The Doctors Company Risk Management Department warns physicians "particularly plastic surgeons, dermatologists, ophthalmologists, and otolaryngologists" against participating in any practice involving the offer of professional services for auction or the sale of medical procedures within any bidding system.
It has come to the attention of The Doctors Company Risk Management that medical procedures "often elective aesthetic surgical operations” are being offered at auction or as part of a bidding system. Often involving the Internet, these medical business transactions have appeared in two forms. In one form, a surgeon offers a procedure as an item for auction and sells it to the highest bidder; in another form, the patient seeks the procedure, and the surgeon bids to perform the procedure at the lowest price and gets the job, patient unseen.
It is precisely this lack of patient selection that poses the problem with these transactions. When a doctor agrees to provide services under these circumstances, he or she is obligated to perform a procedure without the benefit of having seen and evaluated the patient.
It must be understood that a physician who participates in such a business transaction has essentially entered into a legal contract to perform the procedure without completing the necessary step of prior patient evaluation. If the patient subsequently turns out to be unsuitable for that procedure for any of a variety of reasons, and the physician then reneges, he or she may be liable for breach of contract, which is not covered by standard professional liability insurance policies.
Should a doctor obtain a less than satisfactory outcome resulting in a malpractice claim, his or her malpractice insurer may be unwilling to cover the claim because the doctor committed to perform an elective procedure without proper preoperative patient evaluation. In such a situation, a plastic surgeon is in violation of the American Society of Plastic Surgeons (ASPS) code of ethics. Similar codes exist for all specialties.
Please be advised that The Doctors Company warns all its member-physicians of the impropriety of such methods of making medical business transactions. Should these practices persist, The Doctors Company will need to attach an endorsement to our standard physician and surgeon policies that specifically denies coverage from claims arising from these practices.
The guidelines suggested in this article are not rules, and they do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
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