Medical Incident at Clinic: Business Defense Algorithm

Alla Tsymanovska, Attorney

Source: Yurydychna Gazeta

In the healthcare business, a clinic’s initial response to an incident dictates not only the quality of communication with the patient but also the subsequent legal trajectory of the case. Complications, conflicts, sudden deterioration, or the death of a patient always generate immense tension within the facility. At this crucial moment, the most important thing is to eliminate emotions, avoid making hasty explanations, and resist attempting to resolve the situation “informally.”

The first 72 hours following an incident do not constitute a procedural time limit established by law. Rather, they represent a managerial “window of risk,” during which a medical institution must transition from a chaotic reaction to a controlled algorithm. Within this timeframe, it is essential to conduct an internal analysis, preserve evidence, and establish a unified communication strategy.

The medical dispute resolution practice at Ilyashev & Partners Law Firm proves that the very first actions taken by management determine whether a conflict remains within the scope of pre-litigation dialogue or rapidly escalates into complaints to the Ministry of Health (MOH), the National Health Service of Ukraine (NHSU), attorney requests, criminal proceedings, and a media-fueled reputation crisis.

What Constitutes a Medical Incident: A Legal Perspective

For risk management purposes, a medical incident should not be limited merely to obvious medical malpractice or severe complications. For a clinic, an incident must be defined as any event that could potentially become the basis for a patient claim, regulatory audit, expert peer review, lawsuit, or criminal prosecution.

This category includes:

• sudden deterioration of a patient’s condition or hospitalization following an outpatient procedure;
• post-operative complications or infectious processes;
• dissatisfaction with the outcome of an aesthetic or plastic surgery procedure;
• disputes surrounding informed consent or the refusal to release medical records;
• aggressive communication with relatives or initial public accusations on social media.

For businesses, it is critical not to wait until a patient files an official complaint. If an event already appears conflictual, it must be treated as a potential legal case and addressed according to the internal algorithm.

The First Mistake of a Clinic: Treating an Incident as a Single Physician’s Problem

In many clinics, the initial reaction to a complex case looks identical: the physician attempts to explain the situation to the patient on their own, the administrator tries to “defuse” emotions, the management learns about the problem too late, and a legal counsel is brought in only after an attorney’s request or a police report is received. This model is highly dangerous.

A medical incident is almost never solely a physician’s problem. It simultaneously involves medical records, communications, personal data, the patient agreement, financial documents, internal protocols, the institution’s reputation, and potential liability. Therefore, the response must be collaborative rather than individual.

The medical director, the head of the institution, the quality assurance officer, the in-house lawyer or attorney, and, if necessary, an IT specialist, the communications manager, and the person responsible for interaction with the NHSU or the insurer must be involved in the initial assessment of the incident.

Legal Consequences for Medical Business Resulting from a Medical Incident

The legal consequences for a medical business usually develop concurrently across several areas:

• Civil liability: claims by the patient or their relatives for compensation of material damages (medical treatment expenses) and moral damages (pain and suffering).
• Criminal risks: reports filed with law enforcement agencies under Article 139 (Failure to Provide Assistance to a Patient by a Medical Professional) or Article 140 (Improper Performance of Professional Duties) of the Criminal Code of Ukraine.
• Regulatory threats: unscheduled audits by the MOH for compliance with Licensing Conditions, clinical expert assessment of the quality of medical care (clinical expert commission – CEC), and sanctions by the NHSU or insurance companies.

The Fundamentals of Legislation of Ukraine on Healthcare clearly safeguard the patient’s rights to information, medical confidentiality, and informed consent. Order of the MOH No. 110 strictly regulates the maintenance of primary medical records. Any discrepancy in the paperwork is automatically interpreted in favor of the patient. Thus, the main task during the first hours is to assist the patient, prevent the loss of evidence, and avoid chaotic comments from the staff.

Step-by-Step Guide: Algorithm of Actions for a Medical Institution in the First 72 Hours Post-Incident

This action model has been developed by Ilyashev & Partners Law Firm to protect healthcare businesses and assist executives during acute crises. A medical institution can adapt this framework to its own profile, structure, and risk levels.

0–6 Hours: Patient Safety and Initial Fact-Finding

The first priority is the patient’s medical safety. The clinic must ensure an examination, necessary medical assistance, consultation with an allied specialist, hospitalization, or referral to another facility if the patient’s condition so requires. At this stage, it is dangerous to substitute medical actions with legal explanations.

Concurrently, management records the facts:

• When exactly did the complication or conflict arise?
• Which staff members were present?
• What complaints did the patient voice, and what vital signs were recorded by the equipment?
• What recommendations were provided to the patient (and did they sign them)?

In my experience, the most problematic issue in many disputes is not the complication itself, but the lack of a clear timeline. When, months or years later, it becomes impossible to establish who reacted to the patient’s complaints and when, the institution’s position is significantly weakened.

6–24 Hours: Evidence Gathering and Preservation

At this stage, it is necessary to look at the situation through the eyes of a future forensic medical expert or investigator. It is crucial to verify whether there are discrepancies between paper medical charts, entries in the eHealth system (electronic health record system), financial invoices, acceptance acts, and medical prescriptions.

Ilyashev & Partners Law Firm recommends immediately securing and preserving the following for internal analysis:

• the medical chart, operating room logs, anesthesia charts, and prescription sheets;
• printouts and logs from medical equipment, and laboratory test results;
• CCTV footage and audio recordings of call center conversations;
• screenshots of communication with the patient in messengers and telemedicine systems;
• data from electronic systems regarding the exact time of creation or modification of medical entries.

It is vital to prevent any uncontrolled “correction” of records. If an entry requires clarification, it must be transparent, dated, justified, and made in a manner that does not create the impression of retroactive editing. An attempt to quickly “clean up” the history after a conflict usually poses a greater risk than the initial flaw in the record itself.

24–48 Hours: Stabilization of Communication and Confidentiality Protection

The third stage is communication. This is where clinics frequently make mistakes: they ignore the patient, provide formalistic answers, offer contradictory explanations, shift the blame to the patient, promise outcomes without an internal analysis, or, conversely, immediately admit liability without verifying the facts.

Proper communication does not equate to admitting guilt. It means that the patient is not left without an answer, understands the subsequent steps, has the opportunity to obtain the necessary documents, and sees that the institution is not hiding from the problem. In many cases, it is humane yet legally cautious communication that reduces the risk of the conflict escalating to the police or the media.

Separately, it is essential to verify exactly who the clinic is communicating with. A relative of a patient does not automatically have the right to receive medical information. The legal basis for this must be the patient’s consent, legal representative status, a power of attorney, procedural status, or another ground provided by law. If this is not verified, a medical incident may also escalate into a dispute over the disclosure of medical secrets or personal data breach.

48–72 Hours: Formulating the Legal Strategy

At the fourth stage, the clinic must transition from gathering facts to strategy. It is necessary to determine whether there are grounds for a pre-litigation settlement, whether an independent expert should be involved, whether the insurer should be notified, whether to prepare a response to a written complaint, whether to expect an attorney’s request, whether there is a risk of criminal proceedings, and whether a dedicated communication position is required for the public space.

If the situation involves severe consequences, the death of a patient, or a likely report to law enforcement, the clinic must be prepared for procedural actions: temporary access to documents, interviews of staff, seizure of records, investigator requests, or the ordering of a forensic medical examination. In such cases, a chaotic internal position of the staff can be no less dangerous than defects in the documentation.

The manager’s task is not to “close” the situation at any cost, but to correctly identify the scenario. Sometimes, the best strategy is negotiations and a compensatory solution. Sometimes, it is a calm, evidence-based position without unjustified concessions. Sometimes, it is readiness for criminal proceedings and defense of the staff.

What a Clinic Must NOT Do After an Incident

The greatest risks are often created not by the medical events themselves, but by the managerial response to them. In the first 72 hours, a clinic should avoid the following:

• ignoring the patient or responding only with formal clichés;
• allowing different employees to give non-synchronized explanations to the patient;
• discussing medical information with relatives without verifying the legal basis;
• deleting correspondence, photos, videos, call recordings, or internal messages;
• making backdated entries or creating the impression of retroactive “editing”;
• forbidding staff from recording the circumstances of the event if needed for internal analysis;
• immediately admitting guilt without reviewing documents and medical circumstances;
• shifting responsibility onto the patient in an emotional manner;
• refusing to issue medical documents without a legal assessment of the grounds;
• waiting for an official complaint instead of conducting their own initial analysis.

Attorney’s Requests or Police Visits: How Not to Worsen the Situation with the First Response

Often, the first signal of a legal attack is not a lawsuit, but an attorney’s request from the patient’s representative or a written demand from an investigator. Upon receiving an attorney’s request, the management is obliged to verify the attorney’s authority: the warrant (orden), the agreement, and most importantly, the written consent of the patient to disclose medical secrets to this specific lawyer. If such consent is missing, releasing the medical chart is illegal. If the request is lawful, the response must be provided within the established 5-day period, and it must be dry, factual, and free of unnecessary subjective assessments.

In the event that criminal proceedings are initiated (records entered into the Unified Register of Pre-Trial Investigations), the preparation of staff for the first interrogations must be based on the timeline and evidence collected by the clinic in the first 72 hours. Chaotic, uncoordinated testimonies of physicians during the initial stages of the investigation are the main reason for losing medical cases in court.

Why a Risk Response System Matters for a Medical Business Owner

For a clinic owner or executive, a medical incident is not just a matter of quality of treatment. It is a matter of business valuation, brand trust, team stability, relations with the state, insurers, patients, and partners.

If a clinic lacks a response algorithm, every complex case triggers crisis management on the fly: one doctor messages the patient in a messenger, another is unaware of the complaints, an administrator makes promises, the medical chart is filled out late, the manager receives fragmented information, and the lawyer sees the situation only when the institution’s position is already weak.

Conversely, a clinic that has an internal incident response procedure acts predictably. It quickly gathers facts, preserves evidence, controls communication, respects medical confidentiality, avoids chaotic entries, and can select the correct scenario: medical explanation, pre-litigation settlement, response to a complaint, preparation for an audit, or defense in criminal proceedings.

Practical Checklist for a Clinic’s Incident Response

The practical purpose of the first 72 hours is to ensure that the clinic has a clear internal algorithm rather than a set of random reactions. This algorithm should cover the medical, legal, communication, and organizational aspects of the response, namely:

• Appoint a coordinator responsible for actions following a medical incident.
• Ensure the patient’s medical safety and proper recording of their condition.
• Collect primary medical documentation and prevent its uncontrolled modification.
• Preserve correspondence, photos, videos, call recordings, CRM data, eHealth entries, and internal systems data.
• Obtain staff explanations as close to the time of the event as possible.
• Review informed consent, agreements, prescriptions, invoices, and acceptance acts.
• Determine who communicates with the patient or relatives and how.
• Verify the legal basis for transferring medical information to third parties.
• Conduct an initial medical-legal risk assessment.
• Define the strategy: settlement, response to a complaint, audit preparation, involvement of an insurer, expert, or attorney support.

The practice of medical dispute support at Ilyashev & Partners Law Firm shows that early managerial decisions often dictate the subsequent course of the case. The exact same incident can remain within the limits of a pre-litigation settlement if the clinic acts calmly, consistently, and professionally, or rapidly turn into a crisis if documents are not gathered, communication is chaotic, and staff members provide conflicting explanations.