Legal Nurse Consulting –
Issues, Ideas, Information
Posted by Kathleen on December 22nd, 2012
Research shows that a surgeon who has been working for 24 hours is impaired as much as a drunk person in thinking and motor function. So should patients have a right to know if their doctor has been up all night? Yes, say a group of sleep researchers, who argued for full disclosure of sleep deprivation in a recent article in the prestigious New England Journal of Medicine. No, responded the American College of Surgeons, whose leaders say it should be up to the individual surgeon to decide if he or she is too tired to operate — or if the surgeon needs to tell the patient before heading to the OR.
The debate shows that surgeons and hospital administrators are just beginning to consider some basic issues of fatigue and patient safety that in other contexts — piloting airliners and driving large trucks on interstate highways — have long been settled. Surgeons understandably don’t want to be subject to the welter of bureaucratic rules that truck drivers and pilots deal with. And patients might not like it either if a surgeon was required to announce that he would be starting their surgery but another doctor would come into finish it because the time would stretch beyond the first doctor’s hour limit.
But some sensible limits could easily be put in place. For one, the opportunity for a surgeon to work inhuman hours is created by hospitals who let a surgeon sign up for overnight call, which often results in working all night in the OR, and let the same surgeon schedule elective non-urgent cases for the next day.
Why would a surgeon do this in the first place? The lure of money, as a number of commenters on the New England Journal of Medicine website candidly admitted. Which raises a problem with the American College of Surgeons’ idea that surgeons should be left to their good judgment on when and when not to operate. Anyone who schedules back-to-back call nights with elective cases is not showing good judgment in the first place.
Another issue for patient safety is the surgeon who is well rested but inexperienced, for not having gone through sleepless nights filled with surgical cases. Residency training programs are now starting to limit young surgeons to 16-hour days, which many surgeons say is going to result in a generation of rested but green doctors.
The right of informed consent gives at least one answer to the conundrum. Every patient has a right to know what any reasonable patient would want to know going into a surgery. And since we would all pause before submitting to the knife with a surgeon smelling of alcohol, the same right should apply to the less obvious danger of the sleep-deprived surgeon. If a doctor wouldn’t want a family member to undergo surgery with that glassy-eyed doctor, then the same right should apply to all patients.
This means patients should be told, and should be given the option of rescheduling or bringing in a fresh replacement to operate. This will be inconvenient for hospital schedulers and may cause some surgeons to lose income. But patients will ultimately be safer for it. And if hospitals want to minimize patients getting upset for having their plans upended at the last minute, all they have to do is adjust their call schedules to make these up-all-night dilemmas a rare event.
Kathleen A. Mary, RN, Certified Legal Nurse Consultant is a medical expert proven to be invaluable in helping attorneys navigate through meritorious complexities of any medical negligence claim. Please contact her for your next medical-legal case.
Tags: American College of Surgeons, attorney, doctor, hospital, informed consent, legal nurse consultant, medical expert, medical malpractice, medical negligence, medical-legal, meritorous, New England Journal of Medicine, patient, patient safety., surgeon, surgery
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Posted by Kathleen on November 30th, 2012
Compartment syndrome is a medical emergency that develops over hours in which increased pressure within a closed muscle compartment compromises the circulation and function of tissues, muscles, nerves and blood vessels within that space with escalating compression. The most common cause of compartment syndrome is trauma, usually after a fracture or crush injury. It occurs most commonly in an osseofascial compartment of the leg or forearm, but it may occur in the upper arm, thigh, foot, buttock, hand, and abdomen. It is seen more commonly in patients <35 years of age and in males. Compartment syndrome also occurs in the context of reperfusion, ischemia, burns, tight casts, swelling from soft tissue injury, and poor positioning for prolonged surgical procedures (particularly lithotomy position) and in drug-affected individuals.
Acute compartment syndrome is a challenging diagnosis which requires a high clinical index of suspicion. Compartment syndrome requires prompt recognition and urgent management in order to avoid disastrous complications. Physicians and nurses are mandated to recognize the symptoms of compartment syndrome, identify patients at risk for its development, and provide emergent standard of care. The assessment of pulses, sensation, and limb movement will detect early signs of compartment syndrome. Delays in treatment can result in significant disability including neurological deficit, muscle necrosis, amputation, and death.
Pain is thought to be a cardinal feature of compartment syndrome and it has been claimed that analgesia may delay its diagnosis resulting in a poor patient outcome. Literature however does not support convincing evidence that patient-controlled analgesia (PCA) opioids or regional analgesia delay the diagnosis of compartment syndrome provided patients are adequately monitored. Regardless of the mode of analgesia used, a high index of suspicion, ongoing assessment of patients, and compartment pressure measurement are essential for early diagnosis.
Management of compartment syndrome in the modern era involves not only avoiding the sequelae of a missed diagnosis but also minimizing the risk of a medical negligence claim. While medical malpractice claims involving compartment syndrome are uncommon, they have resulted in a high rate and amount of indemnity payments. Early fasciotomy not only improves patient outcome but is also associated with decreased indemnity risk. Factors associated with a successful medical malpractice defense:
♦ Evidence of poor physician-nurse-patient communication
♦ Duration of time from onset of symptoms to the fasciotomy – [linearly associated with an increased indemnity payment]
♦ Fasciotomy performed within 8 hours after first presentation of symptoms [uniformly associated with a successful defense]
Kathleen A. Mary, RN, Certified Legal Nurse Consultant is a medical expert proven to be invaluable in helping attorneys navigate through meritorious complexities of any medical negligence claim. Please contact her for your next medical-legal case.
Tags: amputation, clinical index of suspicion, communication, compartment syndrome, complications, crush injury, death, defense, delay in diagnosis, diagnosis, disability, drug-affected, emergent, failure to recognize, fasciotomy, fracture, high indemnity payment, legal nurse consultant, medical emergency, medical expert, medical malpractice, medical negligence, medical-legal, meritorious, missed diagnosis, neurological defecit, nurse, opiods, pain, patient, patient controlled analgesia, patient outcome, PCA, physician, prompt recognition, regional analgesia, risk, standard of care, surgery, trauma
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Posted by Kathleen on November 13th, 2012
Hoping to decrease the risk of medical error, hospitals and physicians’ offices have invested heavily to place iPads, iPhones and other electronic devices into the hands of medical staff for instant access to patient data, drug information and case studies. The implementation of this technology in our healthcare system has come with an unintended side effect that is well-supported in the literature – During critical care moments caregivers are concentrating on their electronic device screens rather than the patient.
Distracted Doctoring is a term coined in a recent publication that discussed surgeons who use laptops, iPhones & iPads while performing surgery. A plaintiff medical malpractice attorney from Denver, Scott Eldredge, recently represented a patient who was left partially paralyzed after surgery. The neurosurgeon was distracted intraoperatively using a wireless headset to talk on his cell phone, at least 10 of them to family and business associates, according to discovery – His client’s case was settled before a medical negligence lawsuit was filed. Additionally, a peer-reviewed study published this year in Perfusion, a journal on cardio-pulmonary bypass (CPB), reported medical personnel while performing CPB compromised patient safety – 55% admitted to texting, 21% admitted to checking email, 15% admitted to internet navigating, and 3% admitted to posting on social networking sites.
Patient Safety Concerns:
▪ Standard of Care is breached by non-adherence to intraoperative sterile technique
▪ HIPAA violation
▪ The growing number of wrongful deaths & grave personal injuries is rampant
▪ Introduction of Electronic Medical Records (EMR’s) adds confusion
▪ Attorneys routinely request the opposing party’s iPhone, iPad & cell phone records
One in twenty hospital patients will develop a nosocomial infection – outcomes are devastating as well as deadly. 290,000 post-sugrical site infections occur every year. Contaminated hands of doctors, nurses and other healthcare workers are common causes.
The American Medical Association supports that a physician’s first priority should be with the patient, yet the technology’s ubiquitous influence has clearly come between the doctor and patient. Dr. Peter J. Papadakos at the University of Rochester Medical Center, recently published an article in the journal Anesthesiology News on electronic distraction, and stated “as doctors use more devices, potential for distraction grows – lives are in danger and it’s only getting worse”.
Standardization is mandated for resolution – All hospitals and outpatient surgical centers must have strict guidelines in place regarding the use of electronic devices during surgery without exception. Patients also have the right to video record their surgery.
With patient safety now at greater risk, electronic distraction has created an increased demand for Certified Legal Nurse Consultants. Please contact Kathleen A. Mary, RN, CLNC to assist you in your next medical-legal case.
Tags: American Medical Association, anesthesiology, cardiopulmonary bypass, certified legal nurse consultant, critical care, discovery, doctor, drug, electronic medical records, grave injury, healthcare, HIPAA, hospital, intraoperative, lawsuit, legal, medical, medical error, medical malpractice, medical negligence, neurosurgeon, nosocomial infection, nurse, outpatient, patient safety., personal injury, physician, plaintiff attorney, post-surgical site infection, standard of care, sterile technique, surgeon, surgery, wrongful death
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Posted by Kathleen on October 31st, 2012
Defensive Medicine refers to the concept that doctors order unnecessary tests and extra medical procedures as a means to avoid medical negligence lawsuits. However, research at Dartmouth Hitchcock College of Medicine and other studies support there is very little evidence of widespread defensive medicine.
Research does however support that physician motivation behind defensive medicine is not a liability concern but rather a need to abide by a patient’s demands, and in some cases, financial incentive – boost physician income. Healthcare authorities in Florida discovered diagnostic-imaging centers and clinical labs were ordering excessive tests because the majority were physician-owned and the tests provided a streamlined income. Federal law now prohibits the referral of Medicare patients to certain physician-owned facilities, many of which were found to charge double fees. In the wake of discovering increased income generated by physicians, research by the National Practitioner’s Databank found that increased medical malpractice risk paralleled improved mortality rate, and concluded that defensive medicine had a positive effect on patients.
It is widely believed that physicians hand-select patients and self-refer profitable procedures and insured patients to their own hospitals, drawing much-needed income away from community hospitals where patient population is becoming more complex and less well-financed. The American Hospital Association is debating a policy that would forbid doctors from referring patients to hospitals in which they have financial stake.
Please contact Kathleen A. Mary, RN, Certified Legal Nurse Consultant to assist you in your next personal injury or medical negligence case.
Tags: Amercican Hospital Association, certified legal nurse consultant, community hospital, defensive medicine, diagnostic, doctors, healthcare, hospital, imaging, liability, medcial malpractice, medical negligence, Medicare, medicine, mortality rate, National Practitoner's Databank, patient, personal injury, physicians
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Posted by Kathleen on October 28th, 2012
The Joint Commission, which accredits most hospitals in the US and many abroad, consistently identifies communication as the number one cause of medical errors. Healthcare providers are increasingly becoming aware of the opportunities for information to get lost during handoffs which often leads to medical negligence. Handoffs occur when:
A physician turns care of his practice over to a covering doctor for a night, weekend or vacation; A nurse transfers a patient out of the recovery room to a medical-surgical unit; A primary care physician refers a patient to a specialist; A hospitalist discharges a patient back to the care of the primary physician; An ER nurse calls the intensive care unit to give report on a patient on the way to the critical care unit; A nurse tells the oncoming shift of nurses about patients under her care; A patient leaves a hospital for a nursing home.
A study in the January 10, 2011 Archives of Internal Medicine found wide disparities among primary care physicians’ and specialists’ perceptions of how often they send and receive patient information. The study showed that 69.3% of primary care physicians said they send specialists notification of patients’ history all or most of the time, while only 34.8% of specialists said they routinely receive such information.
Meanwhile, 80.6% of specialists said they send consultation results to the referring physician all or most of the time, but 62.2% of primary care physicians reported never receiving that information. Direct communication between hospitalists and primary care physicians also is rare, happening between 3% to 20% of the time, according to a study published in the Feb. 28, 2007, issue of The Journal of the American Medical Association.
What can you do as a patient about handoffs? You have little or no control over how nurses transfer information about your care when you are in the hospital. You might become aware of change of shift report if it takes place during “walking rounds”. These take place when the nurse from the oncoming shift and the nurse from the off going shift walk to each room to discuss each patient. This form of change of shift report is believed by many to foster better communication. Some change of shift reports occur in a conference room. You may be unaware they’re occurring, except when you need a nurse during this time, and no one comes. If there is something of importance that you want the next nurse caring for you to do, ask that person directly. While you should be able to rely on the handoff process to transmit the information, we know it does not always happen.
What can you do about communication between physicians? First, if you are in the hospital, under the care of a hospitalist, you may request the hospitalist to call your primary care physician and update him or her on your condition. Second, if you see a specialist, ask that person to write a note to your primary care physician with updated information on your condition and treatment plan. Your request is hard to ignore. Speak up proactively for improved communication – it could save your life.
Please contact Kathleen A. Mary, RN, Certified Legal Nurse Consultant to assist you in your next medical-legal case involving medical errors.
Tags: American Medical Association, certified legal nurse consultant, communication, critical care, doctor, emergency room, handsoff, healthcare, hospital, hospitalist, intensive care, Internal Medicine, Joint Commission for Accreditation of Healthcare Organizations, medcial errors, medical negligence, medical-legal, medical-surgical, nurse, nursing home, physician
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Posted by Kathleen on October 8th, 2012
Preventable medical errors kill and seriously injure hundreds of thousands Americans every year. Any discussion of medical negligence that does not involve preventable medical errors ignores this fundamental problem. Reducing medical errors is the best way to address all problems within the infrastructure of our healthcare system – lower health care costs, reduce doctors’ insurance premiums, and protect the health, safety and well-being of patients.
Nearly half of U.S hospitals were graded C or lower in patient safety by The Leapfrog Group. The Group’s focus on healthcare quality estimates: 1.4 million Americans each year are seriously injured by hospital error (alarming stats apply only to Medicare patients); 400 patients die each day from hospital error; one medication error per day occurs for every hospital patient; 180,000 Americans die every year from rampant preventable hospital errors, accidents and infections.
1 Heart Disease 652,091
2 Cancer 559,312
Preventable Medical Errors 180,000
3 Stroke 143,579
4 Chronic Pulmonary Disease 130,933
5 Accidents (unintentional injuries) 117,809
6 Diabetes 75,119
7 Alzheimer’s Disease 71,599
8 Influenza/ Pneumonia 63,011
9 Nephritis/ Nephrosis 43,901
10 Septicemia 31,136
Researchers at The Harvard School of Medicine have found that patient harms remain common with little evidence of widespread improvement – 18% of patients in hospitals are injured during the course of their care with many of the injuries being life-threatening or fatal. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently reported 40 wrong site, wrong side, wrong patient procedure, occurrences every week in the U.S.
Medical errors have caused serious injury to 1 in 5 Americans and 1 in 3 Americans have experienced a medical error. Contrary to American beliefs and despite the shocking number of medical errors, few injured patients ever file a medical negligent lawsuit & fewer still file frivolous claims. Research supports that nearly all medical negligence lawsuits are meritorious – claims without associated error are rarely paid, yet errors never compensated for is a problem of great magnitude. Research supports patients file claims seeking accountability because there is complete disclosure omission of a medical error by the doctor to the majority of patients who have endured medical errors. Research also supports one half of our nations doctors admit to not reporting colleague incompetence or medical errors – Hospitals however, that have embraced a full disclosure policy of medical errors to patients through Medical Error Apology Programs, have found the number of medical malpractice claims and related costs have declined.
Only 6% of doctors are responsible for 60% of all medical negligence in which the civil justice system is the only effective means to hold them accountable. Alternative disciplinary mechanisms have proved inadequate – State Medical Boards are held responsible to discipline doctors who consistently violate Standard of Care, yet two thirds of doctors who make 10 or more medical negligent payments are never disciplined. While hospitals advocate being the heart of patient safety, nearly half of all U.S hospitals have never filed a single incident report of a doctors disciplinary action to the National Practitioner Databank since its inception in 1990.
While prevention of medical errors will drastically lower healthcare costs, reduce doctor’s insurance premiums, and protect the health and well-being of patients, the accountability promoted by the civil justice system remains undeniably the impetus for patient safety. The civil justice system holds doctors, nurses, hospitals and insurance companies accountable for their actions – this accountability is the front line of patient safety helping to prevent medical negligence before it occurs.
Kathleen A. Mary, RN, Certified Legal Nurse Consultant has evaluated thousands of medical records involving preventable hospital errors. Please contact her to help you navigate through the medical complexities of personal injury and medical malpractice.
Tags: accident, claim, colleague incompetence, disciplinary, disclosure omission, doctor, error, healthcare, hospital, infection, JCAHO, lawsuit, Leapfrog, medical error, Medical Error Apology Program, medical malpractice, medical negligence, Medicare, medicine, meritorious, national practitioner's data bank, negligent, patient safety., personal injury, preventable, serious injury, standard of care, state medical board, wrong site occurrence
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Posted by Kathleen on September 30th, 2012
Hospitals nationwide are currently implementing medical error apology programs. Healthcare group advocates are proactively pushing these programs to encourage doctors and their insurers to openly disclose medical negligence errors along with physician apology for personal injury and proactive voluntary offering of monetary compensation to injured patients for breaching standard of care.
While every hospital is unique, the standard concept of each program remains the same – If the patient accepts the apology and compensation, the patient cannot legally pursue filing subsequent civil actions. The program’s goal is to minimize negligent errors, reduce hospital costs and decrease the threat of litigation.
The programs are not intended to improve patient safety or provide advanced care for those injured. While the incentive towards accountability is to be applauded, injured patients by medical negligence still deserve fair monetary compensation for their injuries, just as the patient should recognize that the program does not sway or obstruct them from seeking representation for justice.
Please contact Kathleen A. Mary, RN, Certified Legal Nurse Consultant to assist the plaintiff attorney in your next medical-legal case.
Tags: apology, attorney, doctor, healthcare, hopsital, insurers, justice, legal nurse consultant, medical error, medical negligence, medical-legal, negligent, patient safety., personal injury, physician, plaintiff, standard of care
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Posted by Kathleen on September 15th, 2012
While a majority of medical malpractice claims against physicians involve an adverse outcome, or the patient’s perception of one, a small but growing percentage of patient injuries are the result of medical negligence or physician incompetence. Adverse outcomes can occur despite excellent medical care as well as non-adherence to the standard of care.
Analysis of closed claims and depositions gives insights into the reasons patients are angry enough to pursue litigation after they’ve experienced an adverse outcome of personal injury, as well as insight into a physician’s liability and medical negligence. Here are the top 10 reasons physicians are sued for medical malpractice:
- Weak medical records
Attorneys may be encouraged to pursue a personal injury case if the medical record does not adequately explain what the doctor did or did not do. Records will undermine a defense if they lack documentation of the physician’s rationale for critical decisions, as will factual errors, omissions, illegible entries, unresolved contradictions, or questionable alterations. An altered medical record almost always guarantees even a medically-defensible case will be settled.
- Inadequate history-taking
Important medical information is not elicited, identified or documented, such as allergies, drug use, family history, past medical history, and names of other treating physicians. Incomplete medical histories remain a major reason for diagnostic delays in breast, lung and colorectal cancer, and heart disease.
- Inattentive follow-up
Pending medical problems identified on one visit are not adequately followed up on subsequent visits, resulting in patient injury. – When a doctor elects to observe and monitor, rather than refer the patient to a specialist or for diagnostic studies: 1) document the reasons for deferring action, 2) revisit the problem when the patient is next seen; and 3) document a course of action, or note that the problem has been resolved.
- Informed consent was not obtained
Risks of treatment and the elements of informed consent discussion are not explained or properly documented. Informed consent – the physician has explained the purpose of treatment or tests; the risks, alternatives and their risks, and the expected outcome; and answers the patient’s questions. The consent form patients sign is virtually worthless unless the doctor has personally obtained the patient’s consent by following the steps described. A handwritten or dictated note about the consent discussion is often more helpful in defending the physician than a signed consent form.
- Informed refusal was not obtained
Risks of refusal of care discussed with a patient are not documented. – Patients have the right to decline hospitalization, referral to other doctors, or any treatment. When the patient declines, the physician is obliged to explain the possible consequences of the patient’s choice. Only after the patient has been given the information can it be said that the patient has given an “informed refusal,” which should be documented by a confirming letter to the patient.
- Overlooked lab studies
Diagnostic lab studies and imaging tests are not received in a timely manner or acted upon. – Utilize an effective diary system for keeping track of ordered tests and referrals. Assign a staff member to find out why an expected report was not received. To safeguard against overlooking significant test results or consultant’s letters, physicians should prohibit filing such items unless the doctor has initialed them as evidence they have been reviewed. Claims in which filed, unreviewed reports resulted in a delayed diagnosis or treatment and contributed to a patient injury are rarely defensible—and always costly.
- Communications problems
Miscommunication with co-treating, referring and consulting physicians results in overlooked or duplicate therapy, and delays in diagnosis or treatment. – Keep track of referrals; question delays in receiving reports; and document telephone conversations with colleagues, medical experts and patients in which important information is given or received.
- Medication problems
Prescriptions and refills are not adequately documented, causing or adding to patient injury. – Careless medical record charting and incomplete documentation of prescriptions and refills are common factors in facilitating claims. Use a medication control record to easily track medications and reduce the risk of overlooking drug interactions or patient dosing errors.
- Weak patient education
Patients are inadequately educated about their medical condition, treatment, and follow-up, which results in non-compliance, injury, misunderstanding, disappointment, and an inclination to litigate. – Oral education may be inadequate and easily forgotten by patients. Relying on a pharmacist to educate patients about drug use, side effects and interactions can be risky. Dispense written information about diseases or conditions, drugs prescribed, self-care and follow-up. Document that this information was dispensed.
- Inattention to the importance of a sound doctor-patient relationship
Litigation often ensues when doctor-patient relationships are damaged by poor telephone etiquette; excessive or unexplained waiting time; rudeness by physicians or staff; inattention to the patient’s concerns; and delays in reporting significant test results. – Make sure your staff understands they are your “patient relations department.” The way staff treats patients on the phone and in person reflects favorably or unfavorably on the doctor. Don’t over-schedule. Apologize for delays; everyone’s time is valuable. Treat patients respectfully. Plaintiff’s attorneys say that most people who want to sue are more angry than injured.
Kathleen A. Mary, Certified Legal Nurse Consultant, has reviewed hundreds of medical malpractice and personal injury cases that involve negligent omissions. Please contact Kathleen to assist you in your next medical-legal case.
Tags: adverse outcome, attorney, defense, deposition, diagnostic delay, doctor, documentation, informed consent, informed refusal, liability, litigation, medical malpractice, medical negligence, medical record, medically-defensible, medication, omission, patient injury, personal injury, physician, physician incompetence, plaintiff, prescription, standard of care
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Posted by Kathleen on August 31st, 2012
A hospital emergency room is an area where medical errors are common and often overlooked. Because of the increasing patient load and the need to triage patients by order of medical urgency, many things often go clinically wrong in an emergency room setting. However, as long as the patient eventually receives the appropriate standard of care, which often involves hospital admission for observation and further testing & treatment, the errors and omissions in the emergency room often hold little consequence. However, when the patient is improperly discharged from the emergency room and told there were no significant clinical findings and ultimately misdiagnosed, or when diagnosis is delayed or treatment is delayed, it is within this framework where patient safety becomes compromised and the initial medical errors and omissions very often prove to hold significant consequences supporting medical negligence.
A Legal Nurse Consultant is an attorney’s expert in recognizing medical errors and omissions that serve as foundation for medical malpractice relating to breaches in standard of care.
Please contact Kathleen A. Mary, RN, Certified Legal Nurse Consultant to assist you in your next medical-legal case.
Tags: attorney, certified legal nurse consultant, clinical, delayed treatment, diagnosis delay, emergency room, hospital, medical error, medical malpractice, medical negligence, misdiagnosed, omission, patient, patient safety., standard of care, standard of care breach
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Posted by Kathleen on August 25th, 2012
A Sentinel Event is defined by The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious personal injury specifically includes loss of limb or function. The phrase, “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called “sentinel” because they signal the need for immediate investigation and response.
The Joint Commission for Accreditation of Healthcare Organizations is one of the preeminent bodies that accredits a wide variety of healthcare organizations. JCAHO has reviewed nearly 9,000 sentinel events since its database inception in 1995 to 2012. Sentinel Event statistics reported to The Joint Commission as of March 2012, demonstrates the need of the Joint Commission and accredited healthcare organizations to continue to address these serious adverse events. The Joint Commission provides critical information in the prevention of sentinel events to accredited health care organizations and the public.
Because Never Events are devastating and preventable, health care organizations are under increasing pressure to eliminate them completely. The Centers for Medicare and Medicaid Services (CMS) announced in August 2007 that Medicare would no longer pay for additional costs associated with many preventable errors, including those considered Never Events. Since then, many states and private insurers have adopted similar policies. Since February 2009, CMS has not paid for any costs associated with wrong-site surgeries.
The top ten list of reported sentinel events, in order of the most reported since 1995, are:
• Wrong-site surgery
• Suicide
• Operative/post-operative complication
• Delay in treatment
• Medication error
• Patient Fall
• Assault, rape or homicide
• Perinatal death or loss of function
• Patient death or injury in restraints
The Joint Commission is a needed directive in the complex healthcare culture that advocates for patient safety and standard of care. Sentinel Events open health care organizations up to transparency of legal issues relating to medical errors. Hospitals attempt to refrain from providing information which can be discoverable, and used against them in medical negligence. Often hospitals place such documents under attorney-client privilege or peer review privilege. If however, an attorney supplies the Joint Commission with a RCA/Action plan, the privileged status of these documents can be considered waived by the courts. This waiver comes from the fact the Joint Commission is not an entity that is used as legal counsel or in peer review – it is an independent entity that focuses on safety and quality of care provided by participating organizations. The U.S. Supreme court ruled in 1993 that there be automatic disclosure requirements. The decision to provide the Joint Commission with RCA/Action plans can be both detrimental and beneficial to any healthcare organization because the healthcare organization can be compiling extremely damaging discovery that was intended for safety rather than medical-legal use.
It is essential for any lawyer handling medical malpractice cases to have a firm grasp of Sentinel Event, Root Cause Analysis and Peer Review procedures. The JCAHO website is a great place to start educating yourself on the subject. www.jointcommission.org/
As a medical expert, a Certified Legal Nurse Consultant can assist in educating an attorney about the complex infrastructure of our healthcare system and navigating The Joint Commission. Please contact Kathleen A. Mary, RNC, Certified Legal Nurse Consultant for further information.
Tags: attorney-client privilege, certified legal nurse consultant, court, delay in treatment, discoverable, health care, healthcare, hospital, injury in restraints, investigation, JCAHO, Joint Commission for Accreditation of Healthcare Organizations, lawyer, legal, legal counsel, loss of function, medical, medical expert, medical malpractice, medical negligence, medical-legal, medication error, never event, operation complication, patient death, patient safety., peer review privilege, perinatal death, personal injury, post-op complication, preventable, psychological injury, quality of care, risk, root cause analysis, sentinel event, serious adverse outcome, standard of care, wrong-site surgery
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