Liability (& Ethics)

Sice I thought this was drifting off the subject of the original discussion I though I'd move here.

I understand the thrust of the orginal thread and this away from the spirit of that thread, but I'd like to discuss this area.

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Originally posted here by Negative
Doesn't the "Patient dies from allergic reaction to meds after Doctor can't access patient records" part of the question imply that there were allergy records (meaning that the patient provided allergies to the hospital)? How in the world are you going to hold the patient responsible?

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I agree it does imply that records have been given to the hospital, but it does not imply that any allergy records were given, although the point is moot. I still hold the patient responsible because:

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That sentence tells me that:
- the hospital had patient records, including patient allergies
- the hospital lost the records
- the doctor tried to check the records because that's what a doctor is supposed to do
- the doctor could not get access to the records

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What is not mentioneded here is what would occur in reality. The doctor would explain to tthe patient (or relatives etc) that there were records and are now unavailable and would then do what all decent doctors do:

They would take a proper hsitory! Including asking the patient about allergies and/or checking to other sources of information.

As a doctor you should always take a full history from the patient rather that relying on the patients notes or records for one very important reason:

It is the doctor who is making his decision on the course of treatment for the patient, no one else. Records and notes should be viewed as support materiels for that decesion, but not the soul source of information. You should never make any assumptions about the quality of the information in patient records, unless you wrote them, and remeber clearly why they were written.

So to a doctor, no records may make things harder, but they should not prevent a proper history being taken and relevant questions being asked and answered regarding allergies.

If the patient doesn't know about any allergies, it is unreasonable to expect the doctor to be able to divine this.

If they do know they have life threatening allergies the patient holds responsinbility for informing people about them.

For goodness sake, if you knew that if you got a shot of tetracycline it would kill you, you'd make damn sure anyone could get that information regardless of computers/records or your own state of consiousness.

I know I would. It's no good blaming other people after you're dead.

You can't!

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- the doctor went ahead and administered drugs
- those drugs happen to kill the patient because (s)he was allergic to them

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So the patient dies through their own contributory negligence?

Steve

I agree..

I've had a doctor ask me three times if I was alergic to iodine..
While on my records it was clear I wasn't allergic..
I think it's a habit for most doctors to do so..

Also when I was a Radiological Assistant in a hospital we were tought to allways ask the patient for known allergies before administering any kind of contrast solutions, even if it was clear on their charts (priors) they were not !!

ok......lets suppose that the allergy records were provided and then lost.

Why is the patient responsible if:

He/she provided the records and doesnt know they are lost so he/she assumes that the doctor knows about the allergies because the patient has already put them on record.

In a perfect world, yes, a doctor would re-evaluate the patient in person, gathering all information in person to insure accuracy. However, this world is far from perfect. The doctor could have chosen to not say anything or ask the patient anything, which makes it the doctor's fault. The sentence makes me think that the patient was in a critical condition where time was of the essence. It makes me think that the patient needed medication immediately. Suppose the patient was not in a condition where he/she could respond, and the doctor chose to give him/her meds that he/she was allergic to? Then who's responsible.

And...at this point, its hard to tell whether the patient knew they were allergic to any meds, because the records are gone, so they cant be referenced. But in that case, the hospital or its staff is not liable, true.

(I didnt read the original thread, cuz it was very long and unorganized. So forgive me if these questions have been asked and answered.)

Kthln01

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:In a perfect world, yes, a doctor would re-evaluate the patient in person, gathering all information in person to insure accuracy.

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My experience is that this happens all the time, not just in a perfect world. Remeber the doctor may be required to defend their decision to treat, and not taking a good history because the notes said something will be viewed as no defence. As I said, doctors are taught to view records as supporting material.

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And...at this point, its hard to tell whether the patient knew they were allergic to any meds

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Like I said, it's a patients responsibility to know, cause if you don't you can't complain when you're dead. This isn't a legal or medical opinion, it's just plain common sense.

Steve

Steve, the issue is that someones medical records where lost, this is a clear HIPPA violation, my guess is some heads would roll in the IT satff fallod by legal action targeted at the same staffers. The Doctor is somwhat protected, assumeign he falloed his SOP (asking the patiant directly if he has any alergies). THe fault lays with the hosptal and they will take it out on the IT staff that screwed up...this is assumeing there where notes about known allergies in the patiants records, if there where no mention of this in the records, well this is just an ufortuant accident.

then, the question becomes...

since the records are not available and there is obviously a difference of opinion on whose fault it is,

how do the courts decide this?

Do they assume that the information was in the records or do they just drop the case? However, i agree somewhat with bballad. The hospital should be in some sort of trouble for losing the patient's records.

Legaly the hospital is in a lot of trouble for loseing records, one of the main points of HIPPA is that records must be quickly retrevable...if this is not true you are in violation of federal law.

There are some legal protections that come with being a licensed doctor, unless it can be shown that the doctor acted knowinly and malliciously the worst that can happen to him is a malpractise suite and poss loss/suspension of license.

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Originally posted here by bballad
Steve, the issue is that someones medical records where lost, this is a clear HIPPA violation,

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I agree, which is a discussion for the other thread.

What I' trying ot discuss in this thread is the patient's (everyone's ?) responsibility in this scenario.

It is in my opinion irellevant that records were lost. If you have a life threatening allery then it is your responsibility to make sure that everyone knows about. I know if I was in that position everyone would know. The consequences of doing otherwise are too great for the individual.

There are far too many people these days that are negligent in their own behaviour and then seem to think they are entitled to compensation when something goes wrong.

Well, the law may or may not support you in your claim, but once you're dead you've blown it, haven't you

In my experience with doctors, nurses, EMTs, or any medical staff, I have been asked multiple times if I possess any allergies, even if no medication is going to be administered to me. Additionally, if I am there for a specific treatment (vaccination, eye-dialation, check-up, etc) then I always have to fill out a form of info, including if I possess any allergies or not. Then, even before anything is administered, the medical staff always looks over the sheet and additionally ask me if I have any allergies.

This happens every time.

That's a rather thurough analysis if you ask me. Not only are current records checked, but I am asked several times throughout my processing. Also, at one point have to write such information down and then endorse it with my signature. With this kind of verification, having lost records doesn't seem to have much merritt. Unless this situation was an emergency and the patient could not respond, I find no fault on the doctor. Like said, in any case, probably only the Hospital administration and IT staff will take any real damage.