Medical Malpractice and the Primary Care Provider
- Mon, 9/15/08 - 9:28am
- 0 Comments
Pages 27 - 30
Although all healthcare providers are at risk of being sued as part of a medical malpractice case, only a minority of healthcare providers have had the uncomfortable experience of actually being sued 1 Medical jurisprudence is not taught in most medical schools or residency programs, so most healthcare providers enter a medical malpractice case for the first time with little or no knowledge of what will happen and what is expected of them. Using an illustrative case, this article will lead the reader through the course of a typical malpractice case, giving advice on how to prepare for and strengthen your defense. Risk management strategies will also be discussed.
Mr. Jones is 84 years old. He has a history of atrial fibrillation, congestive cardiac failure, and a distant history of a seizure disorder. He is taking warfarin, atenolol, furosemide, and phenytoin. His international normalized ratio (INR) is tested approximately every three weeks, and he is consistently in the therapeutic range of 2-3. After discussing the issues with the patient, you decide to discontinue his phenytoin. Two weeks later, Mr. Jones is admitted to a local emergency room because of a stroke. The computed tomography (CT) scan shows a large cerebral infarct, and his INR is 1.1. The patient dies the following day. Three months later, you receive notification that you are being sued for malpractice. The patient’s son has contacted a plaintiff attorney. They contend that inadequate monitoring of the patient’s anticoagulation status led to his stroke and subsequent death.
The Litigation Process
Four criteria must be met for malpractice litigation to have merit2:
1. Did the named individual or institution have an established duty or obligation to perform a particular service or provide care to an individual?
2. Was there a breach of this duty that fell below the applicable standard of care?
3. Was there an injury to the individual that occurred?
4. Was there a proximate cause that links the breach of this duty directly to the injury being alleged by the plaintiff?
A patient or a patient’s family member(s) may approach a plaintiff attorney if they feel that poor care has resulted in a bad outcome. The plaintiff attorney will review the case and decide whether to proceed with the suit. Most states have a state-specific statute of limitations governing how soon a case needs to be filed after the alleged malpractice occurred. In Connecticut, for example, the case must be filed in most instances within two years of the occurrence.3 Most plaintiff attorneys work on a contingency basis and will only proceed with the case if they believe it can be won or settled.
In the case outlined above, the plaintiff attorney has a nurse on staff who reviewed the case and felt that there was sufficient evidence to proceed with a suit. The patient’s son was upset that the attending physician did not call and explain what had happened at the time a stroke occurred.