PEDIATRICS Vol. 106 No. 6 December 2000, pp. 1492-1493

AMERICAN ACADEMY OF PEDIATRICS:
Pediatricians' Liability During Disasters

Committee on Pediatric Emergency Medicine and Committee on Medical Liability

	ABSTRACT

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This statement addresses the need for professional liability insurance coverage for pediatricians during disasters and suggests measures to ensure adequate coverage.

	ARTICLE

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Physicians have often volunteered their services during and after disasters. During a disaster, health care providers may be called on to respond to community needs for assistance and to treat victims at the scene, casualty collection points, hospitals (where they may not have privileges), and shelters. These services, whenever possible, should be coordinated through the local disaster plan or emergency medical service (EMS) agencies.^1-3 After a disaster, offices or clinics may become sites for emergency care if area hospitals cannot provide adequate services. Local offices may be unusable, and alternate sites for primary care may need to be identified. Recent experiences have demonstrated that health care may be administered in parking lots, malls, and tents. In addition, pediatricians may still need to provide urgent and routine care to their practice-based patients outside of the usual practice location(s).^4-7

The recent statement by the American Academy of Pediatrics, "The Pediatrician's Role in Disaster Preparedness," discusses the role of Academy members in disaster planning and care.⁸ In the past many physicians have provided care without affiliation with recognized government or volunteer agencies. It is important that when providing medical service during a disaster providers are part of an organized program or they may be providing service without professional liability insurance coverage. Most malpractice coverage is limited to the provider's usual scope of practice and practice setting. Good Samaritan statutes provide some liability protection when rendering medical care at the scene of an emergency to one who would not otherwise receive it. Good Samaritan statutes cover physicians at the scene of acute incidents but vary among states and may not provide liability protection during or after disasters.⁹ In many states, for health care providers to be covered for liability in a disaster, they must practice under the umbrella of an official disaster agency, such as the Federal Emergency Management Agency, the Department of Health Services, the local EMS authority, or other recognized government or volunteer agency.¹⁰ In some states, individual malpractice insurance policies cover neither out-of-office care nor the expanded scope of practice that may be required during a disaster.¹¹ Good Samaritan laws do not cover a physician if there is any payment for services or if there is an accusation of gross negligence.

The Committee on Pediatric Emergency Medicine and the Committee on Medical Liability recommend that pediatricians be prepared to give care during disasters. In addition, they should:

1. Be familiar with their state's Good Samaritan statutes and protections afforded while providing emergency care during a disaster.
2. Work with state legislatures to develop statutes to ensure appropriate liability coverage during the acute and recovery phases of a disaster.
3. Be familiar with their individual liability insurance coverage outside of the usual practice settings when providing urgent and routine care.
4. Become involved in local disaster planning activities and work with response agencies before an event occurs.
5. When volunteering to assist during or after a disaster, make every effort to work in concert with the lead organization coordinating disaster relief.

Committee on Pediatric Emergency Medicine, 1999-2000

Robert A. Wiebe, MD, Chairperson

Barbara A. Barlow, MD

Ronald A. Furnival, MD

Barry W. Heath, MD

Steven E. Krug, MD

Karin A. McCloskey, MD

Deborah Mulligan-Smith, MD

Lee A. Pyles, MD

Timothy S. Yeh, MD

Liaisons

Cindy Doyle, RN, BSN, MA

Maternal and Child Health Bureau

Marianne Gausche-Hill, MD

American College of Emergency Physicians

David Markenson, MD

National Association of EMS Physicians

Dennis W. Vane, MD

American College of Surgeons

Section Liaisons

M. Douglas Baker, MD

Section on Emergency Medicine

Joseph P. Cravero, MD

Section on Anesthesiology

Michele Moss, MD

Section on Critical Care

Dennis W. Vane, MD

Section on Surgery

Consultant

Dee Hodge, MD

Staff

Sue Tellez

Committee on Medical Liability, 1999-2000

Jan Ellen Berger, MD, Chairperson

Jeffrey I. Berman, MD

Jerome M. Buckley, MD

W. Hugh Craft, MD, MPH

Charles H. Deitschel, Jr, MD

Geoffrey Evans, MD

John J. Fraser, Jr, MD, JD

Liaisons

Susannah M. Frasier, JD

American College of Obstetricians and Gynecologists

Staff

Julie Kersten Ake

	FOOTNOTES

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

	ABBREVIATIONS

EMS, emergency medical services.

	REFERENCES

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1. Schultz CH, Koenig KL, Noji EK A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med. 1996; 334:438-444 [Free Full Text]
2. Auf der Heide E. Disaster Response Principles of Preparation and Coordination. St Louis, MO: CV Mosby; 1989
3. Haynes BE, Freeman C, Rubin JL, Koehler GA, Enriquez SM, Smiley DR Medical response to catastrophic events: California's planning and the Loma Prieta earthquake. Ann Emerg Med. 1992; 21:368-374 [CrossRef][Medline]
4. Leonard RB Role of pediatricians in disasters and mass casualty incidents. Pediatr Emerg Care. 1988; 4:41-44 [Medline]
5. Quinn B, Baker R, Pratt J Hurricane Andrew and a pediatric emergency department. Ann Emerg Med 1994; 23:737-741 [Medline]
6. Henderson AK, Lillibridge SR, Salinas C, Graves RW, Roth PB, Noji EK Disaster medical assistance teams: providing health care to a community struck by Hurricane Iniki. Ann Emerg Med. 1994; 23:726-730 [Medline]
7. Schultz CH, Koenig KL Earthquakes and the practicing physician [letter]. West J Med. 1992; 157:591 [Medline]
8. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. Emergency Medical Services for Children: The Role of the Primary Care Provider. Elk Grove Village, IL: American Academy of Pediatrics; 1992
9. California Business and Professions Code §2395 and §2396. Available at: http://www.leginfo.ca.gov/calaw.html. Accessed May 8, 2000
10. California Government Code §8659. Available at: http://www.leginfo.ca.gov/calaw.html. Accessed May 8, 2000
11. California Business and Professions Code §900(e). Available at: http://www.leginfo.ca.gov/calaw.html. Accessed May 8, 2000