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  1. According to the AMA’s Division of Economic and Health Policy Research, more than 34% of physicians have had a liability lawsuit filed against them at some point in their careers. Although plaintiffs in the majority of cases don’t win, the average cost for defending a case is more than $30,000 A recent article published on Medscape looked at how physicians are attempting to protect themselves by screening out patients who are more likely to file suits. Not Obligated to Treat Anyone As consumers, we are usually able to pick what physician we see and can change providers if we are not satisfied. What about physicians- are they obligated to treat anyone seeking their services, or do they have a right to self-select patients? According to the American Medical Association’s Economics and the Ethics of Medicine, an office-based physician doesn’t have to treat every patient seeking care. Possible Red Flags Medscape’s article highlights Dr. Marie Bradshaw, a physician practicing internal and emergency medicine over the course of 27 years. What makes Dr. Bradshaw unique? In her long career, she has never been sued as a physician. Dr. Bradshaw interviews potential patients before agreeing to be their primary care doctor and credits this practice for preventing legal problems. Here are other factors Dr. Bradshaw considers before accepting a new patient: How many physicians in that specialty has the patient seen over the past 1-2 years? More than 2 could be a sign of “doctor shopping” Important to ask if they terminated the relationship or did the doctor….and why. Did the patient have problems with other doctors or practices.? Asking the patient if they have ever had “an issue” with another doctor may open the door to learning about a previous lawsuit. What is the patient’s attitude toward the practice’s conditions for treatment? Does the patient complain about or refuse to sign an agreement related to treatment? This could be a red flag the patient will become difficult later in the relationship Compliance with clinical recommendations. Is the patient compliant with health screenings (mammograms, colonoscopies, etc.) and treatment recommendations? Is the patient show consideration for the practice and staff? Impolite behavior and rudeness towards others are a big red flag. Potential for violence should be a deal breaker. Do you communicate well with the patient and have a good rapport? It may be a red flag if intuition is telling you it may be difficult to build a good rapport with the patient. Joseph Scherger, MD, former vice president of primary care and academic affairs at Eisenhower Medical Center, recommends getting the above information while taking the patient’s medical history. Nurses Have Valuable Insight Michael Sacopulos, JD, CEO of the Medical Risk Institute, has sat in on hundreds of malpractice lawsuits over the years and emphasizes the need to pay attention to how a patient treats office staff. He states “I can't tell you how many times I've heard physicians say that when the paperwork arrives, the staff isn't surprised". Patients are more likely to voice concerns or dissatisfaction to nurses and other staff members. Dr. Sacopulos theorizes that staff members are cued in on warning signs quicker because patients tend to be on their best behavior for the doctor. Therefore, it is important for physicians to listen and consider feedback from staff. There Are Risks When it comes to turning away or discharging patients, there are state and federal laws physicians must follow. Noncompliance with these laws may lead to complaints being made to state or federal agencies, resulting in an investigation by the state attorney general’s office. A patient, who was not accepted, could file a complaint with the medical board that they were not treated properly. In this case, the physician would need to demonstrate that a physician-patient relationship never existed. For example, a written letter notifying the patient of nonacceptance may be used as evidence the patient was not under the physician’s care. Taking It to the Extreme What do you think? Does the practice of screening for potentially litigious patients encourage an attitude of “patients are out to sue you”? What ethical pitfalls do you see?
  2. Elder abuse comes in many forms. However, most people believe that patients are safe at the hands of their nurse. This might be why the story out of Pennsylvania feels so jarring. Ashley Ann Smith, a 30-year-old licensed practical nurse, has been accused of taking photos of at least 17 of her elderly nursing home patients. Some of the images show the residents in various states of undress and in need of immediate private care. One video found on her phone showed a patient undergoing a medical procedure while nude. The complaint filed against Smith states, “The images are explicit and private, and some have the sole purpose to humiliate the patients.” Not only did she take the photos, but she’s also charged with sending 20 pictures to a former co-worker, who also happens to be the father of her child. This man, Ron Whittaker, turned Smith into hospital leadership sometime last week. At this time, Whittaker hasn’t been charged with any crimes. If all of this isn’t enough to cause outrage, police also found two pictures of a 2-year-old girl on Smith’s phone that have been called pornographic. So, along with the 30 crimes of invasion of privacy and abuse of care, she’s also facing child pornography charges. Smith was immediately suspended from Kane McKeesport Community Living Center without pay once the photos were discovered. Then, on May 1st, Smith was terminated when local law enforcement notified the long-term care center that the allegations were founded. In a Pittsburgh Post-Gazette article, Lori Rushe, the daughter of one of the alleged victims stated, “You’re taking advantage of people who don’t know their name, where they’re at or anything” about her father, a 90-year-old man with dementia. Lori told the paper that she noted a new sign on the elevator a couple of weeks ago stating that taking unauthorized pictures of residents was prohibited. She went on to say that she wished the staff had told her the seriousness of the allegations. Understanding Elder Abuse While this case seems pretty clear that what happened to the residents at Kane McKeesport Community Living Center is abuse, let’s just review the definition. The National Institute of Aging notes that there five types of abuse: Emotional Abuse, also called psychological abuse, happens when a caregiver or other person yells, threatens, or repeatedly ignores an older person. Neglect happens when the older person’s needs aren’t met. Physical abuse occurs when someone causes bodily harm to the person, such as hitting, pushing, or slapping them. Abandonment is when an elderly person is left alone without having their needs or care planned or met. Sexual abuse happens when a caregiver forces an elderly person to be part of any sexual act. Signs of Abuse We often think that signs of abuse are only physical and usually visible. However, it’s critical to know that some seniors won’t be able to tell you about the abuse, such as what’s allegedly happened to those at Kane McKeesport. Here are a few things to monitor for if you think there’s been any sort of abuse: Withdrawn Stops taking part in activities they enjoy Has unexplained burns, bruises, or other injuries Has trouble sleeping Seems depressed Weight loss with no explanation Rocks back and forth, or shows other signs of trauma Acts violent or agitated How Would You Feel? It’s probably safe to say that if you had a loved one living in this facility, you would be outraged. But, what about if you worked there? Maybe you were even friends with the nurse who’s been charged and didn’t recognize any signs of this heinous crime? How would you feel? What do you think should happen to Smith? Should she lose her job along with any criminal sentence she receives? Post your comments below. We would love to get your take on the situation.
  3. Lorie Brown RN, MN, JD

    It Can Happen to You

    Here are a few ways in which nurses can be called before the Board and how you can protect yourself. Download allnurses Magazine Arrests, Charges, Convictions The first and obvious the Board feels that you are a nurse 24/7 and anything that you do that could look bad on our profession or be a concern for your judgment, they will take action. This means any criminal matter where you are arrested, charged or convicted such as a DUI. Controlled Substances Do not use controlled substances, illegal substances, marijuana or alcohol. If you take a controlled substance and do not have a valid prescription and you have to take a drug test that shows positive, it does not look good for you. And don’t take medications without a valid, current prescription or borrow medications from someone else as this would be considered practicing medicine without a license by self-prescribing and it is also called diversion. In addition, do not give a medication to someone else even if they’ve had a valid prescription for that medication in the past. This also is considered practicing medicine without a license and diversion. Professional Boundaries Do not cross professional boundaries. Nurses are required to care of patients during the time that they are assigned to the patient’s care. Do not come to visit patients after hours and do not continue a relationship with patients after the nurse/patient relationship is concluded. I’ve seen nurses who subsequently marry patients and then, if they divorce, the ex-spouse then files a complaint against the nurse’s license. I have seen nurses who, trying to be nice, will conduct banking chores for the patient. Taking the patient’s debit card and PIN, they do the transaction only to find that the patient then alleges the nurse stole money. Don’t become involved with patients after the nurse/patient relationship has ended and only provide activities within the scope of your practice. HIPAA Violation Be mindful of HIPAA. Talking about a patient outside of their room, even without using names, can be a HIPAA violation. You never know who might be listening. And don’t access patients’ records if you are not providing care for that patient and have no reason to access the patient’s records. One nurse’s adult son was in the emergency room. She could not leave her position but looked at his chart to get his information. She had no business checking the chart which was a violation of HIPAA. Don’t talk about patients except for treatment purposes and only in a secure area and do not access any other patients’ charts unless you are providing care or have a legitimate reason to do so. Narcotics: Administering and Signing Make sure you use due care in administering and signing out narcotics. With the opiate crisis these days, there is software in the Pyxis machine to see who is giving more medications than the others who are on the unit. Don’t be an outlier. Discuss the medication strategy with your coworkers and make sure that everyone is on the same page. When I went to nursing school, pain was considered the 5th vital signs and we always wanted to stay on top of pain. However, things are changing. In fact, sometimes they don’t even give narcotic pain medication, even after surgery. If you do give pain medications, make sure you administer them as soon as they are removed from the Pyxis. Do not carry it in your pocket except to go directly to the patient’s room. I have seen it argued before the Board that by waiting too long to administer injectable narcotic medication, the nurse had an opportunity to take some or all of the medication and replace it with saline. Also, make sure you waste medications right away for the same reason and make sure the witness actually sees the waste and cosigns it. Going to a coworker after you wasted the medication and asking a coworker to cosign the waste without witnessing is in violation of your facility’s policies and procedures. So, make sure you follow all the facility’s policies and procedures. If you do get reported to the Board, my experience has been that if there are discrepancies with narcotics given, the Board will think that you are using them and if you aren’t using them for your own use then you are selling them. They can be very unforgiving. Protect yourself by following your policies and procedures to the letter. The above-mentioned tips may seem obvious but you would be surprised how many nurses are called before the Board for these types of issues. The best protection against a Board Complaint is to be proactive and follow the rules.
  4. Lorie Brown RN, MN, JD

    The Dilemma of Multiple Licenses

    Download allnurses Magazine Dear License Dilemma, If you have multiple licenses, you are subject to multiple actions against it for the same thing. It’s as if you have a suspended driver’s license in Indiana for driving under the influence. Ohio would not want you driving in their state so Ohio has a right to know about the status of your driver’s license. The same is true with your nursing license as Ohio has a right to know about your Indiana nursing license status and possibly could take action on your Buckeye State license in response to issues attached to your Hoosier license. Some think that by refusing to renew their license in another state, no action will be taken. This is incorrect. Actions even can be taken against an expired license because the public has a right to know that action was taken against you in another state. Should you choose to reactivate that license, that state for that license wants to have a record of actions in any other state. Once an action is taken against your license, no matter where, it is on your record forever and available to the public for all to see at http://www.nursys.com. It can also take many years for action to be taken against a nurse’s license. The American Association of Nurse Attorneys has published a position paper on the statute of limitations and retained jurisdiction. The paper’s purpose is to create awareness and, hopefully, states will do something about how long it takes for charges to be filed against your license. When it takes so long for actions to be filed, it can be difficult to remember what happened years ago, memory fades and witnesses become unavailable. The paper also discusses retained jurisdiction, the state’s ability to file charges against your license when you no longer have a license. The paper is a valuable reference but, unfortunately, should you have multiple licenses, I call it the “domino effect” because action can be taken against all of those licenses. Lorie
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