Spoliation, tampering implications

[toomany]

I'm currently in an lnc class and learning about record tampering. I'm not surprised to learn that different inks, changes in hand writing pressure, and overly detailed edits/addendums can all be suggestive of possible tampering with a record and make jury's more likely to rule in favor of defendents. In one of my levtures today, however, we discussed individuals getting criminal charges for tampering and falsification. Have any of you scene examples of this in ur practice? I admit that an overly detailed addendum or using two pens to fill out a flow sheet might look suspicious and the validity should be questioned by the civil court but when it comes down to he said/she said (doctor said/ pt said) arguments about what happened a detailed note doesn't have to mean it's made up or fabricated, does it? I understand that jury's should take a overly explanatory medical record with a grain of salt because they were written in "cya" mode. But making someone a convicted Fellon because of changes in writing pressure or using two pens or creating a detailed addendum seems far fetched. i dont know that a pressure changes in writing meets the standard of evidence for criminal prosecution. Criminal prosecution would require cooperation between a DA and prosecuting civil atourney. I talked to my friend, a practicing criminal defence atourney, who saud he cant imagine a DA prosecuting on such circumstantial eveidenve as using two pens to write a document or changes in hand writing pressure.I look at the Virginia and California rn/md disciplinary actions and never see anyone losing a liscence over it, most of the people in trouble for falsification failed to account for narcotics. A malpractice atourney who spoke with the class said accusations of tampering or spoliation are usuall done toforce a settlement and that he has yet to see any go to jail over it or criminaly prosecuted. I'm becoming an lnc to bring medical expertise into court not try to get people locked up as convicted fellons for having inconsistent handwriting. Just looking for feedback. Thanks in advance.

[lhflanurseNP, APRN]

One of the reasons for electronic charting. Each time anything is done to the record, the date and time as well as the user are attached to the documentation or access...yes, every time we go into a record to just look at something, our activity is recorded.

[ktwlpn, LPN]

I have the handwriting of a serial killer and it can change right in the middle of a sentence. I have arthritis in my hands and I have to get creative with the position of the pen and my hand. I also usually have 2 pens on me and they are not always the same kind-I'm likely to pull either out of my pocket at any given time, lay it down mid sentence and then pick up the other one....I'm very glad we are electronic.

[toomany]

Yeah, I understand that. I would prefer all electronic records because I have horrible writing and I like being able to edit my assessments in a legal and correct way. I just can't believe all the lnc websites I read that claim rn/mds are facing legal consequences and liscence being suspended because they used two pens or have changes in the pressure of their writing. I saw legal write where a lawyer accused a hospital of tampering because the printers had different type alignments.... The floor I used to work on has four different printers... so thats four type allignments. I mean if tampering is blatent by all means throw the book at the people responsible, but making mountains of mole hills by accusing people of fradently writing assessments or adding to them years later based soley on hand writing seems extreme to me.

[toomany]

Sorry about the spelling errors, I'm typing these on my phone.

[toomany]

Do nursing boards keep track of civil litigation outcomes? That would be a ton of follow up work. There's about 23000 civil litigations per year across the country. Perhaps it's an issue if there is a parallel doh investigation being conducted. I read about a couple cases where nurses not only did not date there addition but full out changed whole flowsheets, the case settled for a large amount as a result. No one got arrested according to write ups.