Indemnification clauses such as the one that Dignity Health proposed are especially dangerous for emergency physicians. “There are indemnification clauses, and there are indemnification clauses,” said Dr. Sokolove. “Depending on the way the clause is written, it can be so broad that suddenly an emergency physician group can be responsible for things that, frankly, may be completely out of their control. It is critical that qualified legal counsel with experience in this area provide guidance regarding these clauses.”

Such indemnification clauses expose emergency physicians to an unacceptably high level of uninsured risk, according to ACEP Immediate Past President Dr. Sandra Schneider. “The indemnification clause, which is not typically included in physician contracts across the country, is grossly unfair to physicians and contributes to an increase in the cost of care by encouraging physicians to limit risk through the practice of defensive medicine,” she said in a letter to Dignity Health. Dr. Schneider encouraged Dignity Health to remove the indemnification clause, as well as eliminate the increased minimum liability coverage limits, from its physician contract in a September 2011 letter on behalf of ACEP to Lloyd H. Dean, Dignity Health’s president and CEO.

Dr. Schneider immediately sent the letter on behalf of ACEP upon being alerted of the situation by California ACEP. ACEP has also been in contact with the Arizona and Nevada chapters (where Dignity Health also has locations) and the American Medical Association to discuss this issue.

ACEP’s Medical-Legal Committee is developing a policy statement on appropriate levels of liability insurance coverage and resources regarding indemnification clauses and potential alternative insurance arrangements that groups can explore to meet stricter hospital requirements for liability coverage.