Lessons Learned

Susan Schmerler is a genetic counselor and supervisor in the Section of Genetics at the Children’s Hospital of St. Joseph's Regional Medical Center, Paterson, New Jersey. Her academic post is as Associate in Pediatrics at the University of Medicine and Dentistry-New Jersey Medical School. She is on the Board of Directors of the National Society of Genetic Counselors, where she serves as Chair of the Education Committee. From 1999 through 2003, she was the Chair of the Credentials Committee of the American board of Genetic Counseling.

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 .-