Standards of Care: Could Your PMC Be At Risk for Medical Malpractice?

medical-malpracticeMedical malpractice cases are negligence claims against health care providers for injuries sustained as the result of medical negligence. Medical negligence is the failure to meet the standard of care ordinarily used by health care providers in the same or a similar community.

If a PMC were to be sued for medical malpractice, the patient would need to prove that our clinic had a duty to her, that we breached that duty, and the result caused harm to her.

A duty to the patient arises when she has a reasonable expectation that we agreed to provide care for her. Normally, the duty arises when we ask for any medical information from her.

There are cases where the duty arose based on telephone communications. It matters not whether we think we have created a duty, but whether she thinks we do.

Your PMC should develop standards regarding what a receptionist can say on the phone when a patient calls to make an appointment or to ask questions about her pregnancy and regarding who discusses medical information with the patient.

Besides considering when the duty starts, we also need to understand when the duty stops. Standardized use of a discharge summary, which clearly indicates that your PMC is discharging the patient from your care, offers protection. When signed by the patient, the discharge summary creates evidence that the physician/patient relationship has ended.

A breach of the duty to the patient is medical negligence, as defined above.

So how does one know what the standard of care ordinarily used by health care providers is in the community?

National standards regarding competence in performing ultrasound exams, indications for the ultrasound, and information to be obtained by the exam are issued by AIUM and AWHONN.

When we meet those standards, we lessen the risk of a malpractice claim.

For instance, AWHONN has said “The performance of ultrasound examinations is an appropriate practice for registered nurses.” They go on to say that prior to adding the expanded role, an RN should 1) verify that performance of ultrasounds is within the scope of practice for nurse as defined by their state licensing body; 2) complete the didactic content and hands-on experience outlined in the AWHONN guidelines; and 3) ensure their institution has a written policy, procedure, and protocol addressing the performance of ultrasounds by RNs.

Additionally, the PMC can ask the OBs in their community when they would provide a limited obstetrical ultrasound. Ideally, your PMC has a medical advisory board composed of local physicians who can answer any question that might arise concerning the standard of care.

Areas that Dove Medical’s advisory board have addressed include whether to allow animals in the exam room, providing ultrasound to a patient with an unruly toddler in tow, and lay midwives referring their patients for a non-diagnostic ultrasound to be sure “everything is ok.”

AWHONN recommends that when an ultrasound examination is performed, the woman should be informed about the scope of information provided by the examination and why an ultrasound examination is needed. Women should be informed that a limited ultrasound examination performed by a nurse is not intended to evaluate fetal anatomy, placental anomalies, or maternal pelvic masses. Documentation of the ultrasound examination should follow institutional policy and should indicate that the woman was informed and acknowledged the limitations of the study.

Resulting harm to the patient need not necessarily be physical injury. There is a legal principle called the “physical impact” rule, which may allow recovery for purely emotional injuries caused by medical treatment. Therapy inadvertently provided without informed consent can result in a medical malpractice claim. Missed diagnosis is the most common area causing ultrasound medical malpractice claims. In obstetrics, those missed diagnoses most often are placenta previa, multiple gestations, fetal anomalies, and ectopic pregnancies.

Doctors are liable for the negligence of nurses and others working at their direction. Your medical director has given you standing orders to perform pregnancy testing and diagnostic sonography. Those standing orders establish the standards the PMC MUST follow in providing patient care.

Standards are our shield of protection. Each PMC should have written standards for training, patient care, professionalism, and documentation. To be safe, follow the rules. Only the physician can function outside of protocol. PMCs are the compassionate side of the pro-life movement. But compassion does not mean putting yourself, your organization, or your patient at risk.

Beverly Anderson, J.D.
CEO Dove Medical, Eugene OR
Sparrow Solutions Consultant

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