Health Care and Legislation, Policies

Hospital Departments & Allied Professionals
Chapter 10

LEARNING OBJECTIVES
Describe the wide variety of negligent errors by various health care professionals.
Discuss the purpose of certification, licensure, & reasons for revocation of licenses.
Discuss the purpose of the Emergency Medical Treatment 7 Active Labor Act.
Explain the importance of a multidisciplinary approach to patient care.

PARAMEDICS

Emergency Medical Technician
Emergency Medical Technician
Advanced Emergency Medical Technician

PARAMEDICS – II
Paramedic
Wrong Drug Dosage Administered
Protected by Good Samaritan Statute
Inability to Diagnose Extent of Injury
Patient Refuses Transport
License Denied
Patient Refuses Transport and Expires

Emergency Department
Objectives
All Patients are Treated
Patients are Assessed
Treatment must begin as rapidly as possible to
Maintain Function
Prevent, Minimize Scarring & Deformity
Care & Treatment Regardless of Ability to Pay

CASE: No Duty to Patient
Who Left ED Untreated
In a wrongful death medical malpractice action alleging negligence, the trial court properly granted summary judgment because under Ohio law, an emergency room nurse had no duty to interfere with an individual who left the ED without telling anyone and who refused treatment.
−Griffith v. University Hospitals of Cleveland

CASE: Failure to Admit
Physician was found negligent in failing to hospitalize the patient or failing to inform her of the serious nature of her illness. The trial court found that had the patient been hospitalized on her first visit, her chances of survival would have been increased.
−Roy v. Gupta

Documentation Sparse & Contradictory
ED physician failed to evaluate the patient & to initiate care within first few minutes of patient’s entry into the emergency facility. The emergency physician had an obligation to determine who was waiting for physician care & how critical the need was for that care.
−Fenney v. New England Medical Ctr.

EMTALA
In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) that forbids Medicare-participating hospitals from dumping patients out of emergency departments.

EMTALA
42 U.S.C.A. § 1395dd(a) (1992)
in the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination . . .

EMTALA Text Cases
EMTALA Claim Against Hospital Valid
Stabalizing the Patient
Failure to Stabilize Patient
Inappropriate Transfer
Failure to Admit
Patient Who Left

EMTALA Text Cases -II
Wrong Record: Fatal Mistake
Terry was taken to the hospital after automobile accident. Upon ordering discharge, the ED physician had not realized that he had made a fatal mistake. The physician looked at the wrong chart in determining Terry’s status, thus discharging Terry. Terry died at home in his father’s arms.
−Trahan v. McManus
Who is responsible for Terry’s death?

Wrong Record: Fatal Mistake – II
The ED physician by his own admissions stated that he acted negligently when he discharged Terry and that his actions led to Terry’s death.

Duty to Contact On-Call Physician
Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the ED.
Timely Response Required
Failure to Contact On-Call Physician
Physicians Fail to Failure to Respond
Notice of Inability to Respond to Call
Telephone Medicine Costly

CASE: Telephone Medicine Costly
Lauren was taken to the hospital ED. Hospital personnel contacted the physician by phone. He returned the call & prescribed a Phenergan injection. He did not go to the hospital & had not been given Lauren’s vital signs when he suggested such an injection, & further failed to order any blood or urine tests. Hospital records revealed that Lauren’s glucose level was 507 at the time of admission. Lauren’s went into respiratory failure & eventually died.
Futch v. Attwood
Was the physician liable?

CASE: Yes!
The trial court allocated $98,000 for the conscious pain & suffering of Lauren.
The defendant complained that the award of $98,000 was excessive.
On appeal, the appellate court could not find that the trial court had erred in concluding what sum was fair to both parties.

Preventing ED suits – I
Courteous & prompt treatment
Treatment regardless of ability to pay
Triage – setting treatment priorities
Establishing on-call roster procedures
Providing consultation by specialists
Communicating to ensure complete & accurate picture of the patient’s symptoms & complaints.
Ensuring caregivers effectively communicating.
Provide continuing education programs.
Not taking lightly any patient’s complaint.

Preventing ED suits – II
All patients must be treated.
Hospital determines types of patients & levels of care they can safely address.
Knowing when to admit or transfer a patient.
Provide follow-up instructions.
Hospitals need to determine what types of patients & levels of care they can safely address. If there are several hospitals in a community, they must learn to communicate with one another & include emergency medical services personnel in addressing transport & care issues.

CASE: IMPROPER TRANSPORT
If Hospital A has no neurologist, neurosurgeon, or stroke team & Hospital B, 1-mile away has all of that plus a Level I trauma center, would it be fair to say that a suspected stroke victim should be transported to Hospital B?

Yes!
Its is not just any hospital, it is the right hospital that saves lives.
Taking the patient to hospital A raises both ethical and legal issues.
Under what circumstances would hospital B be the first hospital of choice?

Laboratory Services
Provides vital data
Monitors therapeutic ranges
Measures blood levels for toxicity
Places & monitors instrumentation on patient units
Provides education for lab & other disciplines as necessary

Laboratory Services – II
Provides valuable data utilized in research studies
Provides data on most effective and economical antibiotic for treating patients
Serves consultation role
Provides valuable data as to the nutritional needs of patients . . . .

Failure to Detect Pap Smear Changes
Court determined evidence relating to negligence claims pertaining to Pap tests taken more than 2 years before filing the action were admissible because the patient had a continuing relationship with the clinical laboratory as a result of her physician submitting her Pap tests to the laboratory over a period of time.
−Sander v. Geib, Elston, Frost Prof’l Ass’n

CASE: Importance of Laboratory Results
Impending Stroke
High Glucose Levels Not Addressed
Controlled Glucose Levels =
Improved Recovery
Fewer Deficits

LAB: Text Cases
Test Results and Misdiagnosis
Confusion of Laboratory Specimens
Failure to Follow Recommended Transfusion Protocol
Mismatched Blood
Transfusion of Wrong Blood

Medical Assistant
An unlicensed person who provides administrative, clerical, and/or technical support to a licensed practitioner.
Employment of medical assistants is expected to grow much faster than the average for all occupations.
Those in large practices tend to specialize in a particular area, under supervision.

Nutritional Services
Need to provide nutrition
Failure to do so can result in a lawsuit
facility patient’s highly vulnerable
Lambert v. Beverly Enterprises
Patient suffered malnutrition
Motion to dismiss case denied

Pharmacy: Medications
Immense variety & complexity of medications.
Impossible for nurses or doctors to keep up with the information required for safe medication use.
The pharmacist has become an essential resource in modern hospital practice.

FD Finds Safety Problems
at Specialized Pharmacies
Federal inspectors have found dozens of potentially dangerous safety problems at 30 specialized pharmacies, months after tainted steroid shots made by a Massachusetts pharmacy triggered the worst drug disaster in decades.
−Lena H. Sun, The Washington Post, April 12, 2013

Common Prescription Errors
Wrong patient
Wrong drug
Inappropriate drug ordered due to known drug allergies or drug-drug and food-drug interactions
Wrong dose
wrong route
wrong frequency
transcription errors due to illegible handwriting or improper use of abbreviations
inadequate review of drug appropriateness

Common Dispensing Errors
Improper preparation of medication
Failure to properly formulate medications
Dispensing expired medications
Mislabeling containers
Wrong patient
Wrong dose
Wrong route
Misinterpretation of physician order

Common Documentation Errors
Transcription errors often due to
illegible handwriting
improper use of abbreviations
Inaccurate transcription to medication administration record (MAR)
Charted but not administered
Administered but not documented on the MAR
Discontinued order not noted on the MAR
Medication wasted and not recorded

Control of Drugs
Federal Controls
Controlled Substance Act
Federal, Food, Drug & Cosmetic Act
State Regulations
Storage of drugs
Hospital Formulary

Decreasing Med Misadventures:
Helpful Tips
Be sure handwriting is legible; print if necessary.
For clarity, do not use felt-tip pens.
Abbreviations should be used per hospital policy.
Do not write ambiguous orders.
Always add a zero prior to a decimal.
Hold orders should be accompanied by a time frame.
Know about the med that you are prescribing.
Administered by the proper route.

Role of Pharmacists
Duty to monitor patient’s medications
Computer systems monitor for:
Drug-drug interactions
Drug-food interactions
Limited Duty to Warn
Pharmacists cannot possibly warn caregivers & patients of every potential danger of a drug.
Warning patients – potential for overdose
Refuse to honor questionable prescriptions

Role of Pharmacists – II
Intravenous Admixture Service
Dispensing and Administration of Drugs
Duty to Monitor Patient’s Medications
Warning Patients: Potential for Overdose

Role of Pharmacists – III
Limited Duty to Warn
Refusal to Honor Prescription
Failure to Consult with the Patient’s Physician
Internet Pharmacy

Physical therapy
Art & Science of preventing & treating neuromuscular or musculoskeletal disabilities
Evaluation of patient’s disability & rehab potential
Treatment Modalities
physical agents (heat, cold, ultrasound, electricity, water, and light)
neuromuscular procedures

CASE: Interpreting Physicians Orders
Plaintiff alleged that defendant failed to exercise degree of care & skill ordinarily exercised by physical therapists, failed to heed his protests that he could not perform the physical therapy treatments she was supervising, & failed to stop performing treatments after he began to complain he was in pain. Plaintiff’s expert testified defendant deviated from standard of care by introducing a type of exercise not prescribed by the physician.
−Pontiff, in Pontiff v. Pecot & Assoc.

Court’s Ruling
The appeals court found that the trial court was correct in its determination that the plaintiff presented sufficient evidence to show that this duty was breached & that therapist’s care fell below the standard of other physical therapists.

Case: Neglect

Refusal to allow patient to go to the bathroom
prior to therapy
Court determined
evidence supported a finding of resident neglect.

CASE: Termination
Contracted Services

Hospital could terminate PT contracted services
Hospital decided to establish hospital-based physical therapy program
Hospital had right to terminate services

Physicians Assistant
Graduate of an accredited PA educational training.
Nationally certified and state-licensed to practice medicine.
with the supervision of a physician.
Scope of practice defined by each state.
PAs responsible for own negligent acts.

Respiratory Therapist
Failure to remove endotracheal tube
Multiple use of same syringe
Failure to properly restock the Code Cart

Licensing
Healthcare Professionals – I
Recognition by a governmental or professional association that an individual’s expertise meets the standards of that group.
Some professional groups establish their own minimum standards for certification in those professions that are not licensed by a particular state.
Certification by an association or group is a self-regulation credentialing process.

Licensing
Healthcare Professionals – II
Authority grants permission to a qualified individual to perform certain specified activities.
Licensure refers to the process by which licensing boards, agencies, or departments of the several states grant to individuals who meet certain predetermined standards legal right to practice in a health care profession.

Licensing
Healthcare Professionals – III
Suspension & Revocation of License
procurement of a license by fraud
unprofessional, dishonorable, immoral, or illegal conduct
performance of specific actions prohibited by statute; and malpractice.

Licensing
Healthcare Professionals – IV
Commonly stated objectives of licensing laws are to
limit & control admission to the different health care occupation
protect the public from unqualified practitioners by promulgating & enforcing standards of practice

PROFESSIONAL MISCONDUCT
Reporting medical misconduct
Sexual Improprieties
Dentist
Physician
Psychiatrist

Helpful Advice for Caregivers
Abide by the ethical code of one’s profession.
Do not criticize the professional skills of others.
Maintain complete medical records.
Seek the aid of professional medical consultants when indicated.
Inform the patient of the risks, benefits, and alternatives to proposed procedures.

Helpful Advice for Caregivers – II
Authenticate all telephone orders.
Obtain a qualified substitute when you will be absent from your practice.
Be a good listener, and allow each patient sufficient time to express fears and anxieties.
Safely administer patient medications.
Closely monitor each patient’s response to treatment.

Helpful Advice for Caregivers – III
Develop & implement an interdisciplinary plan of care for each patient.
Safely administer patient medications.
Closely monitor each patient’s response to treatment
Provide education & teaching to patients.
Foster a sense of trust & feeling of significance.
Communicate with the patient & other caregivers.

Helpful Advice for Caregivers – IV
Provide education and teaching to patients.
Foster a sense of trust and feeling of significance.
Communicate with the patient and other caregivers

REVIEW QUESTIONS
What was the reasoning for enacting the EMTALA?
Should medical advice be dispensed on the telephone? Explain your opinion.
Discuss why you think the prescribing, control, administration, and monitoring of medications has become a major area of legal concern for health care professionals.
Describe the difference between the certification and licensing of a health care professional.

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