include acting as a team physician, working at a medical tent for an event or race, and providing physicals for an outside organization. In some cases, you may be able to add a specific outside activity to your coverage, but you may have to pay an additional cost.

Providing care in another state also may nullify your coverage. For example, your policy may include care provided as a team physician in your community, but your coverage may be nullified if the team travels to another state. Similarly, you may not have coverage during mission trips or when assisting in catastrophic events in another state.

Scope of practice

Pediatricians also need to be cautious to provide care within the normal scope of their specialty and experience.

Though pediatricians engage in a broad spectrum of training, they may have minimal experience or expertise in some areas of care such as orthopedics, osteopathic manipulation, mental health, minor surgical procedures and adult care.

If you are providing a service that typically is outside the routine scope of practice for your specialty, be certain liability coverage will be in place and you can show appropriate training to provide that service.

Criminal activity

Malpractice insurance typically does not cover criminal activity. If you are accused of a crime during practice, you likely will be required to cover your defense expenses.

A claim of medical battery can be made if you examine a patient or perform a procedure without proper consent or extend care beyond what was consented. For example, primary care providers who examine patients or perform labs or immunization in their office without consent of a legally responsible proxy can face a battery claim.

Battery claims also can be made if a surgical procedure goes outside the consented scope of care, even if the procedure benefits the patient.

Improper sexual conduct, or a claim of such conduct, can lead to criminal charges that would require the provider to provide legal counsel at his or her own expense. Utilizing chaperones can limit risks for claims of sexual impropriety.

Licensure proceedings

Physicians practice under the licensure requirements of their state. Complaints against pediatricians can be lodged by anyone involved with a patient and can lead to license restrictions or revocation.

Licensure proceedings usually involve an investigation and may lead to a formal hearing. Pediatricians may benefit from legal counsel for some of these proceedings. None of these expenses typically are covered by malpractice insurance, even if the event leading to the claim occurred during routine practice.

Take-home points

  • Though providing medical care in your community provides many benefits and professional satisfaction, malpractice coverage may not protect you for care provided away from your clinic or facility. When providing care in other settings, clarify coverage with your insurance carrier.
  • Be certain you are practicing within the recognized scope of your practice and have proper training or experience to provide broader care.
  • Typically, you will have limited or no protection from claims of criminal activity or licensure complaints.

Dr. Scibilia is immediate past chair of the AAP Committee on Medical Liability and Risk Management.

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