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Emergency practitioners should be aware of the risks that the AMA patient may present, as well as their responsibilities to limit their liability and ensure the patient's best care.
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The confidential nature of the therapeutic relationship between physician and patient is an integral component of the practice of medicine. The landmark Tarasoff case established a legal duty for a physician to breach this confidential relationship to warn third parties from foreseeable violence.
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This is the first in a two-part series on disclosing errors to emergency department patients. This month, we cover whether liability risks are, in fact, decreased by this practice. Next month, we will give specific strategies to reduce liability risks when apologizing to a patient.
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Anyone recently considering an elective medical procedure knows that physicians' efforts in obtaining proper informed consent have become increasingly elaborate.
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The electrocardiogram (EKG) and x-ray of a chest pain patient in his mid-50s were both normal when examined by the treating ED physician. However, the physician's shift ended before the patient's lab results were back. Based on the test results that were back, the oncoming ED physician discharged the patient as "chest pain, non-cardiac." Several hours later, the lab results came back with critical values.
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The federal government, through the Emergency Medical Treatment and Active Labor Act (EMTALA), as well as some states such as California and Florida, mandates hospitals and physicians to provide medical services to anyone presenting to the hospital's emergency department (ED). Why shouldn't governmental liability protections, such as immunity and/or damage limitations, apply to providers of emergency services?
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Over the years, emergency medicine physicians and pediatricians have been sued many times for failure to recognize and report non-accidental trauma and vulnerable children. Unfortunately, there are a number of ways to go wrong when it comes to reporting child abuse, and there are three recognized liability issues: A liability for failure to report suspected abuse, liability for reporting suspected abuse and liability for unauthorized release of confidential information during the course of reporting.
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Use of excessive force. Misapplication of restraints. Failing to follow standards from the Centers for Medicare & Medicaid Services (CMS) or The Joint Commission. Any of these practices can result in a liability claim from an ED patient for injuries arising from restraint.
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Long ago, one of my mentors staunchly opined that "only a 'real doctor' should be allowed to testify that a 'real doctor' breached the standard of care." Two recent high-level court decisions upholding tort state reforms bring us closer to that reality, i.e., requiring the plaintiff's physician expert to actually practice medicine in order to testify in a medical malpractice lawsuit.
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This is the first of a two-part series on missed myocardial infarction [MI] cases. This month, we report on the best practices for reducing liability risks involving triage, and review cases of chest pain patients involving adverse outcomes in ED waiting rooms.
