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Admitted ED patients are "definitely in a gray zone," according to William C. Gerard, MD, MMM, FACEP, chairman and professional director of emergency services at Palmetto Health Richland in Columbia, SC. "Fortunately, they are admitted, and that takes your [Emergency Medical Treatment and Labor Act] risk away. But then you get into the malpractice risks," he says.
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While unauthorized videotapes made by a patient in your ED may seem highly inappropriate, those recordings can often be introduced as evidence in medical malpractice lawsuits, according to William Sullivan, DO, JD, FACEP, an emergency physician at University of Illinois Medical Center in Chicago and a practicing attorney in Frankfort, IL.
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Some emergency physicians (EPs) have admitted that they don't take time to read the nursing notes, according to J. Tucker Montgomery, MD, JD, a health care attorney in Knoxville, TN. "Complaints recorded there that go unaddressed, or a particular abnormal vital sign, can come back to bite an EP," he says.
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When an ED patient is being held while waiting for an inpatient bed, Rolf Lowe, JD, an attorney with Rogers Mantese & Associates in Royal Oak, MI, says "there is no bright line cut off for liability. Substandard care in the ED that has an effect on the patient's outcome can result in liability for the EP and the ED staff."
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Penetrating abdominal trauma (PAT) has the potential to be a devastating injury and ranks in the top 15 causes of death for all ages. This article will define the problem of PAT and review the initial management, including the ability to identify, resuscitate, and initiate treatment in patients with unstable PAT prior to their transfer to the operating room (OR).
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Even though the admission handoff has occurred, the "boarded" ED patient is often still managed by the admitting emergency physician (EP) or another ED attending physician many hours after the shift has ended, warns Uwe G. Goehlert, MD, MPH, an ED attending physician at Northwestern Medical Center in St. Albans, VT, and principal of Goehlert & Associates in South Burlington, VT.
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If a parent objects to a medical evaluation or treatment of a child with a potentially life-threatening emergency, due to religious beliefs or any other reason, says Kevin M. Klauer, DO, EJD, FACEP, chief medical officer of Emergency Medicine Physicians in Canton, OH, the emergency physician (EP) can get a court order to get the child treated.
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When experts on either side of a lawsuit alleging ED malpractice make misleading or false statements, this reflects badly on the whole legal system, according to Ken Zafren, MD, FAAEM, FACEP, FAWM, EMS medical director for the state of Alaska and clinical associate professor in the Division of Emergency Medicine at Stanford (CA) University Medical Center.
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An ED's policy may state that reassessments should occur every 30 minutes, or that EKGs should be given within 10 minutes of the patient's arrival, but there will always be circumstances in which these timeframes aren't met.
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Jurors might be able to understand the fact that patients can't always be treated immediately in a busy ED, particularly if a plaintiff didn't have obviously life-threatening symptoms at the time.
