| Progress Notes | April 2007, Volume 2, Issue 2 |
Saving the Patient Money Proves Costly
The practice of forgoing pathological analysis of tissue following elective surgery can have significant claim ramifications.
In several recent claims involving elective procedures, surgeons opted to either forgo pathological tissue analysis or changed their pathology review procedure in order to reduce the patient’s financial burden. As a result, the surgeons were sued for delay in diagnosing cancer. We aggressively defended these claims, but each involved months of litigation in order to develop a defense that focused primarily on the theory that the delay in diagnosis caused no change in the patient’s treatment or outcome. Defending the doctor’s decision to save the patient money in the face of a delayed cancer diagnosis proved difficult and very costly for the physician’s defense.
What we learned from these claims is that good medical judgment should not be influenced by cost. In addition, being familiar with your hospital’s or surgery center’s policies and adhering to them will provide you with a solid defense. Finally, whenever you send tissue to pathology, be sure that procedures are in place for following up on the results.
Meet Your Texas Claims Specialist
As our presence in the state of Texas grows, we would like to acquaint our Texas members with Resident Claims Specialist Debra Palmatary. Located in Houston, Ms. Palmatary is a native Texan who has been working for The Doctors Company for over five years. She has been handling claims in the insurance industry for 23 years. For the last 15 years, her focus has been on professional liability claims. Ms. Palmatary’s vast experience in the area has earned her the respect of plaintiff and defense attorneys and other malpractice claims professionals.
2007 California Defense Counsel Legal Summit
On June 29 and 30, 2007, we will host our second annual California Defense Counsel Legal Summit at our Napa headquarters. The Legal Summit is directed at the senior trial counsel who defend our members, with the ultimate goal of enhancing their skills.
The substantive portion of the program will be devoted to a practical review of trends and issues affecting the defense of medical malpractice claims. This year we are honored to have Armand Arabian, former justice of the California Supreme Court, as our keynote speaker.
Due to the popularity of the first Legal Summit held last June, we are also looking into holding a second summit, which would take place at a location in the Midwest.
Relying on Radiological Tumor Positioning Results in Plaintiff Verdict
The patient presented to our insured neurosurgeon with complaints of chronic back pain. The radiographic studies read by a radiology tech and radiologist showed discrete spinal column mass. The preoperative marking and intra-operative x-rays confirmed that the insured would be operating at the appropriate level. Additionally, there was no evidence that a “time out” was taken by the surgical team to assure surgery would be performed on the correct site. On pathologic evaluation, however, no tumor was found.
A repeat MRI revealed that the lesion was still present but was located at the adjacent spinal level. A second exploration took place, and the tumor was removed. Currently, the patient requires a walker to ambulate.
The plaintiff alleged that the insured negligently relied on the radiologist’s interpretation and that the insured should have reviewed all available radiological studies personally to confirm the location of the mass. The neurologist’s failure to comply with processes to prevent wrong-site surgery resulted in a second surgery and residual neurological deficits.
The case was tried and resulted in a verdict against our insured of $1.3 million, plus $328,000 in prejudgment interest.
Rx for Patient Safety: Medication Reconciliation
As medicine becomes increasingly specialized, it is not uncommon for patients to have several physicians prescribing for them at a given time. Patients may be receiving the same or similar medications of varying doses from more than one physician. Generic and trade names of medications add to the confusion with the potential for disaster.
A complete medication inventory should be obtained from the patient on the initial visit. It is helpful to record medications on a separate medication sheet for ease in accessing the information. Allergies should be recorded in a prominent location both on the medication sheet and on the front of the chart. Don’t forget to include any over-the-counter medications, vitamins, herbal supplements, dietary supplements, homeopathic medications, alternative medicine, and recreational drugs in your inventory. In some instances, it is helpful to have patients bring in all of their medications in a “brown bag” for review. Instruct your staff to update this list with the patient at each visit.
Ideally, all patients should carry a wallet-sized card listing all of their medications. Recording the patient’s allergies on this card is also helpful. For assistance in developing safe medication practices within your office, please contact the Patient Safety Department at (800) 421-2368, extension 1243.
— Sandra Shalometh, MA, MSN, RN, CPHRM,
Patient Safety/Risk Management Account Executive
Progress Notes is published quarterly by the Claims and Patient Safety Departments of The Doctors Company.
