Liability

PART 1The role of staff in preventing Medical Malpractice Claims

Proper screening and written records are key to keeping out of court.

Hans K. Bruhn, MHS, San Francisco

Just as it takes a village to raise a child, the delivery of ophthalmic care requires a team to help focus on patient well-being. This team includes nurses, ophthalmic technicians and office staff. Typically, care occurs without incident. However, when mishaps by medical staff do occur, it can potentially lead to a professional liability claim alleging negligence. Details about these claims typically focus on the physician. However, an examination of many claims shows actions or inaction by nurses, technicians and office staff can be a contributing factor in a medical malpractice claim.

What are these actions, who is involved and why do they present a risk of a claim? This article reviews the staff ’s role in avoiding malpractice claims.

Failure to Properly Screen Patients

Let’s start with an example: A patient who had been seen by an insured ophthalmologist for a number of years called the office with complaints of seeing streaks and black spots. She was given an appointment in three weeks even though she later claimed that she told the receptionist it was an emergency and she needed to be seen immediately. Three days later, the patient called the office to report seeing spots and showers of stars and asked to be contacted if any appointments became available before her scheduled appointment. Five days later, she again contacted the office to report seeing black over one-third of her vision in the affected eye. She was given an appointment in seven days. The patient presented to the office one day before her scheduled appointment and was diagnosed with a retinal detachment. She was immediately referred to a retinal specialist to reattach the retina. The surgery was successful, but the patient had a minor loss of vision and diplopia. This case centered around a factual dispute between the plaintiff and the receptionist who took the telephone calls regarding the urgency of the plaintiff’s medical complaints. The plaintiff alleged the office staff ignored her complaints and did not treat the situation as an emergency. She also maintained that had the staff brought her complaints to the ophthalmologist’s attention, an appointment would have been obtained in a timelier manner and she would not have suffered a retinal detachment with subsequent diplopia and vision loss.

Written Screening Protocol

The best way to ensure the correct questions are asked (so proper care decisions can be made) is to develop a written screening protocol and to ensure staff are properly using it and documenting the encounter accurately. Staff does not always have the benefit of face-to-face communication and a physical examination of the patient. If the patient is not able to communicate his or her problem accurately, medical decisions made on a limited amount of information are a risky, albeit necessary, aspect of ophthalmic practice.

Nurses and technicians should follow a screening protocol that is specific to their patient population, subspecialty, and staff experience.

Defensive Documentation

The importance of documentation continues beyond calls with patients. It is the best defense, once a claim is filed. Defense attorneys complain that if they can’t defend the records, they can’t defend the doctor. Conversely, plaintiff attorneys, when confronted with good documentation, probably will not pursue a claim.

Who is responsible for documentation? The answer is: everyone in the practice. If an encounter with a patient pertains to the patient’s care, it should be documented. When in doubt about what to document or how, ask others in the practice or contact the risk management department of your professional liability insurer.

Documentation promotes patient safety and continuity of care by providing a comprehensive account of the diagnosis and treatment. It provides evidence that can be used to defend, or possibly assail, the ophthalmologist’s care in a claim or lawsuit, and it serves as a basis for coding and billing of the care provided.

The continuation of Mr. Bruin’s series The Role of Staff in Medical Malpractice Claims will focus on informed consent and managing disgruntled patients. It will run in the March/April issue of Ophthalmic Professional. OP

Mr. Bruhn is the senior risk management specialist at Ophthalmic Mutual Insurance Company (www.omic.com) based in San Francisco, Calif.