Medical/Legal Issues. April 13, 2018 Jennifer K. Brizee Powers, Tolman, Farley, PLLC Twin Falls, Idaho

Transcription

1 Medical/Legal Issues April 13, 2018 Jennifer K. Brizee Powers, Tolman, Farley, PLLC Twin Falls, Idaho

2 National Trends in Medical Malpractice Litigation 1. Standard of care 2. Informed Consent 3.Decubitus Ulcers 4. Wound Vac Sponge Counts 5. National Litigation: * Implants * BairHuggers 6. Social Media

3 Idaho

4 North Dakota

5 State population centers North Dakota Idaho

6 Hospital types/numbers North Dakota 0-25 beds: beds: plus beds: 6 Idaho 0-25 beds: beds: plus beds: 7

7 Standard of care

8 Trying to impose a legal term onto the medical world is like trying to fit a square peg into a round hole.

9 What is standard of care? It s the way you practice every day It s the way you treat the patient you have in front of you It s based upon the resources available to you: *education *training *equipment *specialties of others

10 Why is it important? 1. Plaintiffs have to prove you breached or violated the standard of care 2. So first they have to prove what the standard of care was (ie what you should have done) 3. Then show you did something different than others would have done 4. Then show this is what caused the injury to the patient

11 How do I protect myself? Follow hospital policies/procedures If you are uncertain, ask your supervisor If a circumstance arises that causes you to do something out of the ordinary, document, document, document If physician asks you to do something out of the ordinary, document, document, document

12 Informed Consent

13 What is informed consent? Provision of information to the patient Regarding risk/benefits/alternatives To allow the patient To make an informed decision To proceed with the treatment (ie consent)

14 Why is this a trend? Easier to prove Easier burden of proof Do not have to prove breach of the standard of health care practice He said/she said It has become so route, no one remembers details All providers can always do better Documentation always lacking Foundation for treatment Patient can argue never would have consented = never would have occurred

15 WHOSE JOB IS IT?

16 Two parts to informed consent: 1.Providing the information to the patient so he/she can make an informed decision 2. Housekeeping task of making sure the paperwork is signed

17 1. Providing the information to the patient so he/she can make an informed decision: This is the physician/mid-level s job.

18 Trends within hospitals: Software programs that are specific to procedure/treatment PICC lines Consent required by hospital (like an H & P) prior to surgery

19 2. Housekeeping task of making sure the paperwork is signed This is the nurse s job.

20 What can you do to protect yourself? Physician/Mid-level *provide the information verbally *provide the information in writing/videotape *document, document, document - in your dictation - in your handwritten notes - have patient initial/sign consent in office

21 Risk by risk consent: EXAMPLE EXAMPLE

22 EXAMPLE

23 What can you do to protect yourself? Nurse *verbal: ask whether the patient has had a chance to discuss risk/benefits/ alternatives with the phys./mid-level *document, document, document - that conversation occurred - patient response - signed consent document

24 What if the patient has a question?

25

26 And document, document, document Patient asked what is the risk to my liver. Physician called and informed of patient question. Physician to room to discuss with patient. Patient said had not discussed risks with physician. Physician called to discuss with patient. Physician in room with patient.

27 Decubitus Ulcers

28 Decubitus Ulcers National trend Not an uncommon occurrence Will become more common as population ages Occurs even when gold standard care provided Photographs explicit (wounds deep and large) Can always find fault with documentation Age of modern medicine and expectations

29 Common mistakes Initial skin assessment Failure to follow polices Turning every two hours (lack of documentation) Wound assessments (lack of documentation) Heel protectors Reliance on air beds Failure to check working properly Failure to document checks to make sure bed working properly

30 Wound Vac Sponge Counts

31 Wound Vac Sponge Counts Wound vacs more frequently used Military medical care providers Use wound vacs regularly Due to nature of front line wounds Now moving to private practice

32 EXAMPLES

33 EXAMPLES

34 EXAMPLES

35 EXAMPLES

36 National Litigation - Implants

37 Impact on Nursing Practice 1. Have to document implants (type, size, etc.) Implant stickers Nursing documentation 2. Patients AND manufacturers want implants that have been removed Do NOT produce without a court order (call your hospital attorney) Each side wants to test can be destructive testing If you produce to one side, and that side destroys, you can be liable to the other side Who owns the removed implants?

38 National Litigation - Bairhuggers Use in the OR Allegation = causes infection By moving germs through air

39 Impact on Nursing Practice Nurses are becoming witnesses. Questions asked: 1. Who initiates? 2. Who documents? 3. What are the hospital s policies re use of Bairhugger? 4. Details about OR a. Ventilation system b. Nurses in/out how many times door opened c. Room cleaning process d. Shoes worn e. Scrubs worn

40 Social Media

41 Social Media Your social media will be viewed by attorneys if you happen to care for a patient who pursues litigation What will your social media show about you?

42 Social Media Statistics Generally 68% of all adults use social media 90% of young adults use social media Facebook 68% of all US adults use Facebook Consumers/patients 40% reported information they see while using social media impacts their health decisions

43 Risks of Social Media HIPPA or another form of federal privacy violations Inadvertent disclosure of information Photos Shark bite Rectum x-ray State law Breach of privacy Breach of confidentiality Libel/slander Patient Perception (during work hours POLICY? Cell phone policy?) Admissions in litigation

44 How can you protect yourself? Do NOT give out your social media info to patients Do NOT post any work/work related photographs Do NOT write any information about your work day/events Employers cannot interfere/restrain/coerce employees who are attempting to improve terms and conditions of employment (ie negative comments) My advice: Do NOT include information on your social media about: Your profession Or at least where you work