Guest Post: Liability, Malpractice, & Safety Policies In Academic-Based Street Medicine Programs: A Workshop Summary from ISMS 2022

There were many facets of the COVID-19 pandemic that considerably impacted the lives of persons experiencing homelessness. In response, individuals and families composing the homeless population adapted. The same was true for organizations serving the community. Shelters adapted their floor plans to increase “social distancing”; large-venue congregant shelters opened to accommodate the increased numbers of individuals who found themselves without housing; restrictions on outdoor camping were loosened which in turn made homelessness far more visible; cities struggled with new issues of allowing ‘tent cities’ in parks and parking lots regardless if they were officially sanctioned or not; agencies serving the population fiscally re-evaluated increased need for services with decreased funding from donations; everyone worried about the virus and simply surviving through the worst of the pandemic.

In the midst of these challenges, Street Medicine Institute-affiliated programs carried on. New programs were developed and members of existing programs were made essential service providers for the public’s health during the crisis. For many programs in the summer of 2020, new questions regarding volunteer safety and malpractice coverage formed when encampments co-existed with social justice protests in some cities.
At the September 2022 International Street Medicine Symposium in Toronto, our University of Colorado (CU) Street Medicine team presented a problem-solving workshop to discuss and collaborate on these issues of malpractice, liability, and safety for volunteers in primarily academic-based street medicine programs. We began the session by presenting findings from a literature review on the topic: there is very little published specifically on malpractice, liability, and safety of programs. Doohan and Mishori’s (2020) 12-step blueprint described sorting-out and establishing liability and malpractice coverage of the work as an essential step to developing a new program. Brett Feldman (USC Street Medicine) was in attendance and reminded participants that Good Samaritan Laws in most states and provinces typically have not been the basis for street medicine malpractice coverage mostly since the scope or practice often does not meet the definitions for the provision of care.
Participants in the workshop then set out to describe current and best practices from their home programs. This discussion was framed by findings of key informant interviews from sister programs completed by our CU Street Medicine student leaders, as well as visiting a fantastic working document by the SMI Student Coalition (draft available in ‘SMI Member Resources’) summarizing this critical information for new programs. What we heard was there is no single, easy, standardized way for programs to address malpractice and liability as those procedures are localized to the university and community settings of the program.
While that may have been deflating as a take-home point, participants still heard many examples of programs that have successfully navigated this space. For example, most programs first work through their university settings or affiliated health systems to grant coverage via licensed providers. Other programs have created a 501c3 non-profit to obtain insurance and liability coverage through discount insurance carriers independent of the university. Some educational programs clearly link street medicine clinical experiences to coursework with clinical affiliation agreements to assure students and related faculty are covered in that capacity. For US based programs, HRSA’s designation as a free clinic afforded programs an option for coverage. And individuals sometimes sought out individual, out-of-pocket malpractice coverage specific to their licensure. Everyone agreed on the importance of volunteer waivers to assure risk management is acknowledged by volunteers at the onset of their experience and that licensed providers have an understanding of malpractice coverage prior to clinical work.
Before the workshop session concluded, we heard how many programs were revisiting safety procedures after concerning experiences faced by providers recently. Most agreed it is prudent for programs to reassess and review safety procedures every 6 months and perform process evaluation of volunteer knowledge of safety in an ad hoc manner. We heard from one workshop participant who said their program uses a safety “peacekeeper” in charge of de-escalation when in the field. Other programs regularly employ a rule of all team members following the gut instinct of the most concerned member when deciding to cease operations at locations. In summary, situational awareness of all street medicine team members while in the field is paramount.
Our CU Street Medicine team is committed to continue working with SMI leaders, peer organizations, and the SMI Student Coalition to continue collecting and disseminating best practices for safety procedures, malpractice and liability coverage for programs. We will work with SMI to find a home for that information on the SMI website resource pages. We will also continue to be available to programs for this information the same way so many other programs were a helpful resource for us when we began our work in spring 2021.

  • Scott Harpin, University of Colorado Anschutz Medical Campus
  • Katy Boyd-Trull, University of Colorado Anschutz Medical Campus & YHC Clinic
  • Kiera Connelly, University of Colorado Anschutz Medical Campus 
  • Rebecca Henkind, University of Colorado Anschutz Medical Campus 
  • Chloe Finke, YHC Clinic
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