Medical Malpractice Bulletin – February, 2014

Perspective: Can plaintiff attorneys prevail in stroke cases?
By Charles A. Pilcher MD FACEP

This newsletter assiduously monitors the medical literature on the subject of stroke, as well as news of malpractice suits resulting from the care of stroke patients. In the past 3-4 years there has been almost zero news about lawsuits for failure to treat an acute stroke with tPA. Why is that? Are emergency physicians just better at diagnosing stroke and treating appropriate patients early? Are patients being better informed of the various risks, benefits and contraindications to the drug? Or are plaintiff attorneys now aware of the difficulty in proving causation if the drug is not used? The jury remains out on this topic, and this “Perspective” can help both plaintiff and defense attorneys determine their best course of action. More ->

Chart cloning: Efficiency or fraud?
The EHR has become a great repository of information, but it is a poor substitute for communication. Anyone in health care or med mal litigation need only think back to the days when an entire 5 day hospitalization could be captured in a stack of records about an inch thick. Now, even a single ED visit, when printed out, can produce a stack of records that thick. Physicians, nurses and staff experience the drudgery of responding to the demands of the computerized record on a daily basis, so it is tempting to resort to copy and paste – or cloning – one’s chart, just to avoid fighting the computer. Courts are now looking at that as not just efficiency, but fraud. Donna Marbury addressed this issue in Medical Economics January 14, 2014. 

Hey, Doc, can we chat?
Employed docs may now tell the attorney for their defendant employer about their treatment of a plaintiff patient even when the employed doc being questioned is not the one being sued by a patient. Such discussions may occur without the plaintiff’s counsel, citing the healthcare organization’s corporate attorney-client privilege rather than patient/attorney privilege. The decision by the Washington State Supreme Court has far too much legalese for this simple editor/physician, but for those who speak the language, the full case is available here.

Pulmonary Embolus missed in 1/3 of ED patients
A Spanish report by Torres-Macho in the American Journal of Emergency Medicine found that pulmonary embolus was overlooked or mis-diagnosed in the ED in 1/3 of patients. Delay in diagnosis was most often attributed to the presence of other chronic lung conditions. Comments associated with the online article correctly point out that not all PE’s are life-threatening, accounting for the author’s finding of no significant difference in mortality in hospitalized patients, and death likely due to other causes in discharged patients.

Change of shift/change of doc/change of nurse/change of venue: Structured handoffs reduce errors
Evidence continues to pour in showing that transferring care from provider to provider or unit to unit in a structured fashion will reduce errors. This article in JAMA, December 4, by Starmer et al. showed a decline of almost 50% in all categories of preventable error through the use of structured handoffs. Mis-communication – or worse yet, no communication – leads to error. An accompanying editorial by Horwitz supports the work done by the study’s authors. For more information on handoffs, this bulletin featured two “Perspective” essays on this topic in May and June, 2013.

For further reading:
Surgical “Never Events”
Did you ever wonder what the settlement value might be for a surgical “never event”? This study by Mehtsun et al. from Surgery, April, 2013, addresses that question.
When injured patients aren’t injured enough
Ninety percent of injured patients and their attorneys cannot afford to pursue a claim or lawsuit, according to this February article by Allen and Pierce. Does this present a case for a no-fault arbitration system in which doctors would benefit from more “learnings,” attorneys would have even more cases to resolve, and patients might be injured less often? The author’s also published 10 patient stories supporting the article.
Maybe surgeons really DON’T need sleep
This study by Vinden et al. of some 10,000 laparoscopic cholecystectomies published in JAMA found that there was no increase in complications when the procedure was performed by surgeons who had operated the night before versus those who had not.

It is always better to get the treadmill test the day BEFORE the cardiac arrest rather than the day AFTER the cardiac arrest.
Greg Moore MD FACEP

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