- tPA for stroke: Give it early, but up to 4.5 hours now safe
Does improving patient safety reduce malpractice claims? Rand Corporation study says “yes.”
What seems like common sense, the Rand Corporation has verified. In a study done in California, they showed a direct link between improvements in patient safety and a reduction in malpractice cases. A brief report on the study from the LA Times has links to the original Rand report.
tPA for stroke: Give it early, but up to 4.5 hours now safe
Since a report in May, 2009, the window of opportunity for administration of the clot-busting drug alteplase has been shown to be safe up to 4.5 hours after “last seen normal.” A new report validates those findings, but confirms that earlier is better, especially if the drug can be given within 90 minutes of symptom onset. After 4.5 hours, there is greater risk of harm than benefit from the drug.
Medical records turned over in response to grand jury subpoena in criminal case. Wrong!
In a “can’t win for losing” decision, an Ohio court ruled that the release of an alleged criminal’s medical record by the Cleveland Clinic in response to a grand jury subpoena violated the patient-defendant’s right to medical privacy. Finding that the state’s privacy provisions supersede the provisions of HIPAA, the ruling allows the patient to sue the hospital for invading his privacy. The matter will now be adjudicated, most likely in federal court.
Paramedic disciplined by physician supervisor sues physician
When a physician supervisor determined that a paramedic for whom he was responsible exhibited inappropriate behavior, the physician arranged for the paramedic to be reassigned to work as a firefighter. The paramedic is now suing the physician. A District Court in Washington State granted the defense motion for summary judgment. The case is being appealed to the US 9th Circuit Court of Appeals with amicus curiae briefs being filed by several parties on behalf of the physician. For details of the case, see “Who’s In Charge on Trauma Supervision?” in Washington ACEP News.
Georgia ED docs liable only for “gross negligence”
The Georgia Supreme Court ruled 4-3 to uphold the state standard requiring that ED physicians in that state must be found guilty of “gross negligence” in a malpractice matter rather than simple negligence. The court found that the existing requirement, part of a tort reform package passed earlier, did not constitute a “special law,” which is disallowed when a general law covers a situation. For more details and a link to the ruling, click here.
Has the “locality rule” outlived its usefulness?
Some 20 states still use a version of the “locality rule” with regard to medical malpractice cases. The rule, dating from the 1880’s, is intended to protect practitioners in rural communities, where resources might be limited, from allegations of substandard care with respect to the standards available in larger locales. The questions today should be: 1) Does this rule now protect substandard care when national norms should be readily available and implemented, even in the most rural practice, and 2) Does this rule unfairly penalize a physician when his/her care conforms to national norms, but is less conservative than local standards? A case in point – regarding screening for prostate cancer – is given as an example. Today, the rule is primarily used to disqualify experts who “aren’t from around here.”