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Last month's ED Legal Letter analyzed some recent tort reform court battles. This month, we review cases where physicians are suing state governments to stop them from pilfering the cash in patient malpractice compensation funds, and a few more cases litigating state and federal tort laws.
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"This takes the longest to document," he says. "I might not remember every piece of history I asked, or every part of the physical exam that I did, even with computer guidance," he says. "But I spend most of my time on medical reasoning."
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There are many things that factor into missing a diagnosis of appendicitis, says William Sullivan, DO, JD, FACEP, director of emergency services at St. Mary's Hospital in Streator, IL.
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Have you or one of your colleagues been named in a lawsuit that seems so frivolous that it could be the poster child for tort reform? If so, that doesn't change the fact that you may be in for a life-changing experience.
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"There are unscrupulous lawyers, some of whom are very skilled and may hope to settle for just a little bit of money," says Kelen. "But I've been at this for a while, and I am not really aware of suits that were so frivolous that they were brought just to get money."
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All action in the medical malpractice arena is happening in the states; the U.S. Congress has no stomach to tackle the issue, as evidenced by its failure to include tort reform in its behemoth 2,700-page health care reform bill.
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Although lawsuits against nurse practitioners (NPs) and physician's assistants (PAs), often referred to as "mid-level providers" or "physician extenders," aren't very common, they typically name the supervising ED physician.
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The practice of emergency medicine is unique in that an emergency medicine physician acts as a gatekeeper: while treatment of a patient may be brief, initial examination and assessment will often dictate the course of the patient's treatment after admission to the hospital.
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Your ED patient's bad outcome might have nothing to do with the fact that he or she was held in the hallway while awaiting an inpatient bed. However, it could impact the outcome of subsequent litigation against the ED.
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Misdiagnosis of aneurysmal subarachnoid hemorrhage in the ED has been reported to occur in a significant proportion of cases, due in part to a wide spectrum of presentations and subtle initial signs.
