Health Care Law and Legislation, Statistics Policies

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Hospital Departments & Allied Professionals

Chapter 10

LEARNING OBJECTIVES

Describe the wide variety of negligent errors by various health care professionals.

Discuss the purpose of certification, licensure, & reasons for revocation of licenses.

Discuss the purpose of the Emergency Medical Treatment 7 Active Labor Act.

Explain the importance of a multidisciplinary approach to patient care.

PARAMEDICS

Emergency Medical Technician

Advanced Emergency Medical Technician

PARAMEDICS - II

Paramedic

Wrong Drug Dosage Administered

Protected by Good Samaritan Statute

Inability to Diagnose Extent of Injury

Patient Refuses Transport

License Denied

Patient Refuses Transport and Expires

Emergency Department Objectives

All Patients are Treated

Patients are Assessed

Treatment must begin as rapidly as possible to

Maintain Function

Prevent, Minimize Scarring & Deformity

Care & Treatment Regardless of Ability to Pay

CASE: No Duty to Patient Who Left ED Untreated

In a wrongful death medical malpractice action alleging negligence, the trial court properly granted summary judgment because under Ohio law, an emergency room nurse had no duty to interfere with an individual who left the ED without telling anyone and who refused treatment.

−Griffith v. University Hospitals of Cleveland

CASE: Failure to Admit

Physician was found negligent in failing to hospitalize the patient or failing to inform her of the serious nature of her illness. The trial court found that had the patient been hospitalized on her first visit, her chances of survival would have been increased.

−Roy v. Gupta

Documentation Sparse & Contradictory

ED physician failed to evaluate the patient & to initiate care within first few minutes of patient's entry into the emergency facility. The emergency physician had an obligation to determine who was waiting for physician care & how critical the need was for that care.

−Fenney v. New England Medical Ctr.

EMTALA

In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) that forbids Medicare-participating hospitals from dumping patients out of emergency departments.

EMTALA 42 U.S.C.A. § 1395dd(a) (1992)

in the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination . . .

EMTALA Text Cases

EMTALA Claim Against Hospital Valid

Stabalizing the Patient

Failure to Stabilize Patient

Inappropriate Transfer

Failure to Admit

Patient Who Left

EMTALA Text Cases -II

Wrong Record: Fatal Mistake

Terry was taken to the hospital after automobile accident. Upon ordering discharge, the ED physician had not realized that he had made a fatal mistake. The physician looked at the wrong chart in determining Terry's status, thus discharging Terry. Terry died at home in his father's arms.

−Trahan v. McManus

Who is responsible for Terry’s death?

Wrong Record: Fatal Mistake – II

The ED physician by his own admissions stated that he acted negligently when he discharged Terry and that his actions led to Terry's death.

Duty to Contact On-Call Physician

Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the ED.

Timely Response Required

Failure to Contact On-Call Physician

Physicians Fail to Failure to Respond

Notice of Inability to Respond to Call

Telephone Medicine Costly

CASE: Telephone Medicine Costly

Lauren was taken to the hospital ED. Hospital personnel contacted the physician by phone. He returned the call & prescribed a Phenergan injection. He did not go to the hospital & had not been given Lauren's vital signs when he suggested such an injection, & further failed to order any blood or urine tests. Hospital records revealed that Lauren’s glucose level was 507 at the time of admission. Lauren's went into respiratory failure & eventually died.

Futch v. Attwood

Was the physician liable?

CASE: Yes!

The trial court allocated $98,000 for the conscious pain & suffering of Lauren.

The defendant complained that the award of $98,000 was excessive.

On appeal, the appellate court could not find that the trial court had erred in concluding what sum was fair to both parties.

Preventing ED Lawsuits – I

Courteous & prompt treatment

Treatment regardless of ability to pay

Triage – setting treatment priorities

Establishing on-call roster procedures

Providing consultation by specialists

Communicating to ensure complete & accurate picture of the patient's symptoms & complaints.

Ensuring caregivers effectively communicating.

Provide continuing education programs.

Not taking lightly any patient's complaint.

Preventing ED Lawsuits – II

All patients must be treated.

Hospital determines types of patients & levels of care they can safely address.

Knowing when to admit or transfer a patient.

Provide follow-up instructions.

Hospitals need to determine what types of patients & levels of care they can safely address. If there are several hospitals in a community, they must learn to communicate with one another & include emergency medical services personnel in addressing transport & care issues.

CASE: IMPROPER TRANSPORT

If Hospital A has no neurologist, neurosurgeon, or stroke team & Hospital B, 1-mile away has all of that plus a Level I trauma center, would it be fair to say that a suspected stroke victim should be transported to Hospital B?

Yes!

Its is not just any hospital, it is the right hospital that saves lives.

Taking the patient to hospital A raises both ethical and legal issues.

Under what circumstances would hospital B be the first hospital of choice?

Laboratory Services

Provides vital data

Monitors therapeutic ranges

Measures blood levels for toxicity

Places & monitors instrumentation on patient units

Provides education for lab & other disciplines as necessary

Laboratory Services – II

Provides valuable data utilized in research studies

Provides data on most effective and economical antibiotic for treating patients

Serves consultation role

Provides valuable data as to the nutritional needs of patients . . . .

Failure to Detect Pap Smear Changes

Court determined evidence relating to negligence claims pertaining to Pap tests taken more than 2 years before filing the action were admissible because the patient had a continuing relationship with the clinical laboratory as a result of her physician submitting her Pap tests to the laboratory over a period of time.

−Sander v. Geib, Elston, Frost Prof’l Ass’n

CASE: Importance of Laboratory Results Impending Stroke

High Glucose Levels Not Addressed

Controlled Glucose Levels =

Improved Recovery

Fewer Deficits

LAB: Text Cases

Test Results and Misdiagnosis

Confusion of Laboratory Specimens

Failure to Follow Recommended Transfusion Protocol

Mismatched Blood

Transfusion of Wrong Blood

Medical Assistant

An unlicensed person who provides administrative, clerical, and/or technical support to a licensed practitioner.

Employment of medical assistants is expected to grow much faster than the average for all occupations.

Those in large practices tend to specialize in a particular area, under supervision.

Nutritional Services

Need to provide nutrition

Failure to do so can result in a lawsuit

Nursing facility patient’s highly vulnerable

Lambert v. Beverly Enterprises

Patient suffered malnutrition

Motion to dismiss case denied

Pharmacy: Medications

Immense variety & complexity of medications.

Impossible for nurses or doctors to keep up with the information required for safe medication use.

The pharmacist has become an essential resource in modern hospital practice.

FD Finds Safety Problems at Specialized Pharmacies

Federal inspectors have found dozens of potentially dangerous safety problems at 30 specialized pharmacies, months after tainted steroid shots made by a Massachusetts pharmacy triggered the worst drug disaster in decades.

−Lena H. Sun, The Washington Post, April 12, 2013

Common Prescription Errors

Wrong patient

Wrong drug

Inappropriate drug ordered due to known drug allergies or drug-drug and food-drug interactions

Wrong dose

wrong route

wrong frequency

transcription errors due to illegible handwriting or improper use of abbreviations

inadequate review of drug appropriateness

Common Dispensing Errors

Improper preparation of medication

Failure to properly formulate medications

Dispensing expired medications

Mislabeling containers

Wrong patient

Wrong dose

Wrong route

Misinterpretation of physician order

Common Documentation Errors

Transcription errors often due to

illegible handwriting

improper use of abbreviations

Inaccurate transcription to medication administration record (MAR)

Charted but not administered

Administered but not documented on the MAR

Discontinued order not noted on the MAR

Medication wasted and not recorded

Control of Drugs

Federal Controls

Controlled Substance Act

Federal, Food, Drug & Cosmetic Act

State Regulations

Storage of drugs

Hospital Formulary

Decreasing Med Misadventures: Helpful Tips

Be sure handwriting is legible; print if necessary.

For clarity, do not use felt-tip pens.

Abbreviations should be used per hospital policy.

Do not write ambiguous orders.

Always add a zero prior to a decimal.

Hold orders should be accompanied by a time frame.

Know about the med that you are prescribing.

Administered by the proper route.

Role of Pharmacists

Duty to monitor patient’s medications

Computer systems monitor for:

Drug-drug interactions

Drug-food interactions

Limited Duty to Warn

Pharmacists cannot possibly warn caregivers & patients of every potential danger of a drug.

Warning patients - potential for overdose

Refuse to honor questionable prescriptions

Role of Pharmacists – II

Intravenous Admixture Service

Dispensing and Administration of Drugs

Duty to Monitor Patient’s Medications

Warning Patients: Potential for Overdose

Role of Pharmacists – III

Limited Duty to Warn

Refusal to Honor Prescription

Failure to Consult with the Patient’s Physician

Internet Pharmacy

Physical therapy

Art & Science of preventing & treating neuromuscular or musculoskeletal disabilities

Evaluation of patient’s disability & rehab potential

Treatment Modalities

physical agents (heat, cold, ultrasound, electricity, water, and light)

neuromuscular procedures

CASE: Interpreting Physicians Orders

Plaintiff alleged that defendant failed to exercise degree of care & skill ordinarily exercised by physical therapists, failed to heed his protests that he could not perform the physical therapy treatments she was supervising, & failed to stop performing treatments after he began to complain he was in pain. Plaintiff’s expert testified defendant deviated from standard of care by introducing a type of exercise not prescribed by the physician.

−Pontiff, in Pontiff v. Pecot & Assoc.

Court’s Ruling

The appeals court found that the trial court was correct in its determination that the plaintiff presented sufficient evidence to show that this duty was breached & that therapist’s care fell below the standard of other physical therapists.

Case: Neglect

Refusal to allow patient to go to the bathroom

prior to therapy

Court determined

evidence supported a finding of resident neglect.

CASE: Termination Contracted Services

Hospital could terminate PT contracted services

Hospital decided to establish hospital-based physical therapy program

Hospital had right to terminate services

Physicians Assistant

Graduate of an accredited PA educational training.

Nationally certified and state-licensed to practice medicine.

with the supervision of a physician.

Scope of practice defined by each state.

PAs responsible for own negligent acts.

Respiratory Therapist

Failure to remove endotracheal tube

Multiple use of same syringe

Failure to properly restock the Code Cart

Licensing Healthcare Professionals – I

Recognition by a governmental or professional association that an individual's expertise meets the standards of that group.

Some professional groups establish their own minimum standards for certification in those professions that are not licensed by a particular state.

Certification by an association or group is a self-regulation credentialing process.

Licensing Healthcare Professionals – II

Authority grants permission to a qualified individual to perform certain specified activities.

Licensure refers to the process by which licensing boards, agencies, or departments of the several states grant to individuals who meet certain predetermined standards legal right to practice in a health care profession.

Licensing Healthcare Professionals – III

Suspension & Revocation of License

procurement of a license by fraud

unprofessional, dishonorable, immoral, or illegal conduct

performance of specific actions prohibited by statute; and malpractice.

Licensing Healthcare Professionals – IV

Commonly stated objectives of licensing laws are to

limit & control admission to the different health care occupation

protect the public from unqualified practitioners by promulgating & enforcing standards of practice

PROFESSIONAL MISCONDUCT

Reporting medical misconduct

Sexual Improprieties

Dentist

Physician

Psychiatrist

Helpful Advice for Caregivers

Abide by the ethical code of one’s profession.

Do not criticize the professional skills of others.

Maintain complete medical records.

Seek the aid of professional medical consultants when indicated.

Inform the patient of the risks, benefits, and alternatives to proposed procedures.

Helpful Advice for Caregivers – II

Authenticate all telephone orders.

Obtain a qualified substitute when you will be absent from your practice.

Be a good listener, and allow each patient sufficient time to express fears and anxieties.

Safely administer patient medications.

Closely monitor each patient’s response to treatment.

Helpful Advice for Caregivers – III

Develop & implement an interdisciplinary plan of care for each patient.

Safely administer patient medications.

Closely monitor each patient’s response to treatment

Provide education & teaching to patients.

Foster a sense of trust & feeling of significance.

Communicate with the patient & other caregivers.

Helpful Advice for Caregivers – IV

Provide education and teaching to patients.

Foster a sense of trust and feeling of significance.

Communicate with the patient and other caregivers

REVIEW QUESTIONS

What was the reasoning for enacting the EMTALA?

Should medical advice be dispensed on the telephone? Explain your opinion.

Discuss why you think the prescribing, control, administration, and monitoring of medications has become a major area of legal concern for health care professionals.

Describe the difference between the certification and licensing of a health care professional.