Real World Case 8.1-8.2

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Medicine

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Dec 6, 2023

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Real-World Case 8.1 In October 2018, Cook County (Illinois) commissioners voted to approve a nearly $4 million settlement of a medical malpractice lawsuit at Stroger Hospital, a healthcare organization that is part of the Cook County Health and Hospital Systems (CCHHS). The lawsuit stemmed from a 2013 bedside pericardiocentesis that, the plaintiff's attorneys argued, should have been performed in a cardiac catheterization lab. Despite the large settlement, CCHHS CEO noted that the settlement was neither an admission of malpractice or of wrongdoing by the providers or the health system. Although it is not known how much a jury would have awarded the plaintiff, a jury verdict would have been a declaration of malpractice, which was avoided through the settlement (Pratt 2018). . https://chicagotribune.com/news/local/politics/ct-met-cook- county-lawsuit-settlement-20181017-story.html . Real-World Case Discussion Questions 1. This case highlights the fact that healthcare professionals, in addition to physicians, are subject to professional malpractice liability. Why do you think physicians are most frequently linked with the term “medical malpractice?” The relationship between doctors and patients is an agreement, hence doctors are most usually associated with the term "medical malpractice." The doctors are in charge of the patients' main care. In addition to diagnosing and treating patients, they often issue directives to other medical personnel, including nurses and other allied health professionals. Since doctors are the ones who make the majority of decisions and notify patients, they will be held accountable if there is a problem. 2. Of the three types of negligence, which type do you think most closely describes a healthcare professional who acted too aggressively? Malfeasance 3. Why is it likely that a much larger award would have been rendered at trial than through settlement? Trial would have resulted in a significantly higher award than settlement because most agreements are reached to prevent time, money, and mental stress . If it went to the legal system, I'd suppose more money would be awarded because the patient would have lost more time and experienced other hardships as well.
Real-World Case 8.2 Healthcare organizations develop record retention guidelines in accordance with applicable laws (for example, a state’s statute of limitations for medical malpractice and Medicare Conditions of Participation retention requirements) and operation needs (for example, research, education, and strategic planning). If a healthcare organization follows its guidelines, and those guidelines conform to applicable laws, the healthcare organization is legally compliant. There is generally not a requirement that patients be notified of a healthcare organization’s health record retention periods. This, however, has not been the case in California, which has had a notification requirement in place for several years. Additionally, Senate Bill 1238 was presented in the California Senate in 2018 to amend Section 123106(e) and 123107 of the California Health and Safety Code, to require healthcare providers, by the date that service is first delivered or as soon possible after emergency care, to inform the patient or patient’s representative of the intended retention period for the patient’s health records (California Senate Bill 1238 2018). Providers are also required to notify the patient at least 60 days before the record is to be destroyed. Real-World Case Discussion Questions 1. What is your opinion of California’s requirement that patients be notified of an organization’s record retention periods? Do you think patients should be notified, although this has not been industry practice? Why or why not? I think California’s requirement is proper because, even though the patient and the healthcare organization share ownership of the records, both parties have a place in keeping them. As a result, I believe that the patient must be informed if the record is going to be destroyed because they use their health records to record their lifespan. 2. What is your opinion of Senate Bill 1238, presented to the California Senate in 2018, which requires this notification (of the intended record retention period) to occur by the date of first service delivery? 3. A patient requested a copy of their health record and learned that it had been destroyed. The patient complains to the state health department because they were not notified that their record would be destroyed. What response would you expect from the state health department? Since the healthcare provider followed the law, the state health department will side with them and state to the patient what the law is thus the health record being destroyed . 4. Do you believe healthcare organizations should destroy health records? Justify your choice. Now that we have health records stored electronically, it is not physically taking up space. But nonetheless, If a patient had a condition that could have been treated and prevented future deaths, then I think medical facilities should only erase records once the patient has passed away.
Application Exercises Instructions: Answer the following questions. 1. The National Practitioner Data Bank (NPDB) was established to limit the movement of physicians through the US who have negative histories of medical malpractice lawsuits, loss or suspension of licensure, and loss of privileges at previous employers. Although, theoretically, this provides a safety net, such safeguards are not always realized. Justify this statement. The facility where a doctor is employed is responsible for informing the NPDB of any legal difficulties that arise and convictions. If the NPDB isn't informed, the doctor isn't reported and the new hiring facility isn't made aware of it. If it's not in writing, it didn't happen. 2. Review the AHIMA record retention standards, which can be found in table 8.4. What are the recommended retention periods for the master patient index, adult health records, minor health records, and register of deaths? Why do you think AHIMA established these recommended retention periods? Do you agree with them? Justify your choice. Recommended retention periods: MPI: Permanent Adult health record: 10 years after the most recent encounter Minor health record: Age of majority plus statute of limitations Register of deaths: permanent These, in my opinion, were put in place to make sure that information is accessible when needed. However, there are upper bounds to make sure that records aren't being maintained pointlessly. The long-term organization and preservation of all health records is near-impossible. I believe it is beneficial to have a permanent retention period for death since it is crucial for the government or family, as necessary. 3. You have been invited to make a presentation on advanced directives to a senior citizen group. Create a slide deck presentation and write your script using the notes function. Advance medical directives are a kind of consent that outlines a person's wishes in the event that they are unable to express them for any reason. A reliable power of attorney for healthcare is selected by the individual. When a person is aware and capable of making decisions, a DPOA-HCD is selected. The selected DPOA makes choices in accordance with the wishes of the person. You can also create a living will. When the person is still alive and capable, they draft a living will that outlines their wishes in the event that they become incapable. For instance, if they desire to use a tube for feeding or a ventilator. They will make the person's wishes clear. Some people opt to have a DNR (do not resuscitate) order. These people could be elderly or suffering from a chronic ailment, for example. If necessary, CPR is a legal order; but, if one signs a DNR form, CPR won't be done in case of emergency. After
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the patient signs the necessary paperwork, the doctor drafts a DNR. Review Quiz Instructions: For each item, complete the statement correctly or choose the most appropriate answer. 1. Discovery is described as _____.
a. It is designed to limit access to information that other parties hold b. It is a type of deposition c. It is a pretrial process d. It is intended to result in surprises at trial 2. Which of the following is an example of metadata? a. Text message b. Information that shows who accessed a record c. Voicemail message d. Printout of a patient’s operative report 3. A subpoena requesting patient records _____. a. Is initiated by a judge b. Is also referred to as a court order c. Must usually be accompanied by patient authorization d. Can be ignored 4. A deposition is when _____. a. Testimony is not transcribed because it cannot be used at trial b. An individual appears at an appointed time and place to testify under oath c. Only the testimony of the plaintiff and defendant can be obtained d. Attorneys for the plaintiff and defendant are prohibited from attending
5. A legal hold serves to _____. a. Confine a person in jail b. Subject records to a search warrant c. Preserve information d. Create information 6. The content of the health record _______. a. May include documentation by only the physician b. Is not subject to accreditation standards c. Should facilitate retrieval of data d. Should include many abbreviations to save space 7. The length of time health information is retained ______________. a. Must account for state retention laws, if they exist b. Must be approved by patients whose health information is being maintained c. Should not take into account the healthcare organization’s operational needs d. Is ultimately the physician’s decision 8. The type of law that defines the rights and duties among people and private businesses is _____. a. Public law b. Private law c. Corporate law d. Administrative law 9. Identify the stage of the litigation process that focuses on the strength of the opposing party.
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a. Deposition b. Discovery c. Trial d. Verdict 10. The custodian of record received a _________ requiring her to go to court. a. Summons b. Subpoena ad testificandum c. Subpoena duces tecum d. Deposition 11. Corrected documentation errors should provide a(n) _____. a. Correction per administrative approval only b. Areas where incorrect information can be obliterated c. Option for a “corrected final” version d. Staff should be permitted to correct errors in whatever way they see fit 12. Congress passes laws, which are then developed by federal agencies to provide a blueprint for carrying out these laws. Federal agencies develop _____. a. Statutes b. Regulations c. Judicial decisions d. Ordinances 13. In order for Susan to be able to prove negligence, she must be able to prove injury, standard of care, breach of standard of care, and _____. a. Misfeasance
b. Causation c. Malfeasance d. Joinder 14. Jeremiah files a medical malpractice lawsuit against Dr. Watson, who performed his surgery. He names no other defendants in the lawsuit. Dr. Watson files a complaint against his assistant surgeon, Dr. Crick. By doing this, Dr. Watson has completed the legal action of _____. a. Counterclaim b. Crossclaim c. Default judgment d. Joinder 15. In Lindsay’s lawsuit against her physical therapist, her attorney (a) obtained copies of most documents that he requested such as medical records, contracts, email communications, bills, and receipts. However, at trial, Lindsay was surprised to learn that (b) several of these documents were not permitted to be considered by the jury as evidence. The concepts associated with (a) and (b) are _____. a. Subpoena; default b. Counterclaim; discovery c. Deposition; voir dire d. Discovery; admissibility 16. Elizabeth arrived at the nearest urgent care facility after being bitten by her cat. The physician examined her and gave her a tetanus shot. Based on these facts, a physician- patient relationship has _________. a. Been created by express contract b. Been created by implied contract c. Not been created d. Been breached 17. Alex fell from a tree and was taken to the emergency room. The physician did a physical exam and diagnosed Alex with contusions. In fact, Alex suffered a punctured lung that would have been detected by a radiologic image. In this case, the physician committed _____. a. Nonfeasance b. Misfeasance
c. Malfeasasance d. No wrongdoing 18. If a patient is not asked to sign a general consent form when entering the hospital and later sues the hospital for contact that was offensive, harmful, or not otherwise agreed to, what cause of action has the plaintiff most likely included in his lawsuit? a. Battery b. Lack of informed consent c. Negligence d. Breach of contract 19. A durable power of attorney for healthcare decisions ______________. a. Should not be included in an individual’s health record b. Applies only when the individual is competent c. Applies when the individual is no longer competent d. Prohibits the use of cardiopulmonary resuscitation in the event of a cardiac arrest 20. The maintenance of health records ____________________. a. Is governed by state laws only b. Is governed by Medicare Conditions of Participation for organizations that treat Medicare and Medicaid patients c. Is always left solely to the discretion of the healthcare organization that maintains the records d. Is not addressed by accrediting bodies and governmental agencies 21. Disclosure of health information without the patient’s authorization _____________. a. Is prohibited by federal law b. Is prohibited by most state laws c. May be required by specific state statutes
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d. Is only required for cases of suspected child abuse 22. Metadata are _____. a. Found in personal health records only b. Data about data c. Found in paper records only d. A patient’s billing records 23. Stacie is writing a health record retention policy. She is taking into account the statute of limitations for malpractice and contract actions in her state. A statute of limitations refers to which of the following? a. A limited number of state laws b. The period of time that a case must be brought to trial c. The timeliness of the health records in her facility d. The period of time in which a lawsuit must be filed 24. The Registered Health Information Technician (RHIT) credential is an example of _____. a. Licensure b. Certification c. Accreditation d. Validation 25. Dr. Smith is being sued by a former patient. At issue is whether the care he provided the patient was consistent with that which would be provided by an ordinary and reasonable physician treating a patient in the plaintiff’s condition. The concept in question is whether _____________. a. Dr. Smith owed a duty to the patient b. Dr. Smith was practicing medicine with a valid license c. There was a causal relationship between Dr. Smith’s actions and the harm to the patient d. Dr. Smith met the standard of care