The purpose of this policy is to inform facilities of Medica’s policy pertaining to adverse health care events as described below (“Adverse Health Care Events”). Adverse Health Care Events, sometimes referred to as “Never Events,” are described by the National Quality Forum as “errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a facility.
A facility includes licensed hospital, outpatient surgical center or freestanding ambulatory surgery center (“Facility”).
Effective February 11, 2008, Facilities are prohibited from billing members for services associated with an Adverse Health Care Event and Medica will not reimburse Facilities for services associated with an Adverse Health Care Event.
1. Facility must comply with the Minnesota Adverse Health Care Events Reporting Act of 2003. Facility will maintain policies and procedures that address Adverse Health Care Events reporting pursuant to MN Statutes § 144.706 to 144.7069.
2. Facility will not seek reimbursement from a Medica member or Medica for services associated with an Adverse Health Care Event unless member liability or Medica liability has been determined by Medica.
See MN Statutes § 144.7065 for the full text of each event description.
1. Surgery performed on wrong body part.
2. Surgery performed on the wrong patient.
3. The wrong surgical procedure performed on a patient.
4. Retention of a foreign object in a patient after surgery or other procedure.
5. Death during or immediately after surgery of a normal, healthy patient.
1. Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the Facility.
2. Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended.
3. Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a Facility.
1. An infant discharged to the wrong person.
2. Patient death or serious disability associated with patient disappearance.
3. Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a Facility.
1. Patient death or serious disability associated with a medication error, including, but not limited to, errors involving the wrong drug, the wrong dose, the wrong patient, the wrong time, the wrong rate, the wrong preparation, or the wrong route of administration.
2. Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/HLA-incompatible blood or blood products.
3. Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a Facility.
4. Patient death or serious disability directly related to hypoglycemia, the onset of which occurs while patient is being cared for in a Facility.
5. Death or serious disability, including kernicterus, associated with failure to identify and treat hyperbilirubinemia in neonates during the first 28 days of life.
6. Stage 3 or 4 ulcers acquired after admission to a Facility.
7. Patient death or serious disability due to spinal manipulative therapy.
8. Artificial insemination with the wrong donor sperm.
1. Patient death or serious disability associated with an electric shock while being cared for in a Facility.
2. Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances.
3. Patient death or serious disability associated with a burn incurred from any source while being cared for in a Facility.
4. Patient death or serious disability associated with a fall while being cared for in a Facility.
5. Patient death or serious disability associated with the use of or lack of restraints or bedrails while being cared for in a Facility.
1. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed health care provider.
2. Abduction of a patient of any age.
3. Sexual assault on a patient within or on the grounds of a Facility.
4. Death or significant injury of a patient or staff member resulting from a physical assault that occurs within or on the grounds of a Facility.
December 2007