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 Physicians actions are proximate cause of injury

WHY PATIENTS SUE

Dissatisfied with quality or cost of care Feel theyve 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 (contd)

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 (contd)

DONT
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