Malpractice attorneys who need a physician to review a case often come to Bruce Janiak, MD, for his help. But Janiak usually declines.
“In the past five years, I’ve only found one surgeon who is interested in reviewing cases,” says Janiak, a professor in the department of emergency medicine at the Medical College of Georgia.
Since most faculty members lack interest in medical/legal topics, they’re not covering the information with residents.
“Residents have an intense interest in the medical/legal pitfalls that emergency physicians can get into,” Janiak says. “They want to know how to manage their risk.”
Janiak and several colleagues regularly discuss ED malpractice cases. In the course of these conversations, Janiak came up with the idea of setting up a center with two objectives: education and research.
“Most EDs don’t do much to educate other departments,” Janiak says. “But when you think about it, so many lawsuits that happen in other departments involve the ED. That’s where things begin.”
The group wanted to create the Center for Medical Legal Education and Research. The dean pointed out that a “center” required a level of bureaucracy that one would not see in an “office,” since an office can be created within the department of emergency medicine. So Janiak’s group received approval to establish the Office of Medical Legal Education and Research.
“The dean says if it grows and becomes a big deal, he will support the name change from ‘office’ to ‘center,’” Janiak notes.
The group began by inviting interested faculty members to develop curriculum for residents and/or provide lectures to other hospital departments on their unique medical/legal risks and how these relate to emergency medicine.
“We will not be limiting our educational process to our department. We will be contacting every department within our medical school,” Janiak explains.
One likely topic is the system for reviewing discrepancies in radiology studies performed in the ED. Physicians in other specialties often have no understanding of EMTALA requirements and associated legal risks, Janiak adds. Other planned topics include:
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introduction to the legal process;
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pitfalls in charting;
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importance of medical decision-making documentation;
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triage notes;
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actual case reviews;
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high-risk patients;
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irrational malpractice fears.
“We expect to get an enthusiastic response,” Janiak says. “We have fairly significant institutional support.”
One of the hospital’s risk managers joined the group, emphasizing that he was there to give advice as needed and to serve as a link to the administration.
“It is not an attorney-run project, but rather a physician-run project,” Janiak notes. “He will report what we’re doing to the president and some of the higher-up physicians in charge of education.”
Janiak would like to expand the project outside the institution by providing rural hospitals with education via telemedicine.
The group, which consists of seven EPs, plans to present at grand rounds, focusing on the medical/legal aspects of cases instead of the clinical aspects.
“Getting that scheduled won’t be easy, because every resident’s schedule is packed with lectures that relate to the core competency of the specialty,” Janiak notes.
However, interest and need are both high. Medical students receive “pretty much zero” education on medical/legal issues in medical school, Janiak says. How much information residents receive in the clinical setting usually depends on whether faculty members have expertise in the topic.
“Frequently, a staff attorney speaks to them, but that’s it. They don’t get the nuances of things that get people in real trouble,” Janiak says.
The idea, Janiak adds, is to “deal with risk that’s already occurred and prevent further harm.”
Janiak points to the example of a chart that notes an abnormal vital sign, but says nothing about what the EP did to address it.
“It requires not an attorney but a clinician to explain to a provider what the clinical and quality pitfalls are for the patient — and what the legal pitfalls are for the physician,” he says.
If the education comes from an attorney, “it’s not very well-absorbed, because it’s coming from someone who doesn’t speak medical language as well as we do,” Janiak adds.
The education will identify clinical behaviors that can improve care and avoid lawsuits.
“But much more importantly than that, we can learn from other people’s unfortunate mishaps and hopefully avoid repeating that same problem,” Janiak underscores.
The group is unaware of any institution undertaking something similar but would be open to a joint venture with another hospital.
“I don’t see any downside to this,” Janiak says. “This is a major gap, at least in our institution ... The first phase is to get the database going. We will then open it up to those with an interest.”
Janiak has already started creating a database with some malpractice cases he personally reviewed.
“The database is still a work in progress. We have some technical issues to resolve — not only how we create it but also how we access and store it,” he says.
The goal is to create the ability to search using keywords such as “meningitis” and “multiple visits” so users can track ED malpractice cases in a variety of ways.
The group now has about 2,000 cases to include in the database. Faculty members reviewed all cases in the past 30 years.
“None of the cases came from our own department,” Janiak notes. “Looking at every one of those will be a lot of work.”
Users will be able to access not just a summary of the cases, but also the ED records with identifying information redacted.
Other databases might indicate the number of malpractice lawsuits against EPs alleging missed heart attack, but that doesn’t say whether the diagnosis was truly missed, or if it was, how that happened.
“Existing databases are based on allegations and not clinical behaviors,” Janiak says. “We want to understand the nuances of the problem with the interaction with the patient.”
SOURCE
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Bruce Janiak, MD, Professor, Department of Emergency Medicine, Medical College of Georgia, Augusta, GA. Phone: (706) 721-1005. Email: [email protected].
