{ PIAA INTERNATIONAL SECTION CONFERENCE

{
PIAA
INTERNATIONAL SECTION
CONFERENCE
8-10 OCTOBER 2014 AMSTERDAM | THE NETHERLANDS
“The Good, the Bad, and the Ugly”
How Threats Can Become Opportunities in Medical Liability
PROGRAM
www.piaa2014.com
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TABLE OF CONTENTS
Page
Information on PIAA
2
Sponsors2
Useful Addresses
3
Program Steering Committee
3
Words of Welcome
4
General Information
6
Social Program
7
Program8
- Wednesday, October 8
8
- Thursday, October 9
8
- Friday, October 10
11
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#PIAAIntlConf
1
INFORMATION ON PIAA
PIAA
PIAA International Section
PIAA is the insurance industry trade association that
represents a full range of entities doing business in the
medical professional liability (MPL) arena. These include
U.S.-based and international MPL insurance companies,
risk retention groups, captives, trusts, and other entities.
PIAA membership is open to MPL enterprises owned
and/or operated by physicians, hospitals, health systems,
dentists and oral maxillofacial surgeons, podiatrists,
chiropractors, and healthcare professionals such as nurse
practitioners, nurse midwives, CRNAs, and many others,
as well as insurance carriers with a substantial commitment
to the MPL line.
Members of the PIAA International Section provide MPL
insurance and indemnification and related services to
healthcare professionals around the world. Based in six
nations, their operations include covering parts of Northern
Europe, Canada, Australia, the United Kingdom, and other
international locations.
PIAA members insure more than two-thirds of America’s
private practicing physicians as well as dentists, nurses
and nurse practitioners, and other healthcare professionals
and provide indemnification and other services to more
than 400,000 healthcare professionals around the world.
PIAA members also insure more than 3,000 hospitals.
The sharing of information through PIAA enables members
of the International Section to keep apprised of the latest
global trends and innovations.
The mission of PIAA is to promote, protect, educate,
and connect medical professional liability insurers and
indemnifiers who support the quality delivery of healthcare
and practice of medicine. PIAA’s vision is to be the
recognized forum and voice of medical professional
liability insurers and indemnifiers.
As the world’s foremost industry association specifically
addressing medical indemnification, PIAA has
comprehensive resources for professional development
and education, networking, medical liability research,
patient safety, and much more.
The PIAA International Conference is held every three
years and plays an important role in global information
exchange among MPL insurance and indemnification
executives and professionals, legal experts, and others
with expertise in the MPL arena.
For more information on PIAA or the PIAA International
Section, go to www.piaa.us. You can also follow PIAA on
Twitter: @PIAAKnowsMPL.
• Photo credit: Getty Images
SPONSORS
Over the past 50 years, the insurance and reinsurance
industry has seen tremendous changes. From products,
services and distribution networks to risk management,
capital management and regulation, nothing is how it used
to be. Far from slowing down, the pace of this change is
accelerating. New technology is having a profound impact
on the way in which we assess, model, price and reserve
risks. At SCOR, we have the experience and expertise
to stay at the cutting edge of these developments.
By sharing the art and science of risk with our clients,
we can adapt to a changing risk universe together.
scor.com
2
The Art & Science of Risk
Useful Addresses
Conference Venue
Renaissance Hotel
Kattengat 1
1012 SZ Amsterdam
The Netherlands
Tel: +31 20 621 22 23
Program Steering Committee
Host Organization
VvAA Groep B.V.
P.O. Box 8153
3503 RD Utrecht
The Netherlands
E: piaa2014@vvaa.nl
T: +31 247 41 99
·
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·
·
·
·
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·
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Eric Anderson, PIAA, US
Dr. Hayes Whiteside, ProAssurance, US
Dr. Doug Bell, CMPA, Canada
Herman Falsté, AMMA, Belgium
Fernando Mariona, J.D., TPC, Argentina
Dr. Matthew Lee, MDU, UK
John Tiernan, MPS, UK
Prof. René Amalberti, MACSF, France
Claire Leonard, MIAA, Australia
Harry Henschen, VvAA, the Netherlands
3
WORDS OF WELCOME
I am pleased to welcome you to the 2014 PIAA International
Conference. Our theme of “The Good, The Bad, and The Ugly:
How Threats Can Become Opportunities in Medical Liability”
is particularly relevant.
In these rapidly changing times, it is our hope that this conference will address both the threats and the opportunities
confronting the medical professional liability community. We
have asked our speakers to look ahead into this imagined
future. We encourage all conference attendees to adopt the
same expansive thinking that will produce wide-ranging and
spirited discussions about the issues of today and tomorrow.
There is certainly much that we can learn from each other
about the many medical, legal, and financial challenges.
I would like to express my appreciation to our hosts,
VvAA and MediRisk. Organizing this event is a major
undertaking and all PIAA members are indebted to you.
I’d also like to thank the 2014 PIAA International Conference
Steering Committee, who developed the excellent
conference program.
I would further like to recognize the conference sponsors,
whose support is important to ensure the conference’s
success. Thank you for your generous contributions.
We are pleased to be holding this conference in Amsterdam:
a truly global city. Our hosts have planned an outstanding
program for you to enjoy. I encourage you to explore all this
wonderful city and country have to offer.
I look forward to meeting and learning from each of you
over the next few days.
4
Brian K. Atchinson
President and CEO PIAA
Welcome to the PIAA International Section Conference 2014,
welcome to Amsterdam!
It gives me great pleasure to welcome you on behalf
of VvAA and MediRisk to the PIAA International Section
Conference 2014 in Amsterdam, our beautiful capital of
the Netherlands and known as one of the most liberal
cities in the world.
The PIAA International Conference gets together every three
years. The Netherlands also hosted the first International
conference back in 1999. Now, 15 years later, in the year
that VvAA celebrates its 90th anniversary, we meet again in
an historical conference venue, the 17th century Koepelkerk
(Domed Church).
Herman van Hemsbergen
Chairman Executive Board VvAA /
Chairman PIAA International Conference 2014
Since 1999, these conferences have brought together
hundreds of insurance and medical professionals, all
looking to stay informed on global and day-to-day issues
facing medical professional liability (MPL) insurers. This
edition of the International Section Conference will be all
about ‘The Good, the Bad and The Ugly’ in the MPL industry.
We will cover trending topics on the broad field of medical
liability. More than 150 professionals from all over the world
are in attendance and will discuss the international
developments so that we can learn from each other.
For the first time an International Program Committee was
established, containing members from every participating
country. As a result we are proud to present this appealing
program, which includes international speakers who are
proven leaders in their fields. Topics include the use of social
media in 21st century medicine, serial claims, the
globalization of healthcare and reflections on Alternative
Dispute Resolution (ADR). During the closing session,
you will get a sneak preview in the future of healthcare.
I would like to especially thank Eric Anderson and Bill
Burgess for their enormous contribution to the constellation
of this program.
And please join us at the social gatherings to meet your
colleagues and friends. On Wednesday evening, the
welcome drinks are served in the Domed Church. After
the drinks, you can explore the city and dine in one of
the numerous nice restaurants in Amsterdam. On Thursday
evening, the traditional conference dinner will be held in
The Hermitage Museum. Another special venue in
Amsterdam! Do not miss these opportunities to get
together with your colleagues.
I am happy that you will be a part of this exciting event
and share your professional knowledge and experiences
with your international colleagues.
I wish you an inspiring conference and stay in Amsterdam.
5
GENERAL INFORMATION
Registration desk
Conference staff
The hours of the registration desk are:
Date
Time
Location
If you have any questions, the members of the conference
staff, who can be recognised by their green badge, will be
very pleased to assist you. Please do not hesitate to contact
them if you have any questions.
Wednesday,
October 8, 2014
4:00 p.m. – 8:00 p.m.
Hotel
Lobby
Lost and found
Thursday,
October 9, 2014
07:30 a.m. – 5:30 p.m.
Domed
Church
Friday,
October 10, 2014
07:30 a.m. – 5:30 p.m.
Domed
Church
Please report lost articles to the Registration desk.
Medical and Emergency Services
Badges
Your personal name badge provides access
to the sessions and the welcome reception.
The different colours on the badge indicates the following:
Red = speaker or moderator
Yellow = accompanying person
Green = staff
Certificate of attendance
A certificate of attendance will be mailed to you upon
request, after the conference.
Coffee, tea and meals
All official breaks and meals are included in the conference
fee. Coffee and tea breaks will be held on the first floor of the
Domed Church. Breakfast and lunch on Thursday and Friday
will also be served on the first floor of the Domed Church.
On Saturday, breakfast will be served in the AmsterdamDen Haag Room.
6
Participants in need of medical treatment should
contact the Registration desk.
National Emergency Numbers
Police, Fire Brigade, Ambulance: 112
National Number Police (no emergency): 0900 8844
Program changes
The organizers cannot accept liability for any changes in
the program due to external or unforeseen circumstances.
Safety Tips
As in all major cities, people should be aware of safety
risks. It is advised not to wear your name badge outside
conference activities.
Internet facilities
Free Wifi is available in the official conference rooms
of the Renaissance Hotel.
The code is: PIAA2014
Conference language
Insurance and liability
The conference language is English. Translation service
is not provided.
VvAA, PIAA and MediRisk cannot accept any liability
for personal injuries or for loss or damage to property
belonging to conference participants, either during or
as a result of the conference. Please make sure your
insurance will cover any hospital or medical services
you might require during your stay in the Netherlands.
TonyV3112 / Shutterstock.com
SOCIAL PROGRAM
Welcome reception
Conference dinner
Date: Wednesday, October 8, 2014.
Time: 6:00 – 8:00 p.m.
Location: Domed Church, 1st floor
Date: Thursday, October 9, 2014.
Time: 6:00 – 11:00 p.m.
Please use this opportunity to meet the other conference
participants. Accompanying persons are also welcome!
Please be in the Hotel lobby at 6:00 p.m. in order to
depart to the Hermitage. Do not miss out on this evening!
Special transportation has been arranged: we will travel
by boat to the Hermitage and return by bus to the
Renaissance Hotel.
Delegates will receive a ticket for the Conference Dinner.
If you have misplaced your ticket or have not received
the ticket please see the staff at the Registration desk.
7
PROGRAM
Wednesday, October 8, 2014
Location
6:00 - 8:00 p.m.
Domed Church
Welcome reception (included)
Thursday, October 9, 2014
7:30 - 8:30 a.m.
Breakfast (included)
Domed Church,
First floor
8:30 - 9:15 a.m.
Opening Session
Human Factors in Healthcare and Patient Safety
Moderator: Herman van Hemsbergen, CEO, VvAA
Speaker: Martin Bromiley, Founder and Chair, Clinical Human
Factors Group
Domed Church
A solid understanding of the role that human factors play in adverse
events can have a significant impact on patient safety. To achieve this
goal, education on the broad diversity of human factors should be
included in the core curricula of all healthcare professionals and
managers, throughout their initial training and professional lives. It is
also essential to develop a culture in which visible leadership creates
and promotes strong, respectful, and accountable relationships among
all of the stakeholders involved in providing healthcare. Martin
Bromiley founded the Clinical Human Factors Group (CHFG) in 2007.
CHFG is a broad coalition of healthcare professionals, managers, and
users of services who have partnered with experts in human factors from
healthcare and other high-risk industries to campaign for change in the
United Kingdom’s National Health Service. Mr. Bromiley will discuss human
factors from his perspective and address their role in healthcare, patient
safety, and medical liability.
9:15 - 10:45 a.m.
Plenary Session
Serial Claims: When One Event Leads to Many Lawsuits
Moderator: Ebbo van Gelderen, Director Non Life Insurance, VvAA
Speaker: Professor Han Wansink, Former Faculty, Erasmus University
Speaker: Frederic Fuz, Services Division Director, Sham
Speaker: Dr. Sharmala Moodley, Deputy Head of Claims, MDU
Domed Church
This discussion of the challenge of serial claims will include a comprehensive view of the legal issues at stake, and the possible ramifications of such
claims. It will also include a detailed case study of a serial claim: its origins, how it was handled, and its aftermath. Finally, the session will explore
the insurer’s/indemnifier’s role: the potential impact of serial claims and
best practices for handling them.
10:45 - 11:15 a.m. 8
Refreshment Break
Domed Church,
First floor
PROGRAM
Location
11:15 a.m. - 12:30 p.m.
Plenary Session
Disruptive Behavior: Identifying, Measuring, and Addressing Unprofessional
Conduct in Healthcare
Moderator: Steve Lancken, Mediator, Negocio Resolutions
Speaker: Dr. David Blaney, Head of Risk Member Education, MPS
Speaker: Anton Westerlaken, Maasstad Hospital
Speaker: Andrew Miller, Councillor, MDA National Insurance Pty, Ltd
Domed Church
This session will explore many of the issues summed up in the phrase,
“disruptive doctors.” ­The speakers will tell how to identify these doctors
at the earliest possible point in time, and e
­ xplain how to measure difficult
behavior. Attendees will find out why difficult doctors behave as they do,
and on that basis, learn the best approaches for remediating this
behavior. The speakers will discuss the consequences of disruptive
behavior for medical professional liability insurance and indemnification
organizations—both direct and indirect impacts. In addition, the speakers
will highlight the surprising differences in causes and effects of disruptive
doctors for self-employed vs. employed physicians and also provide
a doctor’s perspective on this difficult issue.
12:30 - 12:45 p.m.
Lunch pickup (return to meeting room for Lunch session)
Domed Church,
Ground floor
12:45 - 1:45 p.m.
Lunch session:
The Pervasive Nature and Cost of Defensive Medicine
Introduction:Marjoleine van der Zwan, COO, MediRisk
Speaker:
Dr. Richard Anderson, MD, FACP, Chairman and Chief
Executive Officer, The Doctors Company
Domed Church
Nearly all medical care in the United States today is delivered in a liability
sensitive context. This phenomenon has made defensive medicine nearly
universal throughout the U.S. In this special working lunch session,
Dr. Richard Anderson will discuss how defensive medicine is a direct
outgrowth of the legal attack on the medical profession over the past
four decades and how it has become a fundamental driver of increased
costs in U.S. healthcare. Dr. Anderson will discuss the U.S. experience
so attendees can identify key points of interest and value in comparison
with other countries.
9
PROGRAM
Location
1:45 - 3:15 p.m. Plenary Session
Electronic Health Records and Other New Media in Healthcare
Moderator: Christine Tomkins, Chief Executive, MDU
Speaker: Chad P. Brouillard, Esq., Foster & Eldridge, LLP
Speaker: Dr. Patrick Ceresia, Managing Director,
Corporate Services, CMPA
Speaker: Dr. Robert Hendry, Medical Director of Medical Protection, MPS
Speaker: Dr. Pierre Campbell, Head of Underwriting, MDU
Domed Church
The adoption of electronic health records and other electronic media in
healthcare is happening at a different pace, and under differing schemes
of law and regulation, in the various countries. Each has essential lessons
to learn from the others’ experience to date. This session will explore
the current and future ramifications of EHRs and other new media for
medical professional liability insurance and indemnification enterprises,
and explain what companies and their policyholders should bear in
mind in doing risk assessment and risk management in regard to new
types of exposures from EHRs, mobile healthcare technology, and other
new media.
3:15 - 3:45 p.m.
Refreshment Break
Domed Church,
First floor
3:45 - 5:00 p.m. Concurrent Session
Improving Diagnoses Through Cognitive Debiasing
Moderator: Doug Bell, Associate Executive Director, CMPA
Speaker: Velma L. Payne, PhD, Biomedical Informatics Specialist,
Micha el E. DeBakey Veterans Affairs Medical Center and
The University of Texas Health Science Center at
Houston School of Biomedical Informatics
Speaker: Laura Zwaan, PhD, Postdoctoral researcher EMGO Institute / VU University medical center
Amsterdam Den Haag Room
Cognitive biases (distortions of thinking) and affective biases (an intrusion
of the physician’s emotions) may interfere significantly in the process of
reaching a correct diagnosis. Cognitive biases often adversely influence
the rapid intuitive mode of medical reasoning. This case-based session will
explore strategies to cognitively “de-bias” clinicians, to help minimize the
incidence of diagnostic error.
10
Location
3:45 - 5:00 p.m. Concurrent Session
High-Severity Claims: Is the Sky Really the Limit?
Moderator: Michel de Ridder, KBS
Speaker: Divya Parikh, Director of Research and Risk Management, PIAA
Speaker: David Pranklin, Technical Claims Controller, MDU
Across the globe, the severity of medical professional liability claims
continues to rise. In many c
­ ountries it is not uncommon for judgments or
awards to be in seven figures or more. What is driving high-severity claims?
Are these claims here to stay? And do these claims have a ceiling in terms
of their cost to medical professional liability insurance companies and
indemnification organizations? ­In this session, the speakers will address all
of these questions and more. They will examine some of the factors that
lead to high-severity claims and offer data that identifies the current
specialties and procedures that may be commonly targeted by plaintiff’s
attorneys due to their susceptibility to high-value awards. This session will
include the presentation of data from the PIAA Data Sharing Project.
6:00 - 11:00 p.m.
Conference Dinner (included). See page 6 for details
Domed Church
Hermitage
Museum
Friday, October 10, 2014
7:30 - 9:00 a.m.
Breakfast (included)
Domed Church,
First floor
9:00 - 10:30 a.m. Plenary Session
Social Media: Friend or Foe in 21st Century Medicine?
Moderator: Dr. Hartley S. Stern, CEO, CMPA
Speaker: Barbara Ficarra, RN, BSN, MPA, founder Healthin30.com, award-winning broadcast journalist, writer - The Huffington Post, consultant
Speaker: Jane O’Brien, former Head of Standards & Ethics,
General Medical Council (GMC)
Speaker: Chad P. Brouillard, Esq., Foster & Eldridge, LLP
Domed Church
The phenomenon of social media has taken the world by storm.
Healthcare, like every other area of life, has been impacted. This session
will provide a broad perspective on all of the factors and issues that
medical professional liability insurance and indemnification organizations
and individual physicians should bear in mind in using social media. These
include potential legal, and new, causes of action for medical liability
claims. The speakers will offer some personal insights on best practices
in using social media to interact with patients – and what professionals
should be wary of as well. They will also provide some informed predictions
on the likely role of social media in the future of medicine.
10:30 - 11:00 a.m.
Refreshment Break
Domed Church,
First floor
11
PROGRAM
Location
11:00 a.m. - 12:15 p.m.
Concurrent Session
Alternative Dispute Resolution: Debating the Pros and Cons
Moderator: Herman van Hemsbergen, CEO, VvAA
Speaker: Steve Lancken, Mediator, Negocio Resolutions
Speaker: Domenic Crolla, Esq., Partner, Gowling Lafleur Henderson LLP
Domed Church
In this session, the speakers will discuss the benefits, and disadvantages,
of using alternative dispute resolution (ADR) for resolving medical liability
claims. Factors considered include staff time involved and immediate
and final costs. Each of the panel members has many years’ experience
in using ADR, within the context of the legal and regulatory scheme in his
or her country. Attendees will learn which factors make ADR work well –
and which, in contrast, make ADR more cumbersome to apply and less
effective in holding down costs and making defendant physicians’ lives
less burdensome.
11:00 a.m. - 12:15 p.m.
Concurrent Session
Failure to Diagnose: The Impact on Patients, Physicians, and MPL Entities
Moderator: Andrew Boldeman, CEO, Avant Mutual Group
Speaker: Helen Vernon, Director of Claims, National Health Service
Litigation Authority
Speaker: Dr. Hayes V. Whiteside, Medical Director and Senior Vice
President, Risk Management, ProAssurance Corporation
Speaker: Charlotta Grunewald, Karolinska University Hospital
Amsterdam Den Haag Room
This session will cover the multiple causes of failure to diagnose, and its
many impacts for each of the parties involved in healthcare: doctors,
patients, and medical professional liability insurance and indemnification
organizations. This session will include data from the PIAA’s Data Sharing
Project to help highlight a claims-based foundation for exploring the
prevalence of failure to diagnose, and its consequences for physicians,
and for medical professional liability insurance and indemnification
organizations. Then, a case study will be presented to identify the key
factors observed in obstetrical cases that involved failure to diagnose.
12:15 - 1:30 p.m.
Networking Lunch
Domed Church,
First floor
1:30 - 2:45 p.m. Concurrent Session
International Claims Trends: Is the Wind Always from the West?
Moderator: Gregg Hanson, CEO and President, Coverys
Speaker: Kate Gillman, Special Counsel, Medico Legal Advisory
and Health Law, Avant Mutual Group
Speaker: Dr. Richard E. Anderson, Chairman and CEO,
The Doctors Company
Speaker: Peter Jeurissen, Ecclesia Gruppe
Domed Church
This session raises a fascinating question: Where do claims trends
originate? Is it always in the West? Or do some new trends in fact begin
elsewhere? Three panelists, each from a different PIAA member company,
will discuss claims trends as observed in their respective jurisdictions.
12
Location
1:30 - 2:45 p.m. Concurrent Session
Public Pressure and Its Influence on Medical Professional Liability
Moderator: Ed Amsler, Vice President, MLMIC
Speaker: Frank O’Neil, Senior Vice President and Chief Communications Officer, ProAssurance Corporation
Speaker: Chris Bronkhorst, LHCS
Amsterdam Den Haag Room
High-profile medical liability cases often require some level of crisis
management. In this session, the speakers will examine the
repercussions of high-profile medicalliability cases, from multiple
­perspectives. They will examine a medical liability case that drew
considerable media attention and offer guidance for handling such
cases. Attendees will learn how to assess the crisis m
­ anagement
situation to determine the threat level to their brand’s reputation,
engage negative commenters on social media, employ measurement
tactics to assess the impact of their crisis management efforts,
develop a post-crisis communications strategy to repair any damage,
and much more.
2:45 - 3:15 p.m.
Refreshment Break
Domed Church,
First floor
3:15 - 4:45 p.m. Plenary Session
The Future of Healthcare: What Will the Patient Want in 2020?
Moderator: Richard Faas, manager Mobile, VvAA
Speaker: René Amalberti, MACSF
Speaker: Rob de Graaf, senior consultant Product Innovation, Philips
Speaker: Adjiedj Bakas, Trend watcher
Domed Church
What will patients be most concerned about in 20 years? This session
tackles that and several other big questions: How will the use of
medical apps change the delivery of healthcare? Will robotic s­ urgery
play a bigger part in healthcare? What does the future hold for the
process of medical diagnosis? What is the impact of all of these factors
on medical professional liability insurance and indemnification
organizations? The panelists will discuss these and other topics about
the future of medicine.
4:45 p.m.
Closing remarks
Domed Church
5:00 p.m.
Farewell drinks
Domed Church,
Ground floor
13
www.piaa2014.com