Potential Danger in "Safe Harbors"

By Dr. Brenda Oiyemhonlan

The last Health Policy Mini-Fellowship meeting discussed “safe harbors”, which can be defined as a set of clinical guidelines that define negligence and appropriate care in the ED. While safe harbors can protect ER docs from medical liability, they have the unintended consequence of attempting to de-regionalize (yes I think I just made that up) emergency medicine practice as they fail to recognize our local environment and resources available to our patient population (eg. admission for anticoagulation for DVT vs. starting pt on anticoagulation in the ED and ensuring follow-up with PMD/anticoagulation clinic in the am.

While I understand the crux of the proposed idea, I fear that the nuances of clinical practice and really being able to tailor a specific management strategy to the individual needs of a given patient may be jeopardized by instituting this type of regulation. We have existing clinical guidelines via the college, which are useful and provide the basis for how to approach a case and actually do allow for good old-fashioned bedside doctoring.

However, proponents of the safe harbor legislation argue that they add protection from medical malpractice liability in addition to decreasing wasteful spending on defensive medicine, encouraging adherence to quality measures, and serving as a bipartisan compromise in the battle over tort reform. No state currently has operational safe harbors, and some hurdles to overcome instituting them include: the time and expense of producing guidelines; the inability to keep guidelines up to date with rapidly changing medical innovations; physician resistance to cook-book medicine, lack of uniform access to healthcare resources (i.e. availability of consulting services in rural areas), and the difficulty with indicating which care should and should not be rendered in an ED setting.

I’m not so certain that safe harbors can achieve all of its lofty goals or contribute much, in the near term, to address the issues of growing medical expenditures. Safe harbors may be better used to supplement general reforms that target more than just medical liability but also health insurance reform, patient safety and quality, as well as the soaring costs of pharmaceutical research and product development.

Please see the article reviewed here