Telemedicine and medico-legal risk
Toby Biddle
Special Counsel
Norton Rose Fulbright Australia
26 March 2014
Outline
• Introduction to telemedicine
• Review of medico-legal cases involving telemedicine
• Five lessons for telemedici...
Telemedicine – introduction
222039063
What is “telemedicine”?
• The use of telephone or the internet in the diagnosis and
...
Introduction - types of telemedicine services
• Mental health lines
• Telephone GP services
• Nurse triage services
• Cons...
Introduction – drivers for growth of telemedicine
• Access to services
• Cost and funding pressures
• Technological advanc...
Telemedicine case # 1
6 22203906
Finding
Clinicians should exercise a high
degree of caution before
reaching important con...
Telemedicine case # 2
7 22203906
Finding
As no physical examination
undertaken – inadequate steps
to diagnose and prescrib...
Telemedicine case # 3
8 22203906
Finding
Counselling over the telephone
could not replace face-to-face
counselling with a ...
Telemedicine case # 4
9 22203906
Finding
Coroner recommended
institution of a telephone
consultation checklist
Inquest int...
Telemedicine case # 5
10 22203906
Finding
Failure to conduct an
examination constituted
unsatisfactory professional
conduc...
Telemedicine case # 6
11 22203906
Finding
Inappropriate to prescribe in
response to an email
HCCC re Dr Zacharia (NSW
Medi...
5 lessons for telemedicine practitioners
Lesson #1: same duty but harder to discharge
• Same duty as care as face-to-face ...
5 lessons for telemedicine practitioners
Lesson # 2 - protocols and checklists: use but don’t over-rely
• A helpful tool b...
5 lessons for telemedicine practitioners
Lesson # 3: right people and right training
• Does the telemedicine operator have...
5 lessons for telemedicine practitioners
Lesson #4 – documentation is critical
• Medico-legal advantages and risks of call...
5 lessons for telemedicine practitioners
Lesson #5 – guard against privacy risks
• Particular dangers of privacy breaches ...
QUESTIONS
17 22203906
Disclaimer
Norton Rose Fulbright LLP, Norton Rose Fulbright Australia, Norton Rose Fulbright Canada LLP, Norton Rose Fulbr...
Toby Biddle, Special Counsel, Norton Rose Fulbright Australia - The Growth of Telemedicine Services and the Particular Cha...
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Toby Biddle, Special Counsel, Norton Rose Fulbright Australia - The Growth of Telemedicine Services and the Particular Challenges and Issues which these Raise in the Medico-Legal Context

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Toby Biddle delivered the presentation at the 2014 Medico Legal Congress.

The Medico Legal Congress this is the longest running and most successful Medico Legal Congress in Australia, bringing together medical practitioners, lawyers, medical indemnity organisations and government representatives for open discussion on recent medical negligence cases and to provide solutions to current medico legal issues.

For more information about the event, please visit: http://www.healthcareconferences.com.au/medicolegalcongress14

Published in: Health & Medicine
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Toby Biddle, Special Counsel, Norton Rose Fulbright Australia - The Growth of Telemedicine Services and the Particular Challenges and Issues which these Raise in the Medico-Legal Context

  1. 1. Telemedicine and medico-legal risk Toby Biddle Special Counsel Norton Rose Fulbright Australia 26 March 2014
  2. 2. Outline • Introduction to telemedicine • Review of medico-legal cases involving telemedicine • Five lessons for telemedicine practitioners
  3. 3. Telemedicine – introduction 222039063 What is “telemedicine”? • The use of telephone or the internet in the diagnosis and treatment of patients by seeking the advice, or a second opinion, from experts at a distant hospital (Oxford Concise Medical Dictionary)
  4. 4. Introduction - types of telemedicine services • Mental health lines • Telephone GP services • Nurse triage services • Consultation liaisons between small and large hospitals • Tele-radiology • Tele-pathology • Tele-dermatology • Doctor to doctor arrangements • HealthDirect • Health fund lines • Video consultations 222039064
  5. 5. Introduction – drivers for growth of telemedicine • Access to services • Cost and funding pressures • Technological advances • Consumer demand “Telehealth will be an integral part of the future of healthcare for up to one in four people in Australia. It has the potential to prevent $4 billion in avoidable annual hospital costs incurred from chronic disease alone” www.aiia.com.au/?OneInFourLives 5 22203906
  6. 6. Telemedicine case # 1 6 22203906 Finding Clinicians should exercise a high degree of caution before reaching important conclusions on the basis of information imparted by telephone Inquest into death of Latoya Quinn (SA Coroners’ Court 2004) • Death of a 12 year old suffering from congenital hydracephalus due to shunt blockage • Admitted to from Noarlunga Hospital for headaches after a knock on the head • Telephone call from Noarlunga to paediatric registrar at Flinders Medical Centre with concern about the shunt • Miscommunication re: neurological examination at Noarlunga • Flinders authorised discharge assuming neurologically normal
  7. 7. Telemedicine case # 2 7 22203906 Finding As no physical examination undertaken – inadequate steps to diagnose and prescribe Re: Dr Dimitra Panagiotopoulos (2004) MPBV 16 • Dr P employed by Advanced Medical Institute • Patient attended AMI clinic • Patient completed a form and was interviewed by a nurse • Nurse telephoned Dr P and handed phone to patient • Dr P prescribed high potency tablets • Patient notified MPBV due to concerns as to the brevity of consultation
  8. 8. Telemedicine case # 3 8 22203906 Finding Counselling over the telephone could not replace face-to-face counselling with a difficult patient Re: Dr Robert Muller (NSW Medical Tribunal 2005) • Dr M was the sole GP who had a long-term patient with a dependence on alcohol and benzodiazepines • Towards the end of the patient’s life many consultations by telephone during which benzodiazepines were prescribed • Patient died from an overdose
  9. 9. Telemedicine case # 4 9 22203906 Finding Coroner recommended institution of a telephone consultation checklist Inquest into death of Joan Dennison (NSW Coroners’ Court 2010) • Patient aged 78 presented to Shellharbour Hospital with anorexia, shortness of breath, nausea and vomiting • Shellharbour contacted Wollongong Hospital as no surgical registrar at Shellharbour on weekends • Dispute as to amount of information provided by Shellharbour to Wollongong • Shellharbour incorrectly assumed Wollongong had computer access to radiology
  10. 10. Telemedicine case # 5 10 22203906 Finding Failure to conduct an examination constituted unsatisfactory professional conduct Assessment tool does not allow for differentiation of the various causes Re: Dr Sergio Staraj (NSW Professional Standards Committee 2010) • Dr S employed by Advanced Medical Institute • Patient attended AMI Clinic, completed form and interviewed by a nurse • Nurse telephoned Dr S • At the end of the consultation, Dr S prescribed an AMI nasal spray
  11. 11. Telemedicine case # 6 11 22203906 Finding Inappropriate to prescribe in response to an email HCCC re Dr Zacharia (NSW Medical Tribunal 2011) • Surgeon with interest in anti-ageing medicine • Prosecution from prescription for human growth hormones and testosterone for cosmetic purposes • Prescriptions over telephone and by email
  12. 12. 5 lessons for telemedicine practitioners Lesson #1: same duty but harder to discharge • Same duty as care as face-to-face practitioners • More difficult to discharge duty due to no physical examination • Additional steps need to be taken 12 22203906
  13. 13. 5 lessons for telemedicine practitioners Lesson # 2 - protocols and checklists: use but don’t over-rely • A helpful tool but double edged • Protocols and checklists cannot replace clinical judgment 13 22203906
  14. 14. 5 lessons for telemedicine practitioners Lesson # 3: right people and right training • Does the telemedicine operator have appropriate clinical expertise? • Has the telemedicine practitioner been trained in the use of the technology? • Is the telemedicine practitioner aware of the particular risks of telemedicine? 14 22203906
  15. 15. 5 lessons for telemedicine practitioners Lesson #4 – documentation is critical • Medico-legal advantages and risks of call recording • Importance of documentation for both recorded and non-recorded calls 15 22203906
  16. 16. 5 lessons for telemedicine practitioners Lesson #5 – guard against privacy risks • Particular dangers of privacy breaches when telemedicine used 16 22203906
  17. 17. QUESTIONS 17 22203906
  18. 18. Disclaimer Norton Rose Fulbright LLP, Norton Rose Fulbright Australia, Norton Rose Fulbright Canada LLP, Norton Rose Fulbright South Africa (incorporated as Deneys Reitz Inc) and Fulbright & Jaworski L.L.P., each of which is a separate legal entity, are members (“the Norton Rose Fulbright members”) of Norton Rose Fulbright Verein, a Swiss Verein. Norton Rose Fulbright Verein helps coordinate the activities of the Norton Rose Fulbright members but does not itself provide legal services to clients. References to “Norton Rose Fulbright”, “the law firm”, and “legal practice” are to one or more of the Norton Rose Fulbright members or to one of their respective affiliates (together “Norton Rose Fulbright entity/entities”). No individual who is a member, partner, shareholder, director, employee or consultant of, in or to any Norton Rose Fulbright entity (whether or not such individual is described as a “partner”) accepts or assumes responsibility, or has any liability, to any person in respect of this presentation. Any reference to a partner or director is to a member, employee or consultant with equivalent standing and qualifications of the relevant Norton Rose Fulbright entity. The purpose of this presentation is to provide information as to developments in the law. It does not contain a full analysis of the law nor does it constitute an opinion of any Norton Rose Fulbright entity on the points of law discussed. You must take specific legal advice on any particular matter which concerns you. If you require any advice or further information, please speak to your usual contact at Norton Rose Fulbright. 2220390619

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