Inadequately TrainedTraining, Legal Liability, and Risk Management Chapter 22 Code Blue Health Science Edition 4
Peer Review Committees Peer review committees are responsible for assuring that the quality of care provided by physicians is high.
Peer Review Committees Peer review committees audit medical records of patients to ensure that correct protocols were followed.
Peer Review Committees • How do peer review committees decide which records to audit? • If there is a complaint, the committee selects the records of a particular physician. • More often, the committee asks the medical records department to provide them with randomly selected records.
Dr. Matthew Brannan Dr. Brannon has received a letter from a peer review committee of the Brannan Community Hospital. They allege he misdiagnosed an illness, which could have resulted in the death of a child.
Poor Clinical Practice Everyone makes mistakes. Physician mistakes, however, have the potential of harming or killing people.
Poor Clinical Practice • Physician mistakes can be caused by: • Inadequate training • Failure to keep up on current practice • Fatigue • Miscommunication • Physical impairment, including aging
Poor Clinical Practice • Once again, physicians who are unable to correct a pattern of poor clinical performance can: • Have their privileges restricted by the board of directors (temporarily or permanently). • Be suspended or terminated from the medical staff.
Poor Clinical Practice Physicians who receive additional training can reapply for privileges or membership.
Hospital Mistakes Mistakes by hospitals are equally dangerous.
How Many Lives Could Be Saved? The Institute for Healthcare Improvement believes that over 100,000 lives of hospital patients could be saved in an 18 month period if hospitals will implement 12 initiatives.
These changes include . . . Deploy rapid response teams at the first sign of patient decline Prevent adverse drug events by implementing medication reconciliation Deliver reliable, evidence-based care for acute myocardial infarction to prevent deaths from heart attack.
These changes include . . . Prevent Central Line infections by implementing a series of inter-dependent, specifically grounded steps Prevent surgical site infections by reliably delivering the correct perioperative antibiotics at the proper time
These changes include . . . Prevent ventilator associated pneumonia by implementing a series of interdependent, scientifically grounded steps
These changes include . . . Prevent harm from high alert medications starting with a focus on anticoagulants, sedatives, narcotics, andinsulin Reduce surgical complications by reliably implementing all of the changes in care recommended by the Surgical Care Improvement Project
These changes include . . . Prevent pressure ulcers by reliably using science-based guidelines for prevention Reduce methicillin-resistant staphylococcus aureus infection by reliably implementing scientifically proven infection controlpractices
These changes include . . . Deliver reliable, evidence-based care for congestive heart failure to avoid readmissions
These changes include . . . • Get boards on board by defining and spreading the best known leverage processes for hospital boards of directors, so that they can become far more effective in accelerating organizational progress towards safe care
Prevention is the best cure . . . I’m sorry . . . But what about when a mistake has already been made? Experience has shown that the best course of action for a healthcare worker who has made a mistake, is to own up to it and try to correct the problem to the best of his or her ability.
Communication Some studies have shown that the primary cause of malpractice litigation is a lack of communication.
Communication • A family that might have shown some understanding, had a doctor or hospital been forthcoming in admitting its mistake, is often enraged and inclined to sue when they discover there was a cover-up.
Legal Responsibilities of Healthcare Workers As Wes Douglas becomes entangled with charges of possible malpractice against Dr. Matthew Brannan, it will help if he learns a little about medical law.
Medical Law This section reviews concepts that all health-care workers should understand. Let’s begin with some basic definitions.
Definition • Law – a rule of conduct enforceable by a government entity. • Laws govern relationships between people and impose punishments for those violating proper behavior.
Parties in a Lawsuit The person who files a complaint against another in a court of law is the plaintiff. The person against whom the complaint is sworn is the defendant.
The Five Sources of Law in the US The United States Constitution Individual state constitutions Common law Statutes and ordinances Administrative regulations
Laws can be grouped into two categories: Criminal law Civil law
Criminal Law • Criminal law – governs crimes against society. • Examples of crimes tried in the court of criminal law include murder, robbery, and arson. • The purpose of criminal law is to punish people who commit crimes.
Civil Law • Civil law – covers all but criminal relationships. • The goal of civil law is to make the harmed party whole. • Successful civil cases create financial liability for the defendant.
Crimes can be classified as: Speeding Misdemeanors – crimes that are less serious than a felony and not punishable by long prison terms.
Crimes can be classified as: Felonies – crimes that are punishable by imprisonment for more than one year.
Crimes can be classified as: • Torts – breaches of duty (excluding breaches of contract) for which the courts will provide a remedy. • Torts are handled in civil, rather than criminal courts. • Taking a complaint to court is called litigation. • Once the case has been litigated, the defendant can appeal his or her case to a higher court.
Unintentional Torts: Unintentional torts include negligence and malpractice.
Negligence The failure to act with care, or the failure to do something a reasonable person what have done, or The commission of an act a reasonable person would not have done.
To prove negligence, one must show that: There was legal duty There was a breach of that duty The breach caused damages Those damages resulted in an injury to the plaintiff
Malpractice Malpractice is defined as professional negligence. Malpractice is a major issue in health care. In medical malpractice lawsuits, judges will often rely on certain standards in determining if malpractice occurred.
Standards For Determining if Malpractice has Occurred Did the practitioner fulfill his or her duty to the patient? Did he or she give the standard of care established by the hospital’s policy and procedures manual?
Standards For Determining if Malpractice has Occurred Is the hospital’s policy and procedures manual consistent with standards required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)?
Standards For Determining if Malpractice has Occurred Was the incident foreseeable, given the nature of the incident and the training of the practitioner? Did the incident cause the patient harm? Did this harm cause financial damage to the patient?
Intentional torts include: Assault Battery False imprisonment Abuse Defamation Invasion of privacy
Assault • Assault is defined as a threat or attempt to harm another person. • Courts use the following criteria when determining if assault has taken place: • Evidence that someone made a threat • Evidence the threat, if carried out, would have caused harm
Battery Battery is defined as the unlawful use of force against a person. Assault and battery are often charged together.
Examples of assault and battery in a healthcare setting include: Rough treatment Improper treatment Performing a procedure that the person has refused
Consent for Treatment In most situations, a patient must give consent to be treated. Sometimes the consent is given in writing, in other situations it can be given verbally.
Failure to Get Consent Failure to get consent before treatment can result in a charge of assault and battery. To avoid this charge, a health-care worker should get an informed consent before treatment.
Informed Consent An informed consent must be in writing, and must be signed by the patient, or his or her guardian.
Informed Consent • For an informed consent to be legal: • The consent must be voluntary. • The person giving the consent must be mentally sound. • The procedure must be explained. • The risk of the procedure, and of not having the procedure, must be explained in a way the patient can understand. • It is a good idea to have the person giving the consent repeat what he or she has been told.
Consent is not required in an emergency where: • The emergency is life or health threatening, • The patient is unable to give consent, and • The person who is legally authorized to give consent cannot be reached.
False Imprisonment False imprisonment is the unjustified restraint or retention of a person without that person’s consent or the legal right to do so.
False Imprisonment • Examples that courts have held up as false imprisonment include: • Keeping a person hospitalized without his or her permission. • Using physical restraint against a person without that person’s permission.