Malpractice Case 2024 PDF

Malpractice case John D. Bennett DPM College of podiatric medicine and surgery Some material has been adopted from Denise Hill JD. presentation. Objectives: Recognize factors associated with malpractice Recall elements associated with negligence What is statute of limitatio...

Malpractice case John D. Bennett DPM College of podiatric medicine and surgery Some material has been adopted from Denise Hill JD. presentation. Objectives: Recognize factors associated with malpractice Recall elements associated with negligence What is statute of limitations Provider/Patient Relationship? Traditional situation—duties attach Makes appointment, seen & treated Relies on provider’s recommendations Limited Purpose Work Physical Court Competency Determination Emergency Work Comp. Not about who pays—duty is to the patient Duty to Treat Treatment relationship is generally a contract between a provider and a patient--Requires agreement by both parties to enter into the relationship. A physician may refuse to treat. Cannot refuse to treat a patient because of the patient’s race, sex or HIV status--federal anti- discrimination statutes. Cannot refuse to treat under emergent situations, or if under contract. Terminating Care Generally Patient right to unilaterally end relationship with provider at any time. Right of provider to end relationship is limited by duties (EMTALA, notice and civil rights/ADA). Can’t discriminate Must provide notice Cannot abandon patient 5 Incidences the Physician may want to end relationship… Failure to comply/show up Failure to pay Disruptive or violent patient Drug seeking patient Violent or Disruptive Patients Negligence: No Intent Required Failure to use reasonable care under circumstances (Standard of Care) Medical Malpractice is negligence because generally there is not intent Negligence: Elements to Prove Duty-obligation to conform to a recognized reasonable care under circumstances (Look at standard of care and use experts to establish) Breach-Breached duty by failing to meet the standard of care. (Experts) Damages-Compensatory and intangible losses Causation-Cause of injuries/damages not occurred any way or for different reason—foreseeable Common Examples of Medical Negligence: failure to diagnose a condition or to diagnose a condition in time to treat it properly failure to treat a condition properly failure to monitor or observe the patient failure to perform surgery properly failure to order necessary tests failure to consult with specialists failure to prescribe/administer correct medication/dose(s)  Defense: Statute of Limitations Negligence (Iowa Code §614/IBME Rules) Statute of Repose: (A statute of repose is a time limit that cuts off a plaintiff's ability to recover damages in a civil lawsuit. The statutes of repose are typically put into place for product liability cases, construction defects or designs, and medical negligence claims) most states, its 10 yrs. Adults 2 years past date of discovery (Up to 6 years last date of service + 1 year for estates) Minors (8-plus-2 rule) If the injured party is a minor under the age of eight, the suit must be filed by the minor's 10th birthday or within 2 years from the date of the injury, whichever occurs later. The Court determined that the limitation applicable to minors in §614.1(9)(b) applies to parental consortium claims when the parent, not the child, is the victim of malpractice. Christy v. Miulli, 692 N.W.2d 694 (Iowa 2005) 2008 Iowa Supreme Court Redefines Statute of Limitations. In two cases (No. 109/04-1727 Murtha v. Cahalan et al /No. 115/04-2081 Rathje v. Mercy Hospital ) the Iowa Supreme Court ruled that the two-year statute of limitations on medical malpractice should begin when the extent and cause of an illness and injury are known, not when an initial diagnosis is made. This interpretation resulted in two cases being returned to district court for reconsideration. Available at http://www.judicial.state.ia.us/Supreme_Court/Recent_Opinions/20080222/04-1727.pdf Attempt for a Legislative Fix in 2009 General Assembly Case Study  35 y/o white female seen for chronic right calf pain. The patient denies trauma, change in shoe gear, or activities. She does stand on her feet a great deal as a cashier. PMH: unremarkable Surgical Hx: unremarkable Soc. Hx: unremarkable Denies any medications or allergies. Patient denies any signs or symptoms of an inflammatory arthropathy.  Physical exam: Neurovascular status: intact. No pain with squeezing of right calf. Dermatological: No edema, erythema, or masses palpated on posterior right calf and Achilles tendon insertion. Musculoskeletal: Pain with palpation at myotendinous junction of right gastroc-soleus complex. Limitation of ankle dorsiflexion with the knee extended and flexed, bilaterally. Pain in posterior right calf at the end range of passive dorsiflexion. Pain with plantarflexion of right ankle against resistance. Muscle power is 5/5 bilateral and symmetrical. Pain in posterior right calf with active toe-standing and heel-standing. Rectus foot in weightbearing. Remainder of biomechanical exam unremarkable. Right ankle and leg x-rays: unremarkable.  Assessment: Right gastroc-soleus equinus causing strain at the myotendinous junction. Plan: ½ inch heel lifts; active, gentle stretching, Ibuprofen 800 mgs. Tid, work release to allow sitting while at work  2nd visit (2 weeks later): Patient denies any improvement. No physical changes upon exam from first visit. Patient placed into a BK walking cast with ankle at neutral and told to follow in one week.  Phone message to doctor on call (3 days later): Patient “irate” that cast is hurting her and seen in ER. Cast removed. On-call doctor says patient was abusive and using foul language to the point that hospital security was summoned.  3rd visit (next morning): Patient claims that on-call doctor did not understand her situation. Claims cast was not hurting her, just a little tight and wanted advice about what she should do. Claims that the cast was greatly reducing her comfort and wanted it reapplied. No signs of cast irritation or swelling seen. Cast reapplied with follow-up in one month, sooner if problems develop.  4th visit (one month later): Patient related complete relief of pain and cast was removed. Patient was advised to return to ½ inch heel lifts, bilaterally; limit unnecessary standing or walking for 2 weeks to allow muscle power and ankle range of motion to return to normal; take NSAID’s as needed.  5th visit (six weeks later): Patient relates pain is worse than before, in spite of following medical advice. Signs and symptoms unchanged. Blood work ordered which showed a sed rate of 45 and patient referred for rheumatology consult.  Rheumatology consult (5 days later): Results unremarkable, but based on level of patient’s pain, a biopsy of tissue from the myotendinous junction is recommended by rheumatologist.  Surgery (following week): Uneventful biopsy of section of tissue from area of concern on posterior calf by podiatrist demonstrated normal histology. Patient was put on crutch walking for 3 weeks to prevent stress on surgical area.  Post-op course: Uneventful with stitches out at 3 weeks and return to shoes with heel lift. Reappointed to rheumatology  6 weeks after surgery: Patient seen as a work-in per the request of the rheumatologist who feels a steroid injection into area of discomfort is appropriate and necessary at this point since pain was unchanged following biopsy. 0.75 cc of triamcinolone (preference of rheumatologist) injected into myotendinous junction. Pt immobilized in a compression dressing to limit calf mobility. Reappointed for 1 week.  2 days after injection: Patient seen on emergent basis in office due to intense calf pain. Compression dressing removed to reveal surgical wound had dehisced with drainage and mild odor. No erythema or edema and patient is afebrile. Betadine dressing applied, calf immobilized, and patient reappointed for 1 week later. Patient requested antibiotics, but they were not prescribed by podiatrist based on appearance of wound.  1 week later: Received phone call from attending at another hospital requesting information on case since patient was admitted for a Pseudomonas infection with apparent tendon and muscle necrosis. When asked to take over care of patient in hospital, podiatrist was denied access because “patient never wanted to see him again”.  3 months later: Patient commences lawsuit against podiatrist for gross negligence.  2 years from date of filing of case: Out-of-court settlement for $25,000.00. Practicing medicine in an imperfect world. Five truths about preventing or surviving a lawsuit. Minn Med. 2013 June;96(6):31-3