Medical Malpractice Bulletin – September/October, 2014

Padgett MD, professional headshotPerspective: Alert fatigue – a pitfall of the EMR
By Ryan Padgett MD FACEP
[Editor’s Note: This month’s “Perspective” is contributed by my colleague, Dr. Ryan Padgett, who provides services as a Consulting Expert with / CP]

As experience with EMRs increases, new challenges are discovered. One of the most critical is “alert fatigue,” an unintended consequence of seemingly infinite information and computer algorithms. The promise of electronic systems is that they can use technology to alert a caregiver to abnormal lab results, drug-drug interaction, drug allergies or changes in patient clinical status. However, alert fatigue occurs when an EMR or other systems such as patient monitors give too many prompts, alerts and alarms resulting in an overwhelmed and unresponsive caregiver. Unfortunately, humans lack infinite capacity to respond appropriately to every alert, so the overwhelmed caregiver begins to ignore them. Read more ->

Claims – not just lawsuits and settlements must be reported to NPDB
HHS has ruled that all medical malpractice claims that include a written demand letter and charge of failure to meet the standard of care must be reported to the National Practitioner Data Bank, just like a lawsuit, verdict and/or settlement. Prior to this ruling, practitioners often failed to report such claims, regardless of outcome.

An expert opinion is NOT peer review
In July a Kentucky appellate court, in the case of Kentucky Board of Chiropractic Examiners v. Barlow(AMA login required. Contact me for more info) unanimously upheld the right of physicians to provide expert review and testimony in keeping with their full scope of practice and training. The plaintiff Board claimed that physicians could not provide expert review of medical records involving chiropractic services, citing a state statute that limits peer review to other chiropractors. The Court ruled that peer review is narrowly defined, while expert opinions of care are a different and broader concept. The Court thus affirmed that providing expert opinions is perfectly within the scope of medical practice. The case involved claimants involved in a car accident, and the physicians were evaluating only whether the services provided to the claimants were sustained in the accident (expert opinion), not the quality of the care provided by any party (peer review).

Does appendicitis require an appendectomy? More data say “Not always.”
UpToDateOnline, perhaps the “bible” of evidence-based support for medical decision-making, based on a recent study, confirms that non-operative management may be a reasonable alternative for carefully selected patients with acute uncomplicated appendicitis. Since this approach is used for diverticulitis, and because diverticula are sometimes considered “small appendices,” the concept is not entirely new. There has also been a long-standing minority opinion in medicine that certain cases of appendicitis can be treated medically, i.e., without surgery. The study supporting this concept included 159 patients with non-perforated appendicitis who were treated with antibiotics alone. Less than 12% required surgery, and after 2 years, less than 14% had a recurrence, often being re-treated with another course of antibiotics. While appendectomy remains the “gold standard,” the finding may complicate the pursuit or simplify the defense of cases of “missed appendicitis.”

How one plaintiff attorney questions experts
A New York plaintiff attorney whose blog I follow posted his rather enlightening and educational approach to cross-examining expert witnesses.  [Editor’s Note: Any time an expert will be asked questions by opposing counsel that deal with the weak points of one’s case, I find that those questions are best asked FIRST by the expert’s own counsel. This pre-empts opposing counsel and allows the expert’s own counsel a better chance of explaining their opinions.] Maybe readers can get some CLE for this one?

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