Selected Podcast
The Reality of Malpractice Risk for the Oral and Maxillofacial Surgeon
Why the malpractice company you choose is critical to your survival. Cheap insurance is just that. What are the considerations to select your malpractice coverage? The OMSNIC advantage. Expertise and knowledge of the specialty of OMS.
Featured Speaker:
James Q. Swift, DDS, FACS
Dr. James Swift is a tenured Professor and was Director of the Division of Oral and Maxillofacial Surgery at the University of Minnesota School of Dentistry for 25 years. He served as the Program Director of the Advanced Education Program in Oral and Maxillofacial Surgery for the second time in his tenure there. He recently served as Acting Dean in regards to promotion and tenure matters. He was named the University of Minnesota School of Dentistry Century Club Professor of the Year in 2001. Dr. Swift has authored over 100 manuscripts, articles, abstracts and book chapters. He has procured funding from the NIDH as a Principal Investigator, securing RO1 support for his scientific work. The James Q. Swift Professorship Endowment was founded and funded at the University of Minnesota in 2016. Dr. Swift received his Bachelors of Arts degree (cum laude) from Cornell College, Mt. Vernon, IA in 1976. He received his dental degree from the University of Iowa in 1980 and his oral and maxillofacial surgery training from the University of Oklahoma College of Medicine, completing his program in 1985. He is also a practicing oral and maxillofacial surgeon at the University of Minnesota. He served the American Board of Oral and Maxillofacial Surgery as President in 2005, as a Director for 6 years and as a member of the Examination Committee for 6 years. He served the American Dental Education Association as President in 2007-2008 and on the Board of Directors from 2002-2008. Dr. Swift served as a Director of the Oral and Maxillofacial Surgery Foundation (OMSF) from 2009-2012. Dr. Swift was elected to the Medical Professional Liability Association Board of Directors in 2015 and elected as its Secretary in 2016. He was elected MPL Association Vice Chair in 2018 and has ascended Chair of the Board of the MPL Association in May of 2020. He has served the AAOMS on numerous committees including service as an officer and chair of the Faculty Section. He received the AAOMS’s Daniel M. Laskin Award for the most outstanding Journal of Oral and Maxillofacial Surgery article published in 1998. He was named the University of Minnesota School of Dentistry Century Club Professor of the Year in 2001. He was the Oral and Maxillofacial Surgery Foundation’s (OMSF) Ambassador Service Award recipient in 2004. In 2011, Dr. Swift received the AAOMS/William J. Gies Foundation Gies Award for oral and maxillofacial surgery. He was given the ADEA Distinguished Service Award in 2009. He received the AAOMS’ R.V. Walker Distinguished Service Award in 2015. He is a Fellow of the International College of Dentists, the American College of Dentists and the American College of Surgeons. Dr. Swift was elected as a Member of the Board of the Gorlin Syndrome Alliance in 2020 and serves on committees of the GSA and Chairs the newly formed Medical and Scientific Advisory Committee of the GSA. Dr. Swift has been a Director of OMSNIC since 2006, served as Vice Chair from 2011 to 2013 and as Chair since 2014. Transcription:
The Reality of Malpractice Risk for the Oral and Maxillofacial Surgeon
Bill Klaproth (host): This is an Amos on the go podcast I'm Bill Klaproth. And with me is Dr Jim Swift And we're going to discuss the reality of malpractice risk for the oral and maxillofacial surgeon according to OMSNIC Dr Swift thank you for being here.
Dr. Swift: Thank you for having me.
Bill Klaproth (host): First off, could you just give us a brief history of OMSNIC and where we are today with it?
Dr. Swift: Sure. I'll be happy to do that. OMSNIC Stands for Oral and Maxillofacial Surgery National Insurance Company. And it was formed in The late 1980s. So it's been 30 years since its inception. And at this time in the United States there was what was called a malpractice insurance crisis. We're commercial carriers were raising the premium costs for malpractice insurance. And as a result oral surgeons couldn't afford very easily in their practices to buy malpractice insurance, which is essential and is mandated by several hospitals. And other clinical environments.
And so, as a result, the AAOMS Formed a committee of individuals to investigate whether they should form. Some type of insurance company to fight malpractice claims. and, based upon the federal government passing the Risk Retention Act. Approximately the same time it made an opportunity for professional associations to be able to form their own insurance companies and sell malpractice insurance in all 50 states and manage those claims. And that's where OMSNIC came from. And so OMSNIC manages only oral and maxillofacial surgery claims. That's it. We don't do other Malpractice. for other providers of different disciplines.
Bill Klaproth (host): Right? Well, Thank you for that. So let's talk about you now and how you fit into this. What is your background and how did you wind up involved in OMSNIC?
Dr. Swift: Well back of the 1980s, I did have a policy from another company. I was practicing in Oklahoma at the time and it was expensive. And then I decided to move to Minnesota. And when I did that, I had to get a different insurance policy. And so, because this coverage wouldn't cover to Minnesota. So I decided to buy the insurance that was available through the professional association because it the most economical move for me to make, as I made that move.
And so I got familiar with the company. I wanted to know the quality of the product I was buying. It was a little bit suspicious at the time because this was a relatively new thing that was happening. And you have to make sure you don't want to be left out in the dark with a malpractice insurance policy that's not going to cover you when you if, and when you have exposure to a malpractice claim. And so you have to be assured that, that the company is going to do what it says it's going to do to protect you.
And so our motto in OMSNIC is defending the specialty because that's what we do. We defend, I defend my colleagues that are all in Mexico, facial surgeons. So I got interested because I was involved in an association where an individual that was working with arms, neck. ask me to be on their claims committee. And this is a committee that they formed, that they wanted to be able to deal with the claims that were made against oral and maxillofacial surgeons. in an aggressive way. And as a result. they Need to have significant review of what happened in the situation. that created the patient that felt that they had to Sue for some reason.
And so a lot of this was related to analysis and analysis of claims and I was active in the professional association doing that to some degree. And so they asked me to be on their claims committee. And so we met every two months and we'd review. Usually three to five claims per person. There were six of us on the claims committee. And we would delve into these claims and the facts associated with these claims. Including the charts and Records. and whatnot, and would try to find a way to defend the doctor that was unfortunate enough to be sued.
In those situations. And I just got really involved with it and I think on the basis of the fact that I really dedicated time and effort as did everyone else that was involved that, they rewarded me by keeping me on. And I, wanted to continue to do that. And then the other kind of weak association is my father was an attorney, my grandfather, his attorney, and I have two brothers that are attorneys. So having dinner at our house. when I was a kid was Like being in court. So to some degree, I didn't get charged to go take a pursue a legal career. But at the same time, I had kind of an extensional interest in that.
Bill Klaproth (host): Through osmosis you kinda inherited that.
Dr. Swift: Yes. At the dinner table, we had several discussions.
Bill Klaproth (host): I bet. I bet. So besides malpractice insurance, What does OMSNIC do for this specialty. What other value does it bring?
Dr. Swift: Well, we provide other insurance products, for cyber liability, which is significant right now. And That's a huge challenge in the MPL world. The medical professional liability world. And so we're working on providing coverage for the Oral and maxillofacial surgeons for that particular challenge that will come into their practice. And in addition, we provide umbrella coverage for assets are uninsured motorists and other insurance products. That we're allowed to do other than just malpractice Through that platform.
And so we, we try to find out from the Amos members, what they need and provide. We actually even provide Embedded in the policy travel insurance. So if they Lose their bags, then they get replaced or if they're injured or hurt when they're away. Then it provides for transportation back. And, those are products we added on and we actually, our product is sold through insurance agents throughout the country. And we, partner with them and they get a, Commission component from selling the policy as well.
Bill Klaproth (host): Well, that's really interesting and varied all the different things you offer. So, how does OMSNIC then handle a claim from an OMS?
Dr. Swift: We inform our insurance what to do when someone calls and says to them we're suing you or if an attorney contacts them and says, I want the records for this patient because I'm going to look at them and we're going to determine if we're going to Sue you. Or if someone reports them to their professional licensing agency, we help them defend that as well. If some patient complaints that there's been a problem of some sort, then we provide legal referral for them.
We have several attorneys that work for us on our claims management team. And so they know what to do when these things all happen. And so when you call in and say, I'm being sued. The response is, well, we'll put our analyst on it and we'll decide what you need. And then we have a core. of defense attorneys that we use across the country that we educate every two years, we have a meeting, we just had it just a couple of months ago.
Where we invite them in and just teach them about Oral and maxillofacial surgery. So they'll know. If in fact, a doctor says I have a patient that has a numb tongue, after a procedure, they'll know what nerve was involved. The attorneys will know this, we teach them anatomy as well as the techniques. And so we have that core of attorneys that we use to manage these claims. So they know what they're doing.
Bill Klaproth (host): It seems like for an oral and maxillofacial surgeon, they would want to go with you because It seems like You are experts in this when defending a claim. Is that right?
Dr. Swift: I would agree with you bill, but, some people go by price. From my perspective, you get what You pay for And so that's not one thing you want to sacrifice on cheap insurance is not a good idea,in my opinion,
Bill Klaproth (host): And what about educational initiatives or opportunities? Does OMSNICprovide those types of things as well?
Dr. Swift: We do. We have a large department called patient safety and risk management. And so we actually held. session on Wednesday of this week here at this meeting for Oral and maxillofacial surgeons and office staff that work with them to learn how guard themselves, to protect them from being sued. In addition to what to do when, when that happens, what kind of chart work they need to do, what kind of informed consent they need to do and what notifications they need to make to prevent them from being sued, how would they manage?
And so what we use our claims that we've already dealt with that have already been to court, we talk about them. Obviously not revealing the individual that was involved, but we tell them here's what happened. Here's a claim that we had to deal with and We used experts,, and we actually have a plethora of experts that we use that are knowledgeable as well about insurance and well as malpractice claims and how to defend those.
So it's all an exercise to make sure that we can minimize the risk or defend the doctor that's being accused of doing something that was not under standard of care.
Bill Klaproth (host): So Dr. Swift, let me ask you then what is on radar in the coming years, where are you going? Your future initiatives?
Dr. Swift: Well, One thing we're looking at is social inflation, which is the propensity for a jury these days, to bump up the amount of money they want to award to a patient or an Individual for a malpractice claim. So, and that's a challenge that you have, what's it worth? I mean, if you, in fact, take out the wrong tooth. And the patient's missing a tooth. What dollar figure should be associated with that? And some of that's generational. Some people saying, well, gee, if it was my tooth, I'd need at least billions of dollars.
And the fact of the matter is there is a common ground there that can be determined. But if the numbers go so high, then the cost of the malpractice insurance is going to go up again and it won't be affordable for individuals in that situation. So we're looking at that. We're looking at the cyber issues, because that does take a practice down when someone hacks them, because right now if you can get a medical record, you can sell that on the black market for a thousand dollars per record. So if they can hack into your files and take 200 files away, they can make money.
The hackers can make money by selling that information to third parties that want to commit crimes. And so, we're trying to make sure that they're protected in their practice so that the machines they use manage the computers the need to manage the practice and the scheduling are set up in such a way that they can't be hacked. They have to take protocol to make sure that there's firewalls there so that, and we provide that service for them as well. And that's part of the future as but what we're trying to do is, make them able to practice without having to be concerned about a large loss of revenue on the basis of a malpractice claim. So we're looking to do those things.
Bill Klaproth (host): Well, electronic records are great, but then of course you have the love unintended consequences. Having everything electronically filed as wonderful, but then you have the potential liability of having something getting hacked. Didn't have to worry about that. Right back in 88, everything was on paper. So Dr. Swift, as we wrap up, anything else you want to add about OMSNIC and the role it plays for an OMS?
Dr. Swift: Sure I. I don't want to scare anybody. But there's always a potential risk for a malpractice claim, even if you're the best oral surgeon in the entire universe. There is always an opportunity or possibility for some disgruntled patient or an individual that for some reason, doesn't want to pay their bill and there are some situations where doctors do make mistakes. And so, it is important that you're very much have a tremendous product.
I'm kind of put aside by some of these commercials I see on TV for insurances and the typically for your car or other things where they essentially tried to convince you to buy cheap. We'll only sell you what you need, Well, you don't know until you have to face the situation, what you're going to need.
Bill Klaproth (host): How do you know what you need?
Dr. Swift: Exactly so we're intending to provide the best product there is out there for our doctors to make sure that their defended.
Bill Klaproth (host): Yeah, well, you're right here at Amos, boots on the ground, you're meeting the members. So you're right here with them. It's not just the TV commercials. So that has to have value as well to them.
Dr. Swift: Yeah, it's, it's good that they know they can walk up to me as chair of the board and talk to me about their situation. And that's obvious all confidential but when someone sues you, it's very difficult emotionally and people have challenges because you're trying out there to do good for people.
You're trying to take care of their, illnesses and their their challenges they need for which they need surgery. And when you're confronted in that way as that someone thinks you intentionally hurt somebody it's really damaging to your psyche, and so.
Bill Klaproth (host): Yeah, that would be very difficult to deal with mentally. I would think.
Dr. Swift: Yes, it is for, and so we want to make sure that our insured are aware of that situation, that we can help them.
Bill Klaproth (host): Right. All taken care of, if there is a claim against them. Well Doctor Swift, thank you for being here. This has been fascinating
Dr. Swift: Thanks Bill. It's a pleasure to be with you. Thank you so much.
Bill Klaproth (host): Absolutely. Once again. That's Dr. Jim Swift. And for more information in the full podcast library, please visit AAOMS.org. That's A A O M S.org. And if you enjoyed this podcast, please share it on your social media and be sure to subscribe. So you don't miss an episode. Thank you for listening.
The Reality of Malpractice Risk for the Oral and Maxillofacial Surgeon
Bill Klaproth (host): This is an Amos on the go podcast I'm Bill Klaproth. And with me is Dr Jim Swift And we're going to discuss the reality of malpractice risk for the oral and maxillofacial surgeon according to OMSNIC Dr Swift thank you for being here.
Dr. Swift: Thank you for having me.
Bill Klaproth (host): First off, could you just give us a brief history of OMSNIC and where we are today with it?
Dr. Swift: Sure. I'll be happy to do that. OMSNIC Stands for Oral and Maxillofacial Surgery National Insurance Company. And it was formed in The late 1980s. So it's been 30 years since its inception. And at this time in the United States there was what was called a malpractice insurance crisis. We're commercial carriers were raising the premium costs for malpractice insurance. And as a result oral surgeons couldn't afford very easily in their practices to buy malpractice insurance, which is essential and is mandated by several hospitals. And other clinical environments.
And so, as a result, the AAOMS Formed a committee of individuals to investigate whether they should form. Some type of insurance company to fight malpractice claims. and, based upon the federal government passing the Risk Retention Act. Approximately the same time it made an opportunity for professional associations to be able to form their own insurance companies and sell malpractice insurance in all 50 states and manage those claims. And that's where OMSNIC came from. And so OMSNIC manages only oral and maxillofacial surgery claims. That's it. We don't do other Malpractice. for other providers of different disciplines.
Bill Klaproth (host): Right? Well, Thank you for that. So let's talk about you now and how you fit into this. What is your background and how did you wind up involved in OMSNIC?
Dr. Swift: Well back of the 1980s, I did have a policy from another company. I was practicing in Oklahoma at the time and it was expensive. And then I decided to move to Minnesota. And when I did that, I had to get a different insurance policy. And so, because this coverage wouldn't cover to Minnesota. So I decided to buy the insurance that was available through the professional association because it the most economical move for me to make, as I made that move.
And so I got familiar with the company. I wanted to know the quality of the product I was buying. It was a little bit suspicious at the time because this was a relatively new thing that was happening. And you have to make sure you don't want to be left out in the dark with a malpractice insurance policy that's not going to cover you when you if, and when you have exposure to a malpractice claim. And so you have to be assured that, that the company is going to do what it says it's going to do to protect you.
And so our motto in OMSNIC is defending the specialty because that's what we do. We defend, I defend my colleagues that are all in Mexico, facial surgeons. So I got interested because I was involved in an association where an individual that was working with arms, neck. ask me to be on their claims committee. And this is a committee that they formed, that they wanted to be able to deal with the claims that were made against oral and maxillofacial surgeons. in an aggressive way. And as a result. they Need to have significant review of what happened in the situation. that created the patient that felt that they had to Sue for some reason.
And so a lot of this was related to analysis and analysis of claims and I was active in the professional association doing that to some degree. And so they asked me to be on their claims committee. And so we met every two months and we'd review. Usually three to five claims per person. There were six of us on the claims committee. And we would delve into these claims and the facts associated with these claims. Including the charts and Records. and whatnot, and would try to find a way to defend the doctor that was unfortunate enough to be sued.
In those situations. And I just got really involved with it and I think on the basis of the fact that I really dedicated time and effort as did everyone else that was involved that, they rewarded me by keeping me on. And I, wanted to continue to do that. And then the other kind of weak association is my father was an attorney, my grandfather, his attorney, and I have two brothers that are attorneys. So having dinner at our house. when I was a kid was Like being in court. So to some degree, I didn't get charged to go take a pursue a legal career. But at the same time, I had kind of an extensional interest in that.
Bill Klaproth (host): Through osmosis you kinda inherited that.
Dr. Swift: Yes. At the dinner table, we had several discussions.
Bill Klaproth (host): I bet. I bet. So besides malpractice insurance, What does OMSNIC do for this specialty. What other value does it bring?
Dr. Swift: Well, we provide other insurance products, for cyber liability, which is significant right now. And That's a huge challenge in the MPL world. The medical professional liability world. And so we're working on providing coverage for the Oral and maxillofacial surgeons for that particular challenge that will come into their practice. And in addition, we provide umbrella coverage for assets are uninsured motorists and other insurance products. That we're allowed to do other than just malpractice Through that platform.
And so we, we try to find out from the Amos members, what they need and provide. We actually even provide Embedded in the policy travel insurance. So if they Lose their bags, then they get replaced or if they're injured or hurt when they're away. Then it provides for transportation back. And, those are products we added on and we actually, our product is sold through insurance agents throughout the country. And we, partner with them and they get a, Commission component from selling the policy as well.
Bill Klaproth (host): Well, that's really interesting and varied all the different things you offer. So, how does OMSNIC then handle a claim from an OMS?
Dr. Swift: We inform our insurance what to do when someone calls and says to them we're suing you or if an attorney contacts them and says, I want the records for this patient because I'm going to look at them and we're going to determine if we're going to Sue you. Or if someone reports them to their professional licensing agency, we help them defend that as well. If some patient complaints that there's been a problem of some sort, then we provide legal referral for them.
We have several attorneys that work for us on our claims management team. And so they know what to do when these things all happen. And so when you call in and say, I'm being sued. The response is, well, we'll put our analyst on it and we'll decide what you need. And then we have a core. of defense attorneys that we use across the country that we educate every two years, we have a meeting, we just had it just a couple of months ago.
Where we invite them in and just teach them about Oral and maxillofacial surgery. So they'll know. If in fact, a doctor says I have a patient that has a numb tongue, after a procedure, they'll know what nerve was involved. The attorneys will know this, we teach them anatomy as well as the techniques. And so we have that core of attorneys that we use to manage these claims. So they know what they're doing.
Bill Klaproth (host): It seems like for an oral and maxillofacial surgeon, they would want to go with you because It seems like You are experts in this when defending a claim. Is that right?
Dr. Swift: I would agree with you bill, but, some people go by price. From my perspective, you get what You pay for And so that's not one thing you want to sacrifice on cheap insurance is not a good idea,in my opinion,
Bill Klaproth (host): And what about educational initiatives or opportunities? Does OMSNICprovide those types of things as well?
Dr. Swift: We do. We have a large department called patient safety and risk management. And so we actually held. session on Wednesday of this week here at this meeting for Oral and maxillofacial surgeons and office staff that work with them to learn how guard themselves, to protect them from being sued. In addition to what to do when, when that happens, what kind of chart work they need to do, what kind of informed consent they need to do and what notifications they need to make to prevent them from being sued, how would they manage?
And so what we use our claims that we've already dealt with that have already been to court, we talk about them. Obviously not revealing the individual that was involved, but we tell them here's what happened. Here's a claim that we had to deal with and We used experts,, and we actually have a plethora of experts that we use that are knowledgeable as well about insurance and well as malpractice claims and how to defend those.
So it's all an exercise to make sure that we can minimize the risk or defend the doctor that's being accused of doing something that was not under standard of care.
Bill Klaproth (host): So Dr. Swift, let me ask you then what is on radar in the coming years, where are you going? Your future initiatives?
Dr. Swift: Well, One thing we're looking at is social inflation, which is the propensity for a jury these days, to bump up the amount of money they want to award to a patient or an Individual for a malpractice claim. So, and that's a challenge that you have, what's it worth? I mean, if you, in fact, take out the wrong tooth. And the patient's missing a tooth. What dollar figure should be associated with that? And some of that's generational. Some people saying, well, gee, if it was my tooth, I'd need at least billions of dollars.
And the fact of the matter is there is a common ground there that can be determined. But if the numbers go so high, then the cost of the malpractice insurance is going to go up again and it won't be affordable for individuals in that situation. So we're looking at that. We're looking at the cyber issues, because that does take a practice down when someone hacks them, because right now if you can get a medical record, you can sell that on the black market for a thousand dollars per record. So if they can hack into your files and take 200 files away, they can make money.
The hackers can make money by selling that information to third parties that want to commit crimes. And so, we're trying to make sure that they're protected in their practice so that the machines they use manage the computers the need to manage the practice and the scheduling are set up in such a way that they can't be hacked. They have to take protocol to make sure that there's firewalls there so that, and we provide that service for them as well. And that's part of the future as but what we're trying to do is, make them able to practice without having to be concerned about a large loss of revenue on the basis of a malpractice claim. So we're looking to do those things.
Bill Klaproth (host): Well, electronic records are great, but then of course you have the love unintended consequences. Having everything electronically filed as wonderful, but then you have the potential liability of having something getting hacked. Didn't have to worry about that. Right back in 88, everything was on paper. So Dr. Swift, as we wrap up, anything else you want to add about OMSNIC and the role it plays for an OMS?
Dr. Swift: Sure I. I don't want to scare anybody. But there's always a potential risk for a malpractice claim, even if you're the best oral surgeon in the entire universe. There is always an opportunity or possibility for some disgruntled patient or an individual that for some reason, doesn't want to pay their bill and there are some situations where doctors do make mistakes. And so, it is important that you're very much have a tremendous product.
I'm kind of put aside by some of these commercials I see on TV for insurances and the typically for your car or other things where they essentially tried to convince you to buy cheap. We'll only sell you what you need, Well, you don't know until you have to face the situation, what you're going to need.
Bill Klaproth (host): How do you know what you need?
Dr. Swift: Exactly so we're intending to provide the best product there is out there for our doctors to make sure that their defended.
Bill Klaproth (host): Yeah, well, you're right here at Amos, boots on the ground, you're meeting the members. So you're right here with them. It's not just the TV commercials. So that has to have value as well to them.
Dr. Swift: Yeah, it's, it's good that they know they can walk up to me as chair of the board and talk to me about their situation. And that's obvious all confidential but when someone sues you, it's very difficult emotionally and people have challenges because you're trying out there to do good for people.
You're trying to take care of their, illnesses and their their challenges they need for which they need surgery. And when you're confronted in that way as that someone thinks you intentionally hurt somebody it's really damaging to your psyche, and so.
Bill Klaproth (host): Yeah, that would be very difficult to deal with mentally. I would think.
Dr. Swift: Yes, it is for, and so we want to make sure that our insured are aware of that situation, that we can help them.
Bill Klaproth (host): Right. All taken care of, if there is a claim against them. Well Doctor Swift, thank you for being here. This has been fascinating
Dr. Swift: Thanks Bill. It's a pleasure to be with you. Thank you so much.
Bill Klaproth (host): Absolutely. Once again. That's Dr. Jim Swift. And for more information in the full podcast library, please visit AAOMS.org. That's A A O M S.org. And if you enjoyed this podcast, please share it on your social media and be sure to subscribe. So you don't miss an episode. Thank you for listening.