The document discusses several medical malpractice cases related to emergency departments and allied health professionals. It begins with cases involving misdiagnoses in emergency departments that resulted in patient deaths. It then discusses cases involving chiropractors, dentists, emergency physicians, nurses, pharmacists, physical therapists, and other medical professionals. Common errors included failing to properly treat or admit patients, providing negligent care, and misinterpreting or failing to follow physician's orders. Consequences included injuries, deaths, and lawsuits against the responsible medical professionals and facilities.

2. Chapter 10
Allied Professionals
Legal Responsibilities
2

3. Dying at the Hospital’s Door
• Communications Breakdown
• A Child’s Death
• A Lawsuit Occurs
• A Court Awards Damages
• But What Has Changed?
• Lessons Learned
– Triage the Patient
• Don’t make hasty judgments about a patient
who arrives at the Emergency Department
Entrance
3

4. Chiropractor – I
• Standard of care required
– degree of care, judgment, & skill exercised by
other reasonable chiropractors under like or
similar circumstances.
4

5. Chiropractor
Case: Immoral Conduct
• Conspiracy to manufacture & distribute misbranded
substance.
• Introduced misbranded & adulterated drugs into
interstate commerce with intent to defraud.
• District & appellate courts found chiropractor’s
conduct immoral.
• Chiropractor’s denial now, after taking advantage of a
plea bargain, that he committed any of the acts he
admitted to in the U.S. district court is disturbing &
not consistent with integrity expected by persons
engaged in a professional occupation.
• See text case: Poor v. State
5

6. Dentistry Cases – I
• Drill Bit Left in Tooth
• Failure to Refer
• Lack of Consent
– Removal of teeth without consent
• Failure to prescribe antibiotics
– Risk of not prescribing an antibiotic is that bacteria
can flow through the bloodstream to the heart.
6

7. Dentistry Cases– II
• Infection Control
– Failure to Wear Protective Gloves
• Practicing Outside Scope of Competecy
– Dentist performed several elective cosmetic
procedures including a face lift, eyelid
revision, and facial laser resurfacing.
• Dental Hygienist Administers Nitrous Oxide
• Failure to Supervise Dental Assistant
7

8. Emergency Department
• Objectives of Emergency Care
– treatment must begin as rapidly as possible
– function is to be maintained or restored
– scarring & deformity are to be minimized
– treatment regardless of ability to pay.
8

9. No Duty to Patient
Who Left ED Untreated
In a wrongful death medical malpractice action
alleging negligence, the trial court properly
granted summary judgment because under Ohio
law, an emergency room nurse had no duty to
interfere with an individual who left the ED
without telling anyone and who refused treatment.
See text case: Griffith v. University Hospitals of
Cleveland
9

10. Failure to Admit
Physician was found negligent in failing to
hospitalize the patient or failing to inform her of
the serious nature of her illness. The trial court
found that had the patient been hospitalized on
her first visit, her chances of survival would have
been increased.
See text case: Roy v. Gupta
10

11. Documentation Sparse &
Contradictory
ED physician failed to evaluate the patient & to
initiate care within first few minutes of patient's
entry into the emergency facility. The emergency
physician had an obligation to determine who was
waiting for physician care & how critical the need
was for that care.
See text case: Fenney v. New England Medical Ctr.
11

12. EMTALA – I
In 1986, Congress passed the Emergency
Medical Treatment and Active Labor Act
(EMTALA) that forbids Medicare-
participating hospitals from dumping
patients out of EDs.
12

13. EMTALA
42 U.S.C.A. § 1395dd(a) (1992)
“in the case of a hospital that has a hospital
emergency department, if any individual (whether or
not eligible for benefits under this subchapter) comes
to the emergency department and a request is made
on the individual's behalf for examination or
treatment for a medical condition, the hospital must
provide for an appropriate medical screening
examination within the capability of the hospital
emergency department, including ancillary services
routinely available to the emergency department, to
determine whether or not an emergency medical
condition . . . exists.”
13

14. Emergency Medical Condition
(A) a medical condition manifesting itself by
acute symptoms of sufficient severity
(including severe pain) such that the absence
of immediate medical attention could
reasonably be expected to result in (i) placing
the health of the individual (or, with respect to
a pregnant woman, the health of the woman or
her unborn child) in serious jeopardy . . . .
14

15. EMTALA Text Cases
– Limited to Actions Against Hospital
– Patient Screening Appropriate
– Stabilizing the patient
– Discharge Found Appropriate
– Screening and Discharge Appropriate
– Transfer Prior to Stabilizing Patient
– Inappropriate Transfer
15

16. Wrong Record: Fatal Mistake – I
• Terry was taken to the hospital after being injured in
an automobile accident.
• Upon ordering discharge, the ED physician had not
realized that he had made a fatal mistake. The
physician looked at the wrong chart in determining
Terry's status, thus discharging Terry.
• Terry slumped died at home in his father's arms as his
head slumped forward.
– See text case: Trahan v. McManus
• Who is responsible for Terry’s death?
16

17. Wrong Record: Fatal Mistake – II
The ED physician by his own admissions stated that
he acted negligently when he discharged Terry
and that his actions led to Terry's death.
See text case: Trahan v. McManus
17

18. Duty to Contact On-Call Physician
• Hospitals are expected to notify specialty on-call
physicians when their particular skills are
required in the ED. A physician who is on call &
fails to respond to a request to attend a patient can
be liable for injuries suffered by the patient.
• Failure to Respond to Call
• Timely Response Required
• Notice of Inability to Respond to Call
18

19. Telephone Medicine Costly – I
Futch v. Attwood
Lauren's was taken to the hospital ED. Hospital
personnel contacted the physician by phone. He
returned the call & prescribed a Phenergan injection.
He did not go to the hospital & had not been given
Lauren's vital signs when he suggested such an
injection, & further failed to order any blood or urine
tests. Hospital records revealed that Lauren’s glucose
level was 507 at the time of admission. Lauren's went
into respiratory failure & eventually died.
Was the physician liable for practicing telephone
medicine?
19

20. Yes!
The trial court allocated $98,000 for the
conscious pain & suffering of Lauren. The
defendant complained that the award of
$98,000 was excessive. On appeal, the
appellate court could not find that the trial
court had erred in concluding what sum was
fair to both parties.
20

21. Preventing ED Lawsuits – I
• Treat each patient courteously and promptly
• Treat all patients regardless of ability to pay
• Triage and treat seriously ill patients first
• Communicate with the patient and the patient’s
family to ensure that a complete and accurate picture
of the patient’s symptoms and complaints are
obtained
• Provide an appropriate examination of the patient
based on the presenting complaint/s and symptoms
(failure to do this may be the single most common
and sometimes fatal mistake in emergency
departments) 21

22. Preventing ED Lawsuits – II
• Require consultations when determined
necessary
• Establish on-call lists for specialists
• Ensure all caregivers are effectively
communicating with one another
• Provide continuing education programs for all
staff members
• Obtain patient consent for procedures
22

23. Preventing ED Lawsuits – III
• Institute a preventive maintenance program for
emergency department equipment
• Determine which diagnoses can be safely
addressed within the organization
• Make appropriate arrangements, when
required, for transfer
23

24. Preventing ED Lawsuits – IV
Hospitals need to determine what types of
patients & levels of care they can safely
address. If there are several hospitals in a
community, they must learn to communicate
with one another & include emergency
medical services personnel in addressing
transport & care issues.
24

25. The Right Hospital? - I
If Hospital A has no
neurologist, neurosurgeon, or stroke team &
Hospital B, 1-mile away has all of that plus a
Level I trauma center, would it be fair to say
that a suspected stroke victim should be
transported to Hospital B?
25

26. The Right Hospital? – II
Yes!
• Its is not just any hospital, it is the right
hospital that saves lives
• Taking the patient to hospital A raises both
ethical and legal issues
• Under what circumstances would hospital B be
the first hospital of choice?
26

27. The Right Hospital? - III
When there is no other hospital within a
reasonable distance to stabilize the patient.
27

28. EDs Vital to Public Safety
The hospital itself has come to be perceived as the
provider of medical services. According to this
view, patients come to the hospital to be cured, and
the doctors who practice there are the hospital's
instrumentalities, regardless of the nature of the
private arrangements between the hospital and the
physician. Whether or not this perception is
accurate seemingly matters little when weighed
against the momentum of changing public
perception and attendant public policy.
[Martin C. McWilliams, Jr. & Hamilton E.
Russell, III, Hospital Liability for Torts of Independent
Contractor Physicians, 47 S.C. L. REV. 431, 473
(1996).] 28

29. State Regulations
Legislation in many states imposes a duty on
hospitals to provide emergency care. The
statutes implicitly, and sometimes
explicitly, require hospitals to provide some
degree of emergency service.
29

30. Laboratory
Georgetown U. Hospital Shuts Lab After Problems
With Cancer Tests
Georgetown University Hospital has shut down a lab
that performs genetic analysis for breast cancer
patients and has had 249 women’s tissue samples
independently retested while federal officials
investigate procedures at the lab.
The Washington Post, Lena H. Sun, August 6, 2010
30

31. Laboratory Services - I
An organization's lab provides data that are vital to a
patient's treatment. The lab monitors therapeutic
ranges, measures blood levels for toxicity, places &
monitors instrumentation on patient units, provides
education for the nursing staff (e.g., glucose
monitoring), provides valuable data utilized in
research studies, provides data on the most effective
and economical antibiotic for treating patients, serves
in a consultation role, provides valuable data as to the
nutritional needs of patients . . . .
31

32. Laboratory Services – II
• Failure to follow transfusion protocol
• Mismatched blood
• Refusal to work with certain specimens
• Lost Chance of Survival – Pap Smear
– Court determined evidence relating to negligence
claims pertaining to Pap tests taken more than 2
years before filing the action were admissible
because the patient had a continuing relationship
with the clinical laboratory as a result of her
physician submitting her Pap tests to the laboratory
over a period of time.
See Text Case: Sander v. Geib, Elston, Frost Prof’l Ass’n32

33. Medical Assistant
• An unlicensed person who provides
administrative, clerical, and/or technical
support to a licensed practitioner.
• Employment of medical assistants is expected
to grow much faster than the average for all
occupations.
• Those in large practices tend to specialize in a
particular area, under supervision.
33

34. Medical Imaging
• Negligence in medical imaging tests &
therapies often involve a failure to protect
patients from falls & the negligent handling of
equipment.
• X-ray Cassette Falls on Patient’s Head
– See text case: Schopp v. Our Lady of the Lake
Hospital
• Poor Communications
34

35. Nutritional Services
• Need to provide nutrition
• Failure to do so can result in a lawsuit
• Nursing facility patient’s highly vulnerable
– Lambert v. Beverly Enterprises
• Patient suffered malnutrition
• Motion to dismiss case denied
35

36. Paramedic
• Protected by Good Samaritan Statutes
• Inability to Diagnose the Extent of Injury
• Lidocaine Administered 44 Times Normal
Dosage
• Failure to Transport Patient
• Paramedic License Denied
36

37. Pharmacy
• Immense variety & complexity of medications
• Impossible for nurses or doctors to keep up
with the information required for safe
medication use
• Pharmacist has become an essential resource
in modern hospital practice
37

38. Government Control of Drugs
• Federal Controls
– Controlled Substance Act
– Federal, Food, Drug & Cosmetic Act
• State Regulations
• Distribution, Dispensing, & Administration
• Storage of drugs
• Drug substitution
• Hospital formulary
38

39. Mediations: Helpful Tips - I
• Be sure handwriting is legible; print if
necessary.
• For clarity, do not use felt-tip pens.
• Abbreviations should be used per hospital
policy.
• Do not write ambiguous orders.
• Always add a zero prior to a decimal.
• Hold orders should be accompanied by a time
frame.
39

40. Mediations: Helpful Tips - II
• Know about the meds that you are prescribing
• Be sure medications have been properly
deluded before administering
• Be sure that medications are properly
administered at the proper time in the
prescribed dosage by the correct route (
e.g., IV, intramuscular, oral)
40

41. Expanding Role of
Pharmacists - I
• Duty to monitor patient’s medications
– Computer systems monitor for:
• Drug-drug interactions
• Drug-food interactions
• Warning Patients - Potential for Overdose
• Refusal to Honor Questionable Prescription
41

42. Expanding Role of
Pharmacists - II
• Limited Duty to Warn
– Pharmacists cannot possibly warn caregivers &
patients of every potential danger of a drug
• Refusal to Fill a Prescription
• Failure to Consult with the Patient’s Physician
42

43. Common Medication Errors
Prescription Errors
• wrong patient
• wrong drug
• inappropriate drug ordered due to: known drug
allergies, drug-drug and food-drug interactions
• wrong dose
• wrong route
• wrong frequency
• transcription errors (due to illegible handwriting &
improper use of abbreviations)
• inadequate review of medication for appropriateness
43

44. Common Medication Errors
Dispensing Errors
• Improper preparation of medication
• Failure to properly formulate medications
• Dispensing expired medications
• Mislabeling containers
• Wrong patient
• Wrong dose
• Wrong route
• Misinterpretation of physician order
44

45. Common Medication Errors
Documentation Errors
• Transcription errors (often due to illegible
handwriting & improper use of abbreviations)
• Inaccurate transcription to medication
administration record (MAR)
• Charted but not administered
• Administered but not documented on the MAR
• Discontinued order not noted on the MAR
• Medication wasted and not recorded
45

46. Physical Therapy
Incorrectly Interpreting Physician’s Orders - I
• Plaintiff alleged that defendant failed to exercise
degree of care & skill ordinarily exercised by
physical therapists, failed to heed his protests that he
could not perform the physical therapy treatments she
was supervising, & failed to stop performing
treatments after he began to complain he was in pain.
• Plaintiff’s expert testified defendant deviated from
standard of care by introducing a type of exercise not
prescribed by the physician.
– Court’s Finding?
– See Text Case: Pontiff, in Pontiff v. Pecot &
Assoc.
46

47. Incorrectly Interpreting Physician’s Orders - II
• For the Plaintiff!
– The appeals court found that the trial court was
correct in its determination that the plaintiff
presented sufficient evidence to show that this duty
was breached & that therapist’s care fell below the
standard of other physical therapists.
47

48. Termination of Contracted Services - I
Hospital claimed that its attempt to establish a
hospital-based physical therapy program
would have been disrupted if the
independent therapist had been permitted to
continue treating patients.
What was the court’s decision?
• See Text case: Armintor v. Community Hospital of
Brazosport
48

49. Termination of Contracted Services
- II
• For the Hospital!
– Exclusion of a therapist is an administrative matter
within the board's discretion.a
49

50. NEGLECT
Physical therapist had been charged with resident
neglect for refusing to allow an 82-year-old
nursing facility resident to go to the bathroom
before starting his therapy treatment session.
See text case: Zucker v. Axelrod
50

51. Physical Therapist License Revoked
Physical therapist was found to have been
properly revoked in several other states. See
text case: Girgis v. Board of Physical Therapy
51

52. Physician’s Assistant
• PAs as physician extenders
• Scope of practice defined by each state
• PAs responsible for own negligent acts
• Respodeat Superior: the employer of a PA can
also be liable for the PA’s negligent acts
52

53. Podiatrist
• The legal concerns of podiatrists, similar to those of
surgeons, include misdiagnosis and negligent surgery.
• Podiatrist in Strauss v. Biggs was found to have failed
to meet the standard of care required of a podiatrist &
that failure resulted in injury to the patient. The
podiatrist, by his own admission, stated that his initial
incision in the patient's foot had been misplaced.
• Podiatrist acted improperly by failing to refer the
patient, stop the procedure after the first
incision, inform the patient of possible nerve injury . .
..
53

54. Respiratory Therapist
• Failure to Remove Endotracheal Tube
• Multiple Use of Same Syringe
• Restocking the Code Cart
54

55. Security
Hospitals have a duty to implement & maintain
reasonable measures to protect patients from
the criminal acts of third parties. However, if
an attack and injury to a patient is not
foreseeable, the hospital’s actions cannot be
the proximate cause of the patient’s injuries.
55

56. Assault in the ED
Patient in was sitting in the ED waiting room when a
teenage boy, D.G., arrived with his mother. After
they had all sat in the waiting room for a short period
of time, D.G. walked up to Lane & began to hit her
on her right arm & shoulder. Lane's son-in-law, who
had accompanied her to the emergency room, jumped
to her aid & struck D.G., knocking him to the floor.
The attack stopped and nothing further happened.
Lane suffered some injuries as a result of the attack.
– Is the hospital liable for Lane’s injuries?
56

57. No!
Evidence in this case depicts a situation in which the
attack upon Lane by D.G. was unexpected & no other
evidence was designated to the trial court from which
it could have concluded that the specific actions of
D.G. on the day in question were foreseeable. The
court was bound to conclude that the attack & injury
was not foreseeable, that the center's actions were not
the proximate cause of Lane's injuries & that the
center is entitled to judgment as a matter of law.
57

58. Failure to Provide Adequate Security
A hospital can be found liable for failing to
provide adequate security.
– see text case: Hanewinckel v. St. Paul’s Property
& Liab.
58

59. Sexual Improprieties
• Dentist
• Nurse
• Osteopath
• Physician
• Psychiatrist
59

60. Surgery
• Improper positioning of arm
• Sciatic nerve injury
60

61. Certification of Healthcare
Professionals
• Recognition by a governmental or professional
association that an individual's expertise meets
the standards of that group.
• Some professional groups establish their own
minimum standards for certification in those
professions that are not licensed by a particular
state.
• Certification by an association or group is a
self-regulation credentialing process.
61

62. Licensing Healthcare Professionals
• Process by which a competent authority grants
permission to a qualified individual to perform
certain specified activities that would be illegal
without a license.
• Licensure refers to the process by which licensing
boards, agencies, or departments of the several states
grant to individuals who meet certain predetermined
standards legal right to practice in a health care
profession & to use a specified health care
practitioner's title.
62

63. Licensing Healthcare Professionals, cont
Commonly stated objectives of licensing laws
are to limit & control admission to the
different health care occupations & to protect
the public from unqualified practitioners by
promulgating & enforcing standards of
practice within the professions.
63

64. Suspension & Revocation of License
Licensing boards have authority to suspend or
revoke the license of a health care professional
found to have violated specified norms of
conduct. Such violations may include:
– procurement of a license by fraud
– unprofessional, dishonorable, immoral, or illegal
conduct
– performance of specific actions prohibited by
statute; and malpractice.
64

65. Helpful Advice for Caregivers
• Abide by the ethical code of one’s profession.
• Do not criticize the professional skills of others.
• Maintain complete and adequate medical records.
• Provide each patient with medical care comparable
with national standards.
• Seek the aid of professional medical consultants when
indicated.
• Obtain informed consent for all procedures
65

66. Helpful Advice for Caregivers, con’t
• Inform the patient of the risks, benefits, &
alternatives to proposed procedures.
• Do not indiscriminately prescribe medications or
diagnostic tests.
• Practice the specialty in which you have been trained.
• Participate in continuing education programs.
• Keep patient information confidential.
• Check equipment & monitor it for safe use.
66

67. Helpful Advice for Caregivers, con’t
• When terminating a professional relationship with a
patient, provide adequate written notice to the patient.
• Authenticate all telephone orders.
• Obtain a qualified substitute when you will be absent
from your practice.
• Investigate patient incidents promptly.
• Be a good listener, & allow each patient sufficient
time to express fears and anxieties.
• Develop & implement an interdisciplinary plan of
care for each patient.
67

68. Helpful Advice for Caregivers, con’t
• Safely administer patient medications.
• Closely monitor each patient’s response to treatment.
• Provide education & teaching to patients.
• Foster a sense of trust & feeling of significance.
• Communicate with the patient & other caregivers.
• Provide cost-effective care without sacrificing
quality.
68

69. REVIEW QUESTIONS
1. What was the reasoning for enacting the
Emergency Medical Treatment and Active Labor
Act?
2. Comment on the statement: A sexual impropriety
committed by a health care practitioner should be
handled in the institution, not in court.
3. Should medical advice be dispensed on the
telephone? Explain your opinion.
69

70. REVIEW QUESTIONS, cont
4. Discuss why the prescribing, control,
administration, and monitoring of medications has
become a major area of legal concern for health care
professionals.
5. Describe the difference between the certification
and licensing of a health care professional.
70