Medical Malpractice
Vithal Vernenkar, D.O St. Barnabas Hospital Department of Surgery
Goals
To understand medical error and appreciate the causes of malpractice claims To learn ways to reduce medical error and avoid claims To view Risk Management as a resource when questions involving medical error arise
MEDICAL ERROR
A “preventable adverse medical event” “adverse event”
“an
injury that was caused by or is associated with medical management and that results in death or measurable disability”
ELEMENTS OF A MALPRACTICE CLAIM
Physician owes duty to patient Deviation from “standard of care” Patient must sustain injury Physician’s actions are proximate cause of injury
WHY PATIENTS SUE
Dissatisfied with quality or cost of care Feel they’ve been wrong Sustain injury or imperfect result Perceived MDs as rude, unsympathetic Culture of a litigious society
PHYSICIAN-PATIENT RELATIONSHIP
Cornerstone of good medical practice and risk management Often more crucial than outcome Negative perceptions based on health care providers’ attitudes Establish good rapport, concern, and trust Establish open communication and effective listening skills Be aware of limitations
MEDICAL RECORD
Records clinical information Provides means to communicate among providers Documents medical necessity of treatment Supports billing and reimbursement Helps evaluate cost-effectiveness of care Serves as a legal document
GOOD RECORD-KEEPING
Use common sense Make them complete, timely, and accurate Write legibly, use correct grammar & spelling Use ink Abbreviate correctly Include date, time, and signature
GOOD RECORD-KEEPING PRACTICES (cont’d)
Document factually and contemporaneously Write entries chronologically Make entries continuous Be specific Be consistent Be thorough Be clear No underlining or starring
DOUMENTING/CHANGING THE RECORD
DO
Know
the facility procedure for making corrections Standard approach:
Draw
single thin pen line through entry Record change in chronological order Date and initial change Note reason entry is being replaced Have notation witnessed if possible
DOCUMENTING/CHANGING THE RECORD (cont’d)
DON’T
Delete
material or destroy record Use correction take or fluid Make self-serving statements Be flip, cavalier, sarcastic or inappropriate Use the record to “vent” even to defend yourself
DISCLOSURE OF MEDICAL ERROR
Preserves patient trust Requires balancing of multiple concerns Respects patient's right to selfdetermination May cause harm Difficult area
REPORT TO RISK MANAGEMENT
REPORT:
Any
Any Any Any Any
significant complaint or complication attorney inquiry threat of legal action subpoena doubt whether or not to report
BENEFITS OF REPORTING
R/M can assist you with
What
to disclose How to make a disclosure What and how to appropriately document record Billing adjustment, when appropriate Flagging and securing medical record
OTHER INTERNAL MECHANISMS
Patient advocate/patient relations dept. Social work Hospital ethics/infant care committees Psych consult re capacity