The CBD Dilemma

Perhaps no industry faces risks as complex as healthcare. Like any other sector, healthcare organizations face traditional business risks including property, general liability, employment practices, workers’ compensation and cyber breach exposures, among others.

But all of those risks are amplified by healthcare’s primary purpose: protecting human life. Patient safety is layered on top of every other concern, and any risk management plans must consider how other exposures relate to and potentially impact the ability to provide quality care.

Not only are healthcare’s risks complex – they are also evolving. Add in the constant specter of regulatory upheaval, exposures associated with COVID-19, mergers and acquisitions amid ongoing consolidation, a shifting malpractice litigation environment, and the perpetual challenge of keeping up with the latest scientific and technological advances. It’s enough to make any risk manager’s head spin.

There is one constant, however – the need for education. To protect organizations and their patients, risk managers and insurance buyers must be informed of emerging threats.
That’s why AXA XL Healthcare has launched its own podcast series dedicated specifically to evolving risks in healthcare. We recognized that there has been a dearth of podcast episodes tailored to the concerns of risk managers, and so AXA XL is filling this gap with short podcasts. The podcasts are brief but informative – approximately 20 minutes in duration – designed to capture the attention of busy risk managers and give them what they really need to hear: how healthcare trends are evolving, and what best practices they should adopt.

The podcast series features conversations with subject matter experts specializing in different areas of risk, ranging from cyber risk to malpractice litigation and the management of insurer relationships.

In the episodes, Carla George, Senior Claims Specialist at AXA XL in Bermuda, and I have had insightful conversations with a diverse group of experts including client account managers, lawyers, claims professionals, and security pros. In case you missed them, here are some of our recent engaging topics:

1. Cyber risk in healthcare
When cyber attacks first appeared on the risk radar, hackers were focused on data theft, and targeted businesses were concerned about privacy more than anything else. Health Insurance Portability Accountability Act violations remain a top worry for healthcare companies, but in today’s world of connected technology, a breach can now have a direct impact on patient safety. A network interruption could disrupt any number of machines that provide vital information to physicians or administer life-saving care to patients.

Among the key takeaways from this conversation: never assume your systems are secure and continually test and strengthen your defenses; and get the C-suite involved in cyber security to drive an enterprise-wide risk management approach.

This episode’s expert also discusses the rising prevalence of ransomware and the role of a breach coach lawyer in navigating a response.

2. Impact of cannabis legislation on healthcare
Because cannabis remains a Schedule I controlled substance at the Federal level, healthcare providers may hesitate to recommend medical marijuana or sign state certifications for eligible patients, despite a growing body of evidence pointing to this plant’s therapeutic effects – when used safely, of course.

This episode sheds light on how physicians can advise patients about medical marijuana without crossing legal boundaries or exposing themselves to medical malpractice claims. In fact, doctors’ risk is only likely to decrease over time as more states legalize cannabis and more research solidifies its safety profile.

Healthcare providers should be on the lookout for more data behind the cost effectiveness of medical marijuana as alternative or complementary treatment for multiple health conditions, which could spur more U.S. states and health systems to endorse this oft-misunderstood drug.

3. Diversity, cultural competency and improved outcomes
Embedding diversity, inclusion and cultural competency into the delivery of care requires a top-down organizational commitment to health equity. In this episode, you’ll hear how a large East Coast health system created a workforce that looks more like – and better understands -- the communities they serve.

Tracking the impact of the initiatives over several years, it became clear that a diverse and culturally competent staff of providers produces better outcomes – which in this case involved reduced readmission rates, increased breastfeeding among new moms, and improved patient satisfaction scores, to name a few.

Key strategies include recruiting and hiring candidates from underrepresented backgrounds, providing web-based cultural competency training to existing providers, and partnering with local, minority-owned vendors.

Other episodes in the podcast series include:

• The Value of The Insurer and Insured Relationship
• Evacuating in The Face of Natural Disaster
• Legal Pitfalls in Clinical Documentation
• Crisis Standard of Care
• Early Disclosure
• Care Considerations for Behavioral Health Adolescents in the ED

Coming Soon
There’s no shortage of topics for discussions of risk in healthcare. Stay tuned for future episodes including on the importance of diversity and inclusion, the opioids crisis, and attorney insights on the undulating litigation landscape in the U.S.

The AXA XL Healthcare Risk Insights podcast can be accessed via axaxl.com/webinars-and-podcasts and most platforms, including the Apple Podcast App and the Spotify App, or by clicking here.

About the Author
Shellé Hendrickson is Head of Healthcare in AXA XL’s Bermuda Insurance Operations. She can be reached via shelle.hendrickson@axaxl.com

While it is still too soon to understand the full impact of COVID-19 on the primary and excess casualty insurance markets, we believe there are some key trends that will reemerge as the economy begins to reopen. In this podcast, Chris Kopser, President of Global Risk Management in North America and Donnacha Smyth, President of Global Excess Casualty discuss the changes in the loss landscape- including social inflation, nuclear verdicts and emerging risks- that continue to impact the casualty insurance market. They address the impact of rising rates on brokers and clients and provide insights for risk managers to help navigate the transitioning market. Tune in below to learn more.

Please note, this sponsored AXA XL podcast was produced in partnership with RIMS.

E-cigarettes have been on our watchlist of emerging risks for the past several years. A recent outbreak of severe pulmonary disease in the U.S., coupled with reports of deaths suspected to be linked to vaping, have given the issue an even greater focus from regulators and policymakers.

In March this year, the EU Scientific Committee on Health, Environmental & Emerging Risks announced it would assess the risks associated with chemicals in e-cigarettes.

Our Q1 2019 Emerging Risks Update underscored the importance of this issue.  E-cigarettes could, we believe, pose product liability concerns - because of potential unknown health risks associated with their use as well as possible injuries from battery fires, among other things.

Big news

This issue has been grabbing headlines in recent weeks after a spate of reports of illness, injury and even deaths that have been linked to use of e-cigarettes.

The U.S. Centers for Disease Control and Prevention (CDC) confirmed in September that it is investigating possible vaping links to multiple cases of lung injury and several deaths.

According to the CDC, at the time of publishing, there have been more than 1300 reported lung injury cases and  26 deaths across the U.S. that may have links to vaping.

The CDC says it is working with the U.S. Food and Drug Administration (FDA), state and local health departments and other bodies, to investigate this multistate outbreak of severe pulmonary disease.

The CDC said the investigation was ongoing and that it had not yet identified a cause, but that all the reported cases have a history of using e-cigarette products. It advised anyone experiencing symptoms reported by victims of the outbreak to seek medical care promptly. Those symptoms include a cough, shortness of breath, chest pain, nausea, vomiting, diarrhoea, fatigue, fever and weight loss.

According to the CDC, more than three-quarters of the cases under investigation may be linked to the use of tetrahydrocannabinol (THC), a psychoactive constituent of cannabis, that can be inhaled via e-cigarette devices.

Youth use and future liability?

An uptick in the use of e-cigarettes among young people is an issue that we are monitoring closely to assess the future liability landscape.

In April, the FDA announced it was investigating reports that some users of e-cigarettes, especially youths and young adults, had experienced seizures after use.

The “epidemic of youth e-cigarette use” has been cited by Surgeon General of the United States Public Health VADM Jerome Adams as an issue of “great concern.”

In 2018, according to the CDC, one in five high-school students and one in 20 middle-school students in the U.S. used e-cigarettes. 

In the UK too, there are concerns that the use of e-cigarettes among young people might lead to future health problems; anecdotal evidence suggests that UK adolescents who use e-cigarettes are six times more likely than their peers to start smoking traditional cigarettes.

Flavours

Many e-cigarettes are flavoured – part of what makes them appealing to young users, experts say. A study by scientists at Harvard found that the chemical diacetyl, which is known to be associated with the lung disease Bronchiolitis Obliterans, was found as an undeclared ingredient in more than 75% of e-cigarettes they tested. A lack of knowledge about the effects on human health of inhaling certain chemicals within e-Liquids has been raised by experts as a cause for concern.

A separate Harvard study found that two of the most widely used flavourings may impair the function of cilia – protuberances on the respiratory tract that help keep airways clear of mucus and dirt.

The scientific jury is still out about potential links between e-cigarettes and lung disease and injury. But in addition to health concerns, there are potential liability issues about the integrity of e-cigarette devices themselves – is there a chance that they could overheat and explode, for example? Is there a potential for third-party injuries? 

Regulator focus

Regulators across the world have been paying close attention to the sale of e-cigarettes. At the time of writing, some countries, including Japan and Brazil, have banned the sale of e-cigarettes, and others may follow.

In recent months, several U.S. states have banned the sale of flavoured e-cigarettes, while the city of San Francisco has banned the sale of e-cigarettes altogether.   And last month, U.S. President Donald Trump announced that his administration would ban the sale of flavoured e-cigarettes.

In the UK, the Tobacco Products Directive came into force in 2016, introducing minimum standards for the safety and quality of all e-cigarettes and refill containers. The directive requires that a certain standard of information be provided to consumers so they can make informed choices. The rules also are intended to promote an environment that prevents children from starting to use the products.

The regulations introduced restrictions on the size of e-cigarette tanks, the maximum volume of nicotine-containing e-liquid for sale in one refill container, the nicotine strength of e-liquids, and a ban on certain ingredients, among other things.

The regulations also introduced new labelling requirements and warnings about potential health side effects.

What next?

Insurers, brokers, regulators and public health bodies will continue to monitor this topic closely.

A direct link between using e-cigarettes and lung injury and disease may not yet have been conclusively made. But the liability landscape never remains constant. We will keep a close eye on these emerging risks and work with our brokers and clients to better understand, manage and mitigate them.