Malpractice Risk On Reservations.

Physicians who are not employed by the Indian Health Service but provide care to Native Americans may be putting themselves at risk for malpractice suits, according to an Albuquerque ob.gyn.

Dr. Michael G. Flax, New Mexico section chair for the American College of Obstetricians and Gynecologists, has received a grant from the organization to confront what he says is a growing problem in his state: "Nonservice" physicians--those who are not full-time, salaried employees of the Indian Health Service (IHS)--who provide care to IHS beneficiaries either by contractual arrangement or on a volunteer basis are being sued under tribal law for medical malpractice.

Nonservice physicians fill manpower gaps in the IHS, especially in specialty areas such as ob.gyn., and increase the quality and quantity of care, Dr. Flax said. "When somebody provides care without compensation, one does not expect to be hit on the blind side by a legal system that doesn't protect you.

Being sued under tribal law carries a number of complications, not the least of which is that, unlike many state laws, tribal law does not put a cap on damages that can be recovered from a malpractice suit. This leaves physicians personally liable for any judgment that exceeds what their insurance covers.

Physicians put, themselves at risk for such suits if they travel to Native American reservations to provide patient care. They also put themselves at risk if they provide care over the telephone, e-mail, or fax--these telecommunications essentially put the physician "on reservation."

Dr. Flax intends to use the grant money to develop a series of lectures and educational videos to inform physicians of the possible medicolegal risks involved in their working on reservations. One of the more prominent cases, and the one that precipitated Dr. Flax's efforts, involved an ob.gyn. who was sued under tribal ...