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Insurance in tough times

December 1, 2008
by Brion P. McAlarney
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MHRRG's new chair advises providers to keep risk management a priority

During these challenging economic times, it's important for community mental health centers (CMHCs) to maintain robust liability insurance coverage and risk-management programs. So says Susan Buchwalter, PhD, chief executive of The Counseling Center of Wayne and Holmes Counties, Ohio, and the recently appointed chairwoman of the Mental Health Risk Retention Group (MHRRG), which is owned by its behavioral healthcare policyholders. She sees the current economic situation as causing some providers to make decisions that could increase their organizations' liability risk.

“For example, some providers have begun hiring paraprofessional staff to do what bachelor's-level staff used to do,” explains Dr. Buchwalter. “These staff come to their jobs with less training and experience,” potentially increasing an organization's liability exposure.

“In addition, funding constraints can result in delayed building repairs, which can contribute to increased safety risks,” she adds, “and closures and service reductions can put providers at increased risk for allegations that they did not provide [clients] the appropriate interventions.”

In addition, some providers may make the mistake of chasing the cheapest liability insurance premium they can find. “That can be one of the riskiest things a provider organization can do,” Dr. Buchwalter says. “It is imperative for behavioral health organizations to have their professional liability insurance coverage with an organization that they trust and that understands their business.”


“Sexual misconduct is something that is really under the control of the person who chooses to engage in that kind of behavior, so it's a type of liability where good staff education and staff training can really make a difference.” —Susan Buchwalter, PhD

These difficult economic times also make it critical that providers implement as much staff training and education as possible, and have a solid risk-management plan in place, notes Dr. Buchwalter, who is only the second chair in MHRRG's 21-year history. (Dr. Buchwalter succeeds Gil Aliber, former chief executive of Rutland Mental Health Services in Vermont.) She advises that such a plan include staff education on suicide assessment, preventing violence, proper medication management, and prohibiting sexual misconduct.

In fact, Dr. Buchwalter points out that staff sexual misconduct involving clients is the most frequent source of professional liability claims, followed by suicide.

“Sexual misconduct is something that is really under the control of the person who chooses to engage in that kind of behavior, so it's a type of liability where good staff education and staff training can really make a difference,” she says. “Make sure that people understand the types of situations that can lead to claims and how they can recognize and avoid compromising situations.”

Medication management is also a high-claim area, typically involving improper medications or errors in administering them. Dr. Buchwalter advises not only having sound procedures for checking medications but also training staff on monitoring patients for adverse reactions, reviewing medical records to ensure required tests and follow-up procedures have occurred, and ensuring patients are educated about their medications and potential side effects so that they can report concerns to their prescribers.

Dr. Buchwalter notes that for CMHC directors and officers, wrongful termination is the highest claims area. “Wrongful termination can be at any level of employ, with people primarily alleging that they were treated unfairly in the termination process or were terminated without the agency following its normal policies and procedures,” she says. “If an organization has certain policies and procedures that they have distributed to their employs, then they need to follow those policies and procedures when they take action.”

To promote excellent risk-management strategies, MHRRG holds an annual contest for the best programs, awarding the winners $15,000 with smaller but sizeable awards for runners-up. The competition usually covers specific topics, such as avoiding medication errors. The 2009 awards will recognize programs targeting sexual misconduct. “It's an opportunity for people to share ideas and make a difference for the field in general,” Dr. Buchwalter explains.

Brion P. McAlarney is a freelance writer. Behavioral Healthcare 2008 December;28(12):16

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