New AAP guidance aims to protect clinicians by reducing risk of liability during a
Robin L.Altman, M.D., FAAP
AAP Technical Report
Pediatricians and the Law
A pediatrician manages to get to her office during a blizzard and resulting widespread
energy blackout. She has no way to access patients’ electronic medical records, no
place to keep vaccines refrigerated and no way to obtain up-to-date information on
conditions or other facilities in the community. Incredibly, parents start arriving
with their children for morning walk-in hours. One of the parents is experiencing
A mass shooting has occurred at a local establishment, and hospital emergency departments
have been receiving ambulances. They have run out of beds, have started to call in
staff from home and have instructed all in-house physicians and surgeons to come to
the ED to assist. Unaccompanied children are being treated in the hallway.
A category 4 hurricane has ripped through a community, leaving a children’s hospital
without power. Pediatric patients on ventilators must be evacuated to other facilities
with power, but their parents cannot be reached.
There were 59 major disaster declarations and 16 emergency declarations in the U.S.
in 2017, according to the Federal Emergency Management Agency. There also were over
300 mass shootings and over 110 other man-made disasters such as fires and industrial
The Academy has been at the forefront of providing education, resources and advocacy
on the importance of disaster preparedness. A new policy statement and technical report
from the AAP Committee on Medical Liability and Risk Management emphasize that preparedness
also is applicable to addressing the professional liability risks that can occur when
caring for patients and families during a disaster.
Although most health care providers will go through their careers without experiencing
a major disaster, such events can be life- and career-altering. Smaller-scale disasters
related to extreme weather can cause less monumental but impactful disruptions in
health care delivery operations.
As the examples above demonstrate, pediatric health care providers may need to address
medical conditions outside their scope of training and experience during disasters.
They may not have access to patient history or data such as laboratory values or physiologic
monitoring; may not be able to get input or consent from parents or guardians; and
may not know how long dire conditions will last. In addition, they may experience
physical exhaustion and have concerns for the safety of their own family members and
the potential loss of professional property and supplies.
It is important to note that malpractice claims after disasters are infrequent. However,
there is evidence that health care providers most at risk of being sued are those
who live and work in disaster-affected areas and report to work instead of evacuating.
Federal and state laws can reduce civil liability for certain health care providers
during disasters, but these protections are not uniformly applied to all categories
of providers. Specifically, non-volunteer and nongovernment-employed health care providers
who work in their usual capacity during a disaster may not be covered by any laws
and may not be protected by their malpractice insurance for claims alleging negligence.
The policy statement includes advocacy recommendations to improve liability protections.
Increase awareness, reduce risks
The technical report explores multiple types of potential liability claims during
a disaster. The goal is to raise awareness, improve preparedness and reduce potential
deficiencies in professional liability protections for health care providers trying
to do their best to care for patients during these infrequent yet debilitating events.
In addition to seeking out education and online resources on disaster preparedness,
pediatricians can take the following steps to address liability risk:
Become familiar with the AAP Division of State Government Affairs (http://bit.ly/1DAP5Ur) as a resource for state laws that may apply to provision of health care during a
state of emergency declaration, such as out-of-state license reciprocity.
Understand potential limitations to one’s professional malpractice insurance coverage.
Add coverage for gaps, such as for claims alleging negligence for the provision of
health care when resources are stressed beyond capacity or not available.
If volunteering in response to a disaster, do so only through an established response
system that assures proper licensing, credentialing, training, mobilization and potential
immunity from some forms of alleged negligence.
Dr. Altman, a lead author of the policy and technical report, is a member of the AAP
Committee on Medical Liability and Risk Management.