Tag Archives: Medical Mistake

Preventing medical malpractice claims with smart strategies

Physicians and their patients all make their best efforts to exchange information to ensure great patient care. At points in the healthcare process, there can be mistakes leading to dissatisfied patients. In many cases, miscommunication and errors can be corrected with little harm done. In other instances, malpractice complaints are filed. Everyone involved in the patient care process would prefer to avoid a negative incident or malpractice complaint. Being diligent in assuring good patient care involves adopting strategies in reducing risks of medical mistake.

In a recent article published in Medical Economics, several doctors and healthcare professionals shared their perspectives on improving patient care, communication and documentation, ideally reducing malpractice lawsuits.[i]

The following is a summary of 5 strategies to reduce malpractice lawsuit threats:

Proper documentation means documenting everything

“Every doctor is taught that if you didn’t put it in the chart, you didn’t do it.[ii]” In error in noting a patient’s chart begs the question of how to correct the typo or wrong word choices. The best practice is to make a separate notation which you identify and incorporate by reference in the original notation. Changing or deleting an error can lead to trouble.

Noting everything in the patient’s chart should also include any communication with patients and family members. Ask them to explain the information back to you to make sure they understand. Make a note in the chart describing exactly how the communication took place. If you note everything with the sense that any other physician could step into patient care without missing a beat, you are engaging in a positive habit that should help avoid medical mistakes and malpractice claims.

Transparency with patients and facilitating access to charts and notes

Does your physician share access to notes and charts? Would you know how to read and interpret those notes if they were made available to you as a patient? Transparency in healthcare services allows patients and their physicians to all understand the reason and course of care. A patient may elect to seek another medical opinion and if they do, the more information you share with them as the primary physician, the better you may be protected from later claims of medical mistake or malpractice. It may take longer to create notes that others can understand, but the benefit in transparency and documentation makes this a best practice.

Expressing empathy when sharing information with patients

When a physician discovers a medical error, they may face tough decisions in communicating errors with patients and their families. While the natural inclination may to apologize and express remorse for a medical mistake, too many physicians are worried about an admission of error which could lead to a malpractice claim. While contrition may be, appropriate and appease concerned patients and families in many instances, there may be times your apology is insufficient to resolve dissatisfaction.

Illinois is one of many states with “sorry laws” protecting physicians from exposure in malpractice cases for expressing apologies and remorse to patients and families. The form of an apology should be sincere and honest. You can effectively express empathy without saying too much that may confuse or give the patient and family the wrong idea. Apologies when due, can be an appropriate best practice. Notwithstanding, being aware of hospital administration and policies that may affect your patient communications is important.

Managing the risks associated with electronic health records

The intended purpose of electronic health records (EHRs) is to solve information and documentation concerns. The portability and access to EHRs should help prevent medical mistakes and malpractice claims. Nevertheless, there are EHR pitfalls to avoid, such as using auto-populating fields in the forms and copying and pasting. Drop down menu errors can also be a problem and cause the wrong information to be populated in the EHRs, which can lead to medical mistakes and malpractice. Imagine another physician relies on wrong information in a patient’s EHRs and misses a drug allergy or gives a patient wrong dose of medications.

Maintaining positive relationships with patients and their family

Reducing uncertainty and increasing understanding is good for physician-patient communication and care. When family members are involved, it is a good practice to let them know what is happening in the care process and what issues may arise and affect the patient’s health. Showing the patient and their family attention and explanation of what is happen and what is anticipated in patient care may give the patient and family solace in knowing their concerns are important and well-attended. Being realistic and transparent is always a best practice to increase understanding and prevent medical mistakes and malpractice claims.

Adding these strategies to your practice

Since so much documentation is required in healthcare, it should be reasonably simple to include these proactive patient care strategies to any healthcare practice. Adding reminders to engage in these tasks is helpful in adopting them as positive habits in practice. Health law, litigation and licensing attorney, Michael V. Favia works with patients, physicians and healthcare organizations to identify and manage risks and to prevent and resolve conflicts when they arise. An audit of a physicians practice can lead to solutions in preventing malpractice.

About us: Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

[i] Medical Economics, 5 strategies to reduce malpractice lawsuit threats, By Liz Seegert, Nov. 10, 2016.

[ii] See HNi above.

On-duty emergency physicians are liable for damages despite the Good Samaritan Act

"To identify the most overlooked risks to physicians, Medical Economics asked several thought leaders to share their insight into strategies for protecting office-based practices."

In Illinois, the Good Samaritan Act protects individuals giving instructions for aid, or rendering aid to others in emergencies, from civil liability for damages resulting in the process. Simply stated, a bystander or passerby who sees someone with an injury or emergency condition does not have a legal duty to stop and give general or medical aid. Moreover, a passerby who stops to assist and render some type of aid, cannot be sued and found liable for civil damages if the endangered individual suffers and injury or dies in the process. The purpose of the Good Samaritan Act is to allow people to try to save a choking victim without worrying about a wrongful death suit if they are not successful.

The Good Samaritan Act includes a physician exemption from civil liability for emergency care. The statute states in pertinent part: “Any person licensed under the Medical Practice Act of 1987 or any person licensed to practice the treatment of human ailments in any other state or territory of the United States who, in good faith, provides emergency care without fee to a person, shall not, as a result of his or her acts or omissions, except willful or wanton misconduct on the part of the person, in providing the care, be liable for civil damages.[i]

While the language of the statute is clear, there question has arisen, what happens when the emergency care physician is not providing health care for a direct fee, but rather works as an on-duty physician.

The Illinois Supreme Court holds that the Good Samaritan Act does not shield on-duty physicians who do not bill for their services, and on-duty physicians have the same standard of care regardless of whether they bill for their services. The issue arose in a case involving an on-duty emergency room physician, responding to a “code blue” for a patient with trouble breathing and swallowing. The doctor intubated the patient and opened the airway, and nevertheless the patient experienced permanent brain damage.[ii] The doctor working as an emergency room physician when the “code blue” was called for a patient on another floor of the hospital, whom the doctor had never previously met or treated.

The First District Illinois Appellate Court held in the case, the emergency room physician responding to the “code blue” for a hospital patient, the immunity from liability under the Good Samaritan Act did not apply because the doctor’s services were not performed “without fee” where the doctor was paid to work in the emergency room.[iii]

If the facts had been different, this court could have applied the Good Samaritan Act. Assume a different set of facts where the doctor was not on-duty, working as an emergency physician at the time he responded to the “code blue” for the patient on another floor, separate from the emergency room. Assume the same treatment was given, the doctor intubated the patient, who experienced permanent brain damage, there would have been a more likely chance the doctor may have been able to be clear of civil liability under the Good Samaritan Act.

As new events and occurrences give rise to litigation over health care liability, the courts will decide those cases and the health care law and litigation firm of Michael V. Favia and Associates will share those holdings.

Michael V. Favia & Associates are available to assist with analysis and advice on all aspects of physician practice and litigation matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

 

[i] Illinois Good Samaritan Act, Sec. 25 Physicians, 745 ILCS 49/25

[ii] Beckers Hospital Review, Illinois Supreme Court: Good Samaritan Act Doesn’t Shield On-Duty Emergency Physicians, by Ayla Ellison, Apr. 29, 2014.

[iii] Home Star Bank & Financial Services v. Emergency Care & Health Organization, Ltd., 2012 IL App (1st) 112321

Caution: Electronic Medical Recording has accuracy and reliability pitfalls physicians should avoid

Judges reviewing EMRs in medical malpractice cases have expressed concerns over the manner in which records are kept using EMR software and pre-populated forms and checkboxes.

Judges reviewing EMRs in medical malpractice cases have expressed concerns over the manner in which records are kept using EMR software and pre-populated forms and checkboxes.

Electronic medical records (“EMR”) might make it easier to see more patients and spend more time caring for patients, but there are inherent risks in technology and human error that can hurt physicians in lawsuits.

Judges reviewing EMRs in medical malpractice cases have expressed concerns over the manner in which records are kept using EMR software and pre-populated forms and checkboxes. When a patient’s medical record is an adjusted template report it is too easy to inadvertently replicate data in a cut and paste process, leaving a trier of fact reviewing the records to question the accuracy of the reported information. The traditional manner of making individual patient records contemporaneously with care is a tested and accepted practice. It might take more time but more authentic records might stand up better under scrutiny.

Documentation of critical findings using EMRs can increase malpractice risks.

  1. Timing of patient diagnosis and care might not be accurately represented in EMRs. If a doctor sees several patients and takes some notes during the short time between patients then makes the EMR entries later that day, the timing can appear incorrect. In one instance, a judge questioned why a diagnosis was reported to have been made at one time and treatment took place six hours later. The physician actually treated the patient within a few minutes of the diagnosis, shortly before noon, but the notes were not added into the EMR until the early evening. Ideally, data would be entered contemporaneous to live events to establish an accurate record of time.
  2. Content and data copy and paste issues are known to lead to confusion and concern. A judge in one case commented on copy and paste errors: “I cannot trust any of the physician notes in which this occurred, and the only conclusion I can reach is that there was no examination of the patient … it means to me that no true thought was given to the content that was going into ‘the note.’[i]” If a mistake was made and a cut and paste error occurred at a prior time in the patient’s history, that incorrect information could be duplicated again. Without better information, it is difficult to rely on data kept in this manner.
  3. Pre-populating forms are also problematic because it is hard to know whether template language was inadvertently selected to be stated in the medical report. The traditional reporting methods using individual data manually recorded is less likely to lead to a medical mistake if a healthcare provider innocently relies on incorrect EMR data and causes harm.
  4. Checkboxes to respond to yes or no questions, and or to trigger pre-populating data are also easy enough to miss or check in the wrong spot in EMR software. An inadvertent mistake causes the same concern for data accuracy.

Despite the concerns about accuracy of information on EMRs, there are several methods a physician can use to best insure the accuracy and reliability of the information. Using specific information and custom reports might take more time but could save the day if the records are ever scrutinized down the line.

Michael V. Favia & Associates are available to assist physicians with professional licensing matters and lawsuits for medical negligence and patient death. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

[i] KevinMD.com blog, EMRs can hurt physicians during lawsuits. Here’s how. By Keith L. Klein, MD, Jan 10, 2015.