Magazine article Medical Economics

Malpractice Consult

Magazine article Medical Economics

Malpractice Consult

Article excerpt

Q My patient needs extensive steroid therapy to heat a potentially life-threatening blood disorder. Joint degeneration is a well-known potential side effect How can I protect myself from a lawsuit?

A Consider the alternatives to any drug with potentially severe side effects, and discuss them with the patient. If you've determined that there really is no better medication available, warn the patient about the risks. Document your conversation and his consent on both a consent form and your progress notes. Try not to deviate from the standard dosage or administration of the drug. If you must make an exception, discuss it with your patient and document your reasoning and his consent. Monitor possible side effects carefully with repeated physical examinations. Periodically re-evaluate alternative treatments with the patient.

These steps will go a long way to insulate you from liability. But you can do everything by the book and still lose a malpractice suit. That's what happened in a recent Pennsylvania case where a nurse won a $4.1 million verdict against her hematologist and pulmonologist. The nurse had been diagnosed with idiopathic thrombocytopenic purpura and sarcoidosis. After six months of steroid therapy, she developed avascular necrosis of the right shoulder and both hips. She could require several joint replacements over her lifetime.

The plaintiff's experts testified that the steroid prescription was unwarranted and the dosage was too high. The doctors' experts argued that the drug was necessary to save the patient's life, the dosage wasn't excessive, and she was carefully monitored. While the defense presented an effective case, the patient's injuries were severe and the jury was clearly sympathetic. The doctors are appealing the verdict.

Can you make a patient agree not to sue you?

Q I'm fed up with worrying about malpractice. Before I treat a patient, I'd like to ask him to sign an agreement nor to sue me. …

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