I heard from a family medicine physician recently who explained she just retired after a long career.
Congratulations.
She had not quite figured out how she planned to spend her free time. But…
She had a long-standing relationship with a local marching band that trains locally. It performs both locally and on the road.
She’d take care of a collection of ailments, none life-threatening. She wanted to continue this relationship.
Since she’s a volunteer, she’s never been paid. She has never submitted a bill for reimbursement. She had been led to believe that if she performs services pro bono, she’s covered by Good Samaritan laws. She was dotting her i’s and crossing her t’s.
She looked into purchasing a bare-bones med mal policy, and she was quoted $5k/year. More than she wanted to spend for the benefit of volunteering.
I hated to be the one “pointing out the turd in the punchbowl.” But I was.
I do not believe Good Samaritan laws would protect her. Here’s why.
Good Samaritan laws are on the books to remove disincentives for the general public (or even those trained professionals) from stepping up and rendering assistance during an urgent or emergent matter. To qualify, the underlying condition being addressed must be urgent or emergent. You cannot be paid for the service. And the care must not be grossly negligent. Gross negligence is even more egregious than ordinary negligence. (There are other qualifiers, such as no pre-existing relationship, such as being on the call schedule for the ER).
My point is this. While not sending a bill is necessary, it is not sufficient.
Good Samaritan laws were implemented to deal with “one-off” situations. Not regular occurrences.
Merely not sending a bill is not a “Get-Out-of-Jail-Free” card. For example, if you provide a prescription to your brother-in-law, you likely would not charge him. You should, of course, document the rationale for the prescription and treat the case formally. But the non-sending of a bill will not, in and of itself, prevent him from later filing a lawsuit alleging negligent care.
Your brother-in-law may love you today. But maybe not later. And he could sue you.
What can a retired physician do, then?
There are options.
(a) One can volunteer at a free clinic (federally qualified health center – FQHC). Staff are treated as federal healthcare employees and provided federal malpractice protection under the Federal Tort Claims Act (FTCA). If someone has a beef with you, they’d sue the federal government under FTCA, not you. This is similar to you working for Indian Health Services, the VA, or military. You’re not directly in the crosshairs.
(b) There are also state-based free clinics. In Illinois, for example, for a retired physician regularly volunteering, the key is Section 30 – Free medical clinic; exemption from civil liability for services performed without compensation. (745 ILCS 49/30)
§ 30 says that a person licensed under the Medical Practice Act (or equivalent out-of-state license) who:
In good faith provides medical treatment, diagnosis, or advice
As part of the services of an established “free medical clinic” that:Provides care to medically indigent patients,
Provides only care that does not require a licensed hospital or ambulatory surgical treatment center,
Receives no fee or compensation from that source (the clinic),
“shall not be liable for civil damages” for that care, except for willful or wanton misconduct.
The statute also defines “free medical clinic,” which typically includes:
An organized clinic (often, but not necessarily, 501(c)(3)) providing care without charge to individuals unable to pay, and
A rule that any voluntary contributions can only be used for overhead, not to pay clinicians.
Finally, the free medical clinic must post in a conspicuous place on its premises an explanation of the exemption from civil liability provided herein.
Would this apply to taking care of the marching band? I doubt it. Among other things, the marchers are probably not indigent, as understood by the law.
Not all states have this carveout of immunity for free clinics. So, check your state before diving in.
(c) One can ask a local institution, such as a hospital, to deputize you as an employee for a limited role, such as caring for this marching band. If so, you’d ask for bundled med mal coverage. This process may come with baggage. You’d technically be an employee. Would you need to maintain privileges, etc? Possibly.
(d) Shop coverage. A good med mal broker should be able to find something less expensive. Here, the number of patients being seen is minimal. The activities being addressed are low risk. The overall risk should be low.
Finally, remember, even if you ARE covered by a Good Samaritan law, that’s an affirmative defense you’d make after being sued. That defense would be made by a lawyer. One you’d have to pay. So, be cautious about going bare.
What do you think?
When I was absolutely done and ready for tail coverage to take over, my carrier, MICA in Arizona, asked me if I ever volunteer my services at sporting events or similar such events. In fact, as an orthopedic surgeon I do exactly that and also give free advice. For $100/yr I can still be covered, who wouldn’t take advantage of that!!!
Shouldn’t she also check with her previous liability carrier, to make sure it’s ok for her to volunteer soon after, IF she had a claims made policy and they provided the tail coverage for her when she retired? My carrier agreed to cover the tail if I was at least 55 and had been with them for at least 5 years, BUT I had to agree to not practice (in fact, do nothing using my license) for 5 years after retiring.
OTOH, if she had an occurence policy I guess that wouldn’t be an issue?
I fully understand the wish to volunteer. However, the plaintiff’s bar has made that just about impossible under almost any circumstances. Why wouldn’t a good deed be treated as such by the plaintiff’s bar? Oh, because they want to sue someone, anyone and get paid.
While yes all of suggestions in the article and comments are valid. However, it is also important to think about what happens if one actually gets sued. Does the retired physician want to spend two years defending herself in court, in depositions, and having to deal with a legal calendar, when she is trying to enjoy her retirement? Unfortunately some retired physicians do not know when it is time to just hang it up, and hand over the volunteer reigns to a younger physician still in practice. It is hard initially to still feel relevant. However, one could teach instead, which theoretically should not carry malpractice risks. One must also be cognizant of that fact that one cannot give medical advice. We are used to doing so for decades. But once we retire, we cannot really do that to friends family and neighbors. It is time to get some other hobby, business, task, to take up the idle time in retirement.
We went into these fields, and stayed in them so long, because we truly loved what we do and love helping people become and maintain healthy living. I am too quickly approaching this stage in life. Sigh.
This feels incomplete. Good Samaritan law is the wrong framework for a lot of organized volunteer medical care.
Many states, including Texas, have separate charitable-immunity or volunteer-physician statutes specifically designed for this situation. Leaving that out makes the risk sound broader than it actually is.
Seems that the question revolves around the meaning of practicing medicine. Does someone who travels with a band and renders first aid qualify? Doubtful. Does merely answering questions about what’s going on with someone’s health qualify? Also doubtful. Is someone required to get the right answers when asked questions constitute medical malpractice? Under these circumstances, also seems unlikely.
Does sewing up a laceration = surgery? Sorta depends, doesn’t it? If there’s no one else around to do it, and it’s indicated, and the means are at hand, that would seem like a good Samaritan situation.
All that said, in retirement, I confine my practice to caring for friends and family. (I haven’t done surgery on a person since 2013.) That inevitably became friends of family and friends of friends. In the latter case, I’m explicit that I’m not their doctor, but merely willing to look over their cases and offer opinions. And referrals if that’s indicated. I never send a bill, and I’ve never been paid so much as a bottle of wine for the services, but these patients seem otherwise genuinely appreciative. Would one of them sue me if I got a wrong answer? Dunno–I’m certainly not perfect. I don’t keep records apart from image files that get uploaded to my computer so I can review studies; there’s nothing to subpoena.
Am I at any risk? Probably. But I’m an old guy, and very few of my patients are spring chickens. They keep coming back–can’t beat the price.
I clearly understand and respect the desire to continue to offer free medical services after your retirement. But in order to retain your medical license, you are also required to maintain your CME’s.
In most cases, that also generates fees you must pay to the agencies that provide those CME’s. And you must also prove you attended them. I assume those fees would no longer be tax deductible.
Even if you paid for your own tail coverage, those fees would no longer be tax deductible.
On balance, it is much safer to simply donate to official charities that provide medical charity. Doctors Without Borders is one example. And there are others.
Michael M. Rosenblatt, DPM