Medical Malpractice

You really don’t want to be involved in a suitHospitalists are becoming bigger targetsYou’re a doctor; leave the lawyering to the

lawyers.Defensive medicine:

a) Is bad medicineb) Doesn’t defend you against anything

It’s not the lawyers’ fault… How does it happen? The best protection: 3 components

MAIN POINTS

Injury, infection, or disfigurement that results from a provider deviating from the “standard of care”

“Standard of care”????

Common root causes: Misdiagnosis failure to provide appropriate treatment unreasonable delay* lack of informed consent*

Malpractice

71 y.o. given Ambien, falls = SDH56 y.o COPD, dies while being transferred 56 y.o. s/p gastric bypass, transferred to see

neurologist, dies of complications from the surgery

63 y.o. readmitted after CABG, hospitalist doesn’t see pt, treats sepsis as dehydration over phone

72 y.o. hematoma from PICC = peripheral neuropathy, nobody f/u on US

Failure to detect a retroperitoneal hematoma, blamed it on a GI bleed

Sent a 23 y.o. home with a large PE

What’s out there….

1. Bad outcome + bad relationship2. Patient contacts attorney

1. SOL/SOR = 1 year from the date of discovery of the injury and 4 years from the date of the action that caused it

3. Pre-suit notice4. Review for meritoriousness5. Filing6. Discovery7. Negotiations8. Settlement or trial

How it goes down…

1. COMPENSATORY – no cap

2. NON-ECONOMIC The greater of $250,000 or 3xCompensatory,

not to exceed $350, 000 unless substantial, then $500,000

3. PUNITIVE in cases of “reckless behavior”, usually fraud

or malice; 2xCompensatory

3 types of damages

YouDuty of prompt noticeDuty to cooperate

Insurance company Duty to defendDuty to indemnify

CaveatsPride provisionHammer clauseThey hire “your” attorney

You & your insurance company

Cap on non-economic damagesJoint & several liabilitySOL/SOREvidence of collateral source paymentsAOMState Medical Board jurisdiction“I’m sorry” LawInsurance can’t change rates based on 180

day letter

Ohio Tort Reform

Don’t talk to ANYBODY (except…)Notify your insurance company and your risk

manager immediatelyBe an active participantKnow who is on your sideDO NOT EVER alter the recordsDO NOT EVER contact the plaintiff or their

attorney

What to do

Transitions of careLack of communicationGroup tunnel visionBad customer service

No loyaltyConsultantsNo supportThe "they'd already been seen by my partner"

and "that's what I was told by my partner" defenses don't work

Hospitalists

1) Relationships are everything2) Informed consent/communication3) Documentation, documentation,

documentationIf it wasn’t documented, it wasn’t done document thought processes!!!!

3 KEY STEPS TO AVOIDING PROBLEMS

Pt. A, in ER37 y.o. femaleCC: cough, sinus

infectionD-Dimer: 1.7(</=0.50 mcg/mL FEU)

40 y.o. maleCC: right shoulder

dislocationD-Dimer: 1.2(</=0.50 mcg/mL FEU)

DEFENSIVE MEDICINE VS.

GOOD DOCUMENTATIONPt. B, admitted to obs

Pt. A, in ER37 y.o. femaleCC: cough, sinus

infectionD-Dimer: 1.7(</=0.50 mcg/mL FEU)

40 y.o. maleCC: right shoulder

dislocationD-Dimer: 1.2(</=0.50 mcg/mL FEU)

DEFENSIVE MEDICINE VS.

GOOD DOCUMENTATIONPt. B, admitted to obs

Pt. A, in ER37 y.o. femaleCC: cough, sinus

infectionD-Dimer: 1.7

CT-PA negative, sent home with a Z-pack

40 y.o. maleCC: right shoulder

dislocationD-Dimer: 1.2

No further testing, shoulder reduced and discharged home

DEFENSIVE MEDICINE VS.

GOOD DOCUMENTATIONPt. B, admitted to obs

Pt. A, in ER37 y.o. femaleCC: cough, sinus

infectionD-Dimer: 1.7CT-PA negative, sent

home with a Z-pack

Cause of death: anaphylactic reaction to contrast dye

40 y.o. maleCC: right shoulder

dislocationD-Dimer: 1.2No further testing,

shoulder reduced and discharged home

Autopsy = saddle PE

DEFENSIVE MEDICINE VS.

GOOD DOCUMENTATIONPt. B, admitted to obs

DEFENSIVE MEDICINE

VS. GOOD

DOCUMENTATION

JURY AWARD: $2.5 million

Pt. A, in ER37 y.o. femaleCC: cough, sinus

infectionD-Dimer: 1.7CT-PA negative, sent

home with a Z-pack Cause of death:

anaphylactic reaction to contrast dye

40 y.o. maleCC: right shoulder

dislocationD-Dimer: 1.2No further testing,

shoulder reduced and discharged home

Autopsy = saddle PE

DEFENSIVE MEDICINE VS.

GOOD DOCUMENTATIONPt. B, admitted to obs

Pt. A, in ERNecessity of the test

was not documentedExplanation of the

risks of the test were not documented

“primum non nocere”

The hospitalist wrote: “+ DD ordered in ER noted, not clear why it was ordered. Pt denies fever, dyspnea, palpitations, chest pain, cough, hemoptysis. Lungs clear, resps unlabored, sats nl. No RFs for VTE disease. Discussed at length with pt. Will forego further workup. Will f/u with PCP”

DEFENSIVE MEDICINE VS.

GOOD DOCUMENTATIONPt. B, admitted to obs