PT Classroom - Risk Management Recommendations for Start Up Clinics ׀ by Art Lubinski, PT, OCS


Art Lubinski, PT, OCS, is a physical therapy graduate of the University of Illinois at Chicago. He has his specialist certification in orthopaedic physical therapy in 2004 (OCS) and his certification as a clinical instructor in 2000. He is the owner and clinic director of Rehab in Motion, Physical Therapy, Ltd. He believes in a patient centered approach to treating his patients and enjoys mentoring physical therapy students.  

Risk Management Recommendations for Start Up Clinics

Just imagine, nearly a year after your clinic opening, one of your patients develops a superficial burn from a hot pack!

There it is, a nickel sized non-blanchable erythema without vesiculation and moderate pain to touch over the left olecranon process. A small cool patch of sweat also manages to develop on your forehead during the rather uncomfortable process of measuring the area of injury, communicating to the patient the events and process of such an injury, and reiterating that the patient communicate her response to treatment during her referring physician’s follow up appointment …. tomorrow morning! Meanwhile, the left hemisphere of your brain is calculating the probability of a lawsuit and the catastrophic financial tidal wave that will capsize your fledgling clinic. The right hemisphere of your brain is, of course, also fast at work imagining the conversation between the patient and physician, conjuring words and tones with exponential creativity.


That being said, this unfortunate situation is not unique to our profession. Analysis of physical therapist professional liability claims from 1993 to 2006 notes that burns rank second (18%) in frequency, only to trauma including fractures (1). The average paid indemnity for a closed claim was $25,155. The most common environment for all claims, regardless of severity or category, was the non-hospital based physical therapy office. Taking into account the implications of such data may lead to the consideration and creation of proactive strategies and responsive tactics that may significantly reduce future and current liabilities. Liabilities that may seem trivial to other start up clinic matters. Consider all potential risk management scenarios broadly through the critical view of an attorney.

Consider the following measures taken that may reduce risk.

Be Proactive:

Equipment Calibration and Maintenance: Implementing regular and at least annual equipment calibration and maintenance may appear redundant and costly compared to daily record keeping. Having a qualified expert, independent of your practice, certify optimal performance/calibration of your equipment eliminates questions of negligence that an attorney may discover.
Staffing: Private practices that grow organically may start as solo-practitioners. Expense control in the beginning stages of development may start out as hiring a front desk coordinator for a part time position. Having at least one other employee on site during patient care time ensures a witness to events or injury and a helping hand in emergent situations.
Program Policy Development: Start up physical therapy clinics need to establish a policy and procedure manual early in order to delineate the standard of care for that clinic as not a formality, but an official record applied uniformly and consistently.

Be Responsive:

Acknowledge the incident: Communicating with the patient as soon as an injury is discovered may not be pleasant, but is the first necessary step to addressing the matter.
Apologize: While this may be a controversial to some physical therapists, stating a general apology that expresses sympathy (and not for outright admissions of guilt) has some anecdotal evidence of reducing the likelihood of litigation (2,3,4,5).
Document the incident: Be specific as needed to the context of the situation. There can be a separate incident form that can be used to record patient response, witness response and event details, etc.
Include other health practitioners: Having another physical therapist or healthcare professional confirm and assess the injury demonstrates not only credibility to your actions as genuine and professional, but may provide additional information to why the injury occurred. Contacting the referring physician for medical consult may also be advised.

Securing professional liability insurance is vital for each clinician and facility. However, liability insurance only considers the endpoint litigation. It does not protect against a potential incident from occurring. Rather, insurance protects against loss once claim has been filed. Our responsibility as practice owners is to prevent such incident outcomes from occurring.

Without the necessary risk management strategies in place, both proactive and responsive, a start up clinic may fail over one mismanaged event, limiting the passionate and comprehensive care we can all deliver!


Last revised: July 6, 2008
by Art Lubinski, PT, OCS


1. CNA/HPSO. An Analysis of Physical Therapist Professional Liability Claims and Risk Management recommendations December 1, 1993 through March 31, 2006. pg 20.
articles/2005 /08/25/when_doctors_say_theyre_sorry/

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