Perspective: Medical Malpractice and Healthcare Reform
By Charles A. Pilcher MD FACEP
Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. At a recent Swedish Hospital 100th Birthday Symposium on “Innovation in the Age of Reform,” an array of well-known speakers made it clear that the end game has yet to be played out. Were this a horse race, I would opt out of betting on anyone.
One of the interesting aspects of almost every such discussion is the relative absence of talk about malpractice reform. Health leaders at their core know that things could be better, and are working hard to make it so. Despite what doctors may feel, the overall plan emphasizes improving quality pro-actively, not just reacting to liability concerns.
It may be that capitation and managed again become a part of the healthcare scene. If so, another aspect of medical litigation may arise: accusations that physicians did not “do the right thing” because he/she had a profit motive. Current case law regarding existing HMO’s and managed care organizations may well need to be dusted off and reviewed. It could come in handy if that we are heading in that direction.
Hippocrates or hypocrisy: Is defensive medicine malpractice?
S. Clark Newhall, a physician and attorney in Salt Lake City, UT, responded to an article in Circulation on over-treatment and over-testing by cardiologists with a letter alleging that such a practice simply to protect oneself against legal liability might well be malpractice. What if a physician orders a contrast CT scan or treats a viral infection with an antibiotic “just to be sure,” and the patient suffers an allergic reaction? Certainly if a physician is planning to order a test or treatment he/she truly believes to be purely “defensive” in nature, he/she should have a frank conversation with the patient and document it. But couldn’t the same approach be used if one chose NOT to order a test?
Washington State law serves as template for youth athletes’ concussions.
The New York Times reports, “A Washington State law that mandates strict procedures for handling youth athletes’ concussions has served as a template for similar policies.” Washington’s law, “known as the Lystedt Law and named after a high school football player who sustained permanent brain damage, requires “education for coaches and parents, the immediate removal of any athlete suspected of having sustained a concussion, and written authorization from a ‘licensed health care provider trained in the evaluation and management of concussion’ before an athlete can return.”
Malpractice? No. Assault? Yes. Hospital sued for circumcising newborn boy against parent’s wishes
A Miami hospital claims it “misread the consent form” and proceeded to circumcise a newborn boy. The upset parents have filed a lawsuit, but for assault and battery, not malpractice.
Expert Says Complaints Of Texting Lifeguards Are Increasing.
The New York Times reports reports that Bernard J. Fisher II, director of health and safety at the American Lifeguard Association, has “heard a sharp rise in complaints about lifeguards who were texting on the job.” According to Fisher, “Lives are being endangered… and pools and waterfronts should have procedures to prevent lifeguards from using cellphones while on duty.”
Stroke: Window of opportunity enlarging
Individuals experiencing a stroke may now have at least six hours – and perhaps longer – after “last seen normal” to avail themselves of some form of treatment. Many of the options may only be available in fairly sophisticated centers, however. These involve advanced techniques such as intra-arterial thrombolysis and thrombectomy by an interventional radiologist. At best, outcomes are still only marginally better, and informed consent is crucial. Guidelines can be found on the American Heart Association website. There are also three essays on emergency management of stroke in the Perspectives archives of this newsletter.
Reminder: “Compression Only CPR”
“Compression Only CPR” is now the new American Heart Association standard. Compress the chest about 2 inches about 100 times a minute. No mouth-to-mouth breathing required. Results are far better than the old way by about 50%.