Lessons Learned

No one wants to be sued. A lawsuit is an assault on one's self-image, reputation, and livelihood. It is physically, mentally, and financially draining. The purpose of this book is to provide genetic counselors with varying levels of experience and expertise. It offers them strategies for minimizing the potential for being named in a lawsuit, and provides guidance for the management of current and emerging situations. This is the first book specifically addressing genetic counseling, as opposed to general healthcare risk management. The author has training and experience in both genetic counseling and law, serving as an expert witness in a malpractice case brought against a genetic counselor. The book includes summaries for convenient reference, important court cases, and an appendix of relevant documents.

1 Introduction.- 2 Sources of Liability.- 2.1 Forms of Legal Complaints.- 2.1.1 Tort Law.- 2.1.2 Fraud.- 2.1.3 Contract Law.- 2.2 Legal Initiatives.- 2.2.1 Federal Regulations.- 2.2.2 State Regulations.- 2.2.3 Criminal Complaints.- 2.2.4 Organizational Requirements.- 2.3 Private Practice.- 2.3.1 Partnerships.- 2.3.2 Billing.- 2.4 Industry/Technology.- 2.5 Reproductive Technology.- 2.6 Research.- 2.6.1 Human Subjects.- 2.6.2 Gene Transfer.- 2.6.3 Clinical Testing on Research Samples.- 2.6.4 Institutional Review Boards.- 2.6.5 Epidemiology.- 2.7 Trainees.- 3 Duty as an Element of a Lawsuit:.- 3.1 Duty Element.- 3.2 Establishing a Professional Relationship.- 3.2.1 Abandonment.- 3.3 Obligations and Duties.- 3.3.1 Standard of Care.- 3.3.2 Specialty Practitioners.- 3.3.3 Good Practice.- 3.3.4 Nongeneticists Providing Genetic Services.- 4 Duty as an Element of a Lawsuit: .- 4.1 Test for a Standard.- 4.2 Sources for Standards .- 4.2.1 Scope of Practice:.- 4.2.2 Code of Ethics.- 4.2.3 Professional Organizations.- 4.2.4 Professional Literature.- 4.2.5 Professional Guidelines.- 4.2.6 Credentials.- 4.2.7 Expert testimony.- 5 Duty as an Element of a Lawsuit:.- 5.1 Medical Records.- 5.1.1 Chart Contents.- 5.1.2 Ownership.- 5.1.3 Storage of Medical Records.- 5.1.4 Shadow Charts.- 5.2 Failure to FollowPolicies and Procedures.- 5.2.1 Informed Consent.- 5.2.2 Confidentiality.- 5.3 Improper Techniques.- 5.3.1 Nondirective.- 5.3.2 Nonjudgmental/Value Neutral.- 5.3.3 Transcultural Competency.- 5.3.4 Defenses for the Duty Element.- 6 Breach, Causation and Damages as Elements of a Lawsuit.- 6.1 Breach .- 6.1.1 Decision Makers.- 6.1.2 Defense to Breach Element.- 6.2 Causation.- 6.2.1 Remote Causation.- 6.2.2 Proximate Cause.- 6.2.3 Informed Consent Cases.- 6.2.4 Defense to the Causation Element.- 6.3 Damages.- 6.3.1 General Damages.- 6.3.2 Compensatory Damages.- 6.3.3 Noneconomic Damages.- 6.3.4 Punitive Damages.- 6.3.5 Assessing Damages.- 6.3.6 Defense to the Damage Element.- 7 Defenses to a Lawsuit.- 7.1 Helping Yourself .- 7.2 Affirmative Defenses to Malpractice Lawsuits.- 7.2.1 Statute of Limitations.- 7.2.2 Contributory Negligence.- 7.2.3 Comparative Negligence.- 7.2.4 Assumption of the Risks.- 7.2.5 Good Samaritan Statute.- 7.2.6 Indemnity or Release.- 7.3 Countersuits.- 7.3.1 Malicious Prosecution.- 7.3.2 Abuse of Process.- 7.3.3 Defamation.- 7.3.4 Negligence.- 7.3.5 Intentional Torts.- 8 Communication.- 8.1 Face-to-Face.- 8.2 Electronic Communication.- 8.2.1 Internet.- 8.3 Privacy.- 8.3.1 Transmission of Information.- 8.4 Managing Your Malpractice Exposure in Cyberspace.- 9 Conclusions: Lessons Learned .- 9.1 Defensive Practice.- 9.2 Advice from Experience.- Appendix.- A.1 Definition of Genetic Counseling.- A.1.1 1975.- A.1.2 2006.- A.2 Scope of Practice.- A.3 The Code of Ethics of the National Society of Genetic Counselors.- A.4 Suggested Readings.- Notes.- Index .