Risk Management in Health Care - Essay Example

The Legality of Risk Management in Healthcare (United s) Risk management in health care is defined as the systematic management of administrative and clinical processes to prevent uncertainties and potential dangers and to mitigate the risk of the institution’s exposure to liability if loss occurs. Risk management can come into play in case of mal practice. In the case study that I have chosen to analyze a legal case entails a medical practitioner who is sued for mal practice. The case was about a 52 year old woman, Mrs. Taylor. Dr. Harris had attended to the patient in the morning as well. The doctor found the patient in acute respiratory distress. Dr. Harris diagnosed the patient with pneumonia and impending respiratory failure. She thought of intubating the patient herself on the floor, but then decided against it and handed over the patient to a pulmonologist and intensivist. The patient suffered intense and seemingly irreversible brain damage. After a few months had elapsed, the relatives of the patient consulted a legal counselor and came to the conclusion that the patient had suffered due to malpractice. Dr. Harris was held accountable. The case was settled by giving compensatory damages to the plaintiff. The end of the paper has an executive summary analyzing the case. Keywords: malpractice, law, risk management, health care, financial implications The Legality of Risk Management in Healthcare (United States) The history of risk management in health care goes as far as four thousand years. The Babylonians were famous for punishing their medical practitioners if they were involved in any malpractice or if their negligence had incurred any physical or metal harm to the ill. The increased incidence of malpractice during the 1970s had a seminal effect on how the legislations that were made regarding health care. Health care providers found themselves in a quandary. The money-intensive lawsuits that had been filed against them was not only a huge financial burden, but also compromised their reputation. They were also faced with the possibility of losing their license. Therefore risk management became all the more important, with agencies using both financial resources and specialized risk management staff to ensure patient safety and higher standard of professional conduct for health care practitioners. Risk management in health care is defined as the systematic management of administrative and clinical processes to prevent uncertainties and potential dangers and to mitigate the risk of the institution’s exposure to liability if loss occurs. Risk management can come into play in case of mal practice. The Joint Commission (2010) defines mal practice as the “improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position; often applied to physicians, dentists, lawyers, and public officers to denote negligent or unskillful performance of duties when professional skills are obligatory. Malpractice is a cause of action for which damages are allowed”. In the case study that I have chosen to analyze a legal case entails a medical practitioner who is sued for mal practice. The case study has been taken from the Annals of Internal Medicine, established by the American College of Physicians in 1927. The names used are all pseudonyms and the article has been written by T. A. Brennan and M. M. Mello (2004). The case was about a 52 year old woman, Mrs. Taylor. She had a history of progressive fevers, nausea, and vomiting. When she presented to the emergency department of the hospital, it was 2.30 a.m. and she appeared to be moderately ill and dyspneic (complexity in breathing). Her initial temperature was raised, blood pressure was very low, heart rate was elevated and had a very high respiratory rate of 26 bpm. Her right lung base was positive for crackles, and her oxygen saturation at room temperature was 92% (normal being greater than 95%). The leukocyte count was raised and a chest radiograph showed a dense infiltrate in the right lower lobe. The illness identified for the was bacterial pneumonia. The patient was treated with evofloxacin, metronidazole, and oxygen. Mrs. Taylor was admitted into a medical ward and the opinion of a pulmonologist was sought over the phone. At 7.45 a.m., a nurse observed that Mrs. Taylor was having a lot of difficulty in breathing and was excessively sweating. Her oxygen saturation had fallen as well, and she was immediately placed on a nonrebreather mask, and simultaneously, Dr. Harris, was paged. Dr. Harris had attended to the patient in the morning as well. The doctor found the patient in acute respiratory distress. Her respiratory rate was 50 bpm, her blood pressure was 140/88, temperature was raised to 37.6 °C and she had diffused ronchi and crackles in her right lung field. The right lung infiltrate had worsened and her arterial blood gas showed a pH of 7.41, a PCO2of 29, and a PO2of 63 on the nonrebreather mask. Dr. Harris diagnosed the patient with pneumonia and impending respiratory failure. She thought of intubating the patient herself on the floor, but then decided against it and handed over the patient to a pulmonologist and intensivist, who were waiting in the ICU. According to Dr. Harris, “In my mind, it was a matter of what would be safest. I really dont have a lot of experience with awake intubation, and I knew that a pulmonologist was already involved in the case, so it was a really easy decision from my standpoint to get … the patient transferred to the ICU for intubation” (Brennan & Mello, 2004). Dr. Harris had completed her investigations by 8.20 a.m. It took another few minutes for Mrs. Taylor to be taken to the ICU, during which time Mrs. Taylor was in more severe respiratory distressed, and had become delirious. Her blood pressure, heart rate and respiratory rate had elevated excessively and her oxygen saturation had fallen to an alarming 64%. The patient was preoxygenated by the pulmonologist and was given midazolam. The pulmonologist attempted to intubate the patient at 8.45 a.m., but in vain due to ventricular fibrillation and a cardiac arrest. After a series of medical procedures like bag-valve-mask oxygenation, standard cardiopulmonary resuscitation, administration of atropine and epinephrine, defibrillation and another successful attempt of intubation, the patient’s respiration showed an improvement and her cardiac condition steadied. However she did not go unscathed. She suffered intense and seemingly irreversible brain damage. When she was going to be discharged, Mrs. Taylor could not recognize her family members and also had problems performing routine tasks. The case was not referred to the risk management board of the hospital; it was discussed unofficially by the professionals involved in providing care and medical treatment to the patient. The patient was transferred to a long-term care facility for twenty four hours custodial care. However after a few months had elapsed, the relatives of the patient consulted a legal counselor and came to the conclusion that the patient had suffered due to malpractice. After 20 months, Dr. Harris got a notice that she had been found culpable of malpractice and the neurological condition of Mrs.Taylor. The civil law under which cases of malpractice fall is known as the tort law (Maurer & Smith, 2005). The lawsuit that had been filed against Dr. Harris is a conventional for medical malpractice; the malpractice is by a physician. In order to prove her side of the story, Mrs. Taylor had to justify that she had a doctor-patient relationship with Dr. Harris that obligated the doctor to perform certain duty regarding Mrs. Taylor. Mrs. Taylor also has to prove that the conduct of Dr. Harris was not up to the standard as set by the law and that Mrs. Taylor incurred an injury that was a consequence of the malpractice. The claim was leveled on the grounds that Dr. Harris had delayed the treatment that caused the patient to fall into more severe pulmonary distress that culminated in cardiac arrest and subsequent neurological damage. Assessing the case as the chief executive officer of the risk management committee, there is little evidence to prove that Dr. Harris had been negligent in her practice. She had referred the patient to the care of specialized experts since she had little experience in intubation. She had only taken forty minutes to evaluate, and had performed all the medical logistics and preoperation vitals. Any responsible medical practitioner would have followed the same strategy. Moreover, it is wrong to blame one person for faulty conduct when there were other professionals involved in the patient’s care like nurses. There were other factors that had influenced the care delivered to the patient, like the physician who had attended to the patient in the morning. The standards of care that are expected from a medical practitioner mean that the physician performs a reasonable level of care that would be performed by a competent professional in similar circumstances. The consequences of a guilty verdict include direct, indirect and punitive damages to the plaintiff. Health care professionals may also face censure, disciplinary action or dismissal from a group practice or suspension of hospital privileges. Licensing companies can censure, suspend or revoke the guilty’s license (Pozgar, 2007). The defense attorney dug up empirical evidence to support his client, and found that her case was strong. Since Mrs. Taylor had experienced brain damage due to the care of the hospital and other health care professionals, the defense attorney suggested that the case be patched up by money. The defense attorney had to consider several factors before suggesting that, like the plaintiff’s economic and non-economic damage if Dr. Harris was found guilty. According to the defense attorney, “Even if you are assessed a very small percentage of responsibility by the jury, given the huge potential damage exposure…it could potentially represent a judgment … in excess of your malpractice coverage. Mrs. Taylor and her family could come after the physician and force her into bankruptcy, resulting in financial ruin for Dr. Harris” (Brennan & Mello, 2004). Compensatory damages are paid to the plaintiff by the defendant to cover for any losses that have been incurred by the harm caused by the defendant. The case was subsequently settled by money. Executive Summary One of the important aspects of avoiding risk management issues and malpractice claims in to ensure that a two-way communication is maintained between the care providers and the service users. If I were in-charge of the issue, I would have handed over the matter to the risk management board. One of the reasons that the relatives of the patient pursued legal compensations was because there was no formal action taken by the hospital. Communication with relatives and the patient is integral to the avoidance and prevention of legal issues. The law states that all evidence that helps establish a claim or fact must be presented. However, peer reviewers do not present their views. The reason for their hesitation is that their statements would then be accessible to the opposition. Peer reviews in this case would have. Statements by doctors regarding the best protocol that could have been provided to the patient would have helped to establish how guilty, if any, Dr. Harris was. Henceforth, her practice would have been proven negligent or otherwise. If Dr. Harris’ conduct would have been regarded as obligatory, and similar to the conduct of a competent doctor, she would have also been able to divert any bad repute that would have occurred as a result of the publicity of the lawsuit that has been filed against her. Malpractice claims not only have financial implications but also discourage peers from continuing their profession, or for people to enter that profession. This would have negative consequences on the repute of the hospital, and money would have been drawn from insurance agencies the hospital is registered with. As the CEO, I would have ensured that the hospital discusses and evaluates the issue with out any reservations. I would have made the discussions formal; as compared to the informal discussions that took place between the professionals involved before the patient was discharged. The hospital administration and health care professionals should have taken a few steps as a follow-up of the admission of the patient into the hospital. One of these could have been cross-coverage. Cross-coverage involves the medical practitioner to perform a service that is beyond the educational rotation the practitioner is working in. The staff could have been trained to handle any emergency regarding patient care that may emerge in the course of practice. The hospital would have also been prepared for any emergency requirements for on-the-floor intubation. The staff would have been given enough exposure to the accurate and effective handling of equipment for intubation and precautionary measures outside the ICU. The responsibility for the transport of the patient to the ICU also rested with the hospital and the staff. It won’t be fair to hold Dr. Harris responsible for malpractice, when other factors had come into interplay that delayed the patient’s transfer for operation. The hospital should not have settled for compensatory damages. The hospital should have adopted the no-fault system that compensates for the damage of the patient regardless of the cause, which can either be malpractice or some fault by the professional. The system can be successful in interprofessional teams. The doctors and the health care institution are covered by the same insurer. The hospital can make the patients sign a form that makes renders them from suing since their damages will be compensated in case of malpractice. The health care professionals are not separate units, but are represented by a single insurance company. The system promotes greater transparency of the incident, since the professionals know that they are not going to be sued. Proponents of no-fault systems assert that if insurance premiums are not experience-rated, it would be able to eliminate one of the reasons that lead to defensive medicine, and fear of performing wrong. This would substantially cut-down the costs of defensive medicine (Patel & Rushefsky, 2006). Reference List Brennan, T. A. & Mello, M. M. (2004). Patient Safety and Medical Malpractice: A Case Study. Retrieved from http://www.annals.org/content/139/4/267.full Joint Commission (2010). Sentinel event. Retrieved from http://www.jointcommission.org/sentinelevents/se_glossary.htm Maurer, F. A. & Smith, C. M. (2005). Community/public health nursing practice: health for families and populations (3rd ed.). Missouri: Elsevier Health Sciences. Pozgar, G. D. (2007). Legal aspects of health care administration (10th ed.). Massachusetts: Jones & Bartlett Learning. Patel, K. & Rushefsky, M. E. (2006). Health care politics and policy in America (3rd ed.). New York: M.E. Sharpe. Read More