Administration and Leadership, News

Pro Bono: The Costs of Medical Errors

Issue 12 and Volume 39.

Medical errors can lead to harm to the patient and liability to the EMS agency and the individual EMS care provider. Most states provide some form of “qualified immunities” for the individual EMT or paramedic in the event that errors occur. Typically, to prove negligence against the individual EMT or paramedic, the plaintiff must show there was “gross negligence” by the care provider. Gross negligence is more than just a mistake; it borders on intentional misconduct or disregard for the patient. It’s likely those immunities will not apply to the EMS agency itself, which is often held to the standard of “ordinary negligence”—what a reasonable EMS agency has done in a similar situation. Negligence of your agency can be proven based on the field provider’s errors in treatment—even if the field provider wasn’t grossly negligent.

There are many ways to prevent medical errors in the field. The first step is to recognize and accept we’re each accountable to ourselves, our agency, and to the patient entrusted to our care. Patient care is a collaborative process—it involves a team effort. We must never forget that lives are at stake and that the patient’s outcome may well depend on what we do or don’t do. We’re accountable not only for our actions (e.g., administering the wrong dose of an IV medication), but our inactions as well (e.g., not carrying the oxygen in to the residence when the call was dispatched as shortness of breath). So every field provider has a duty to question his or her own performance, and to question the performance of others we work with in providing care to the patient. Healthcare must be transparent if we’re to avoid errors in the field—there should be no secrets and we can’t cover-up medical errors or mistakes!

Here are some tips for avoiding the legal consequences of medical errors:

  • Stay laser-focused on the patient. The patient should be the priority in all that we do, and we must always remember that fundamental premise of being a professional EMS provider. Avoid unnecessary distractions and extraneous activities (like checking messages on your smartphone) whenever you’re with a patient. Too many cases involving so-called medical errors are the result of a poor attitude or simply not paying attention to the patient at all times during an incident. Treat everyone as if they were your own loved one.
  • Check your equipment and document it. Numerous cases we have dealt with involving medical errors stemmed from not checking the equipment to make sure it was present and working properly. Case law is full of cases involving dead defibrillator batteries, empty oxygen tanks, and “failures” of medical equipment that led to patient care errors that could have often—and easily—been prevented. Make sure all your tools of the trade are present, are in working order, and document that you checked the equipment at the start of your shift!
  • Follow your treatment protocols. Increasingly, the standard of care is becoming your medically-approved treatment protocols. This is especially true in high risk areas, like treating patients with critical medical conditions or performing advanced procedures such as endotracheal intubation. Anytime you deviate from those protocols (like not properly assessing and documenting proper endotracheal tube placement) you run the risk of a negligence claim if the patient suffers a bad outcome as a result. Checklists are also a great tool to help ensure compliance with medical protocols. Recent research has shown that checklists can reduce medical errors. (See “The Value of a Checklist,” by Shaughn Maxwell, EMT-P, in the June issue). Of course, there may be good cause to not follow treatment protocols, but those occasions should be explained and clearly documented.
  • Thoroughly document on the patient care report (PCR). The PCR is the official record of the patient’s interaction. It must thoroughly document the patient assessment, the care provided to them and the results of that care. The PCR is also your “substituted memory” in the event you are called to account for your actions or inactions on a particular call—especially in courtroom testimony that might not take place until several years after the incident. Always make sure the PCR is complete and paints an accurate picture of the patient at every step of the incident.

As the public and the patient demand more transparency and accountability in the health care provided to them, everyone in the EMS agency must focus on ways to reduce medical errors and improve patient safety. All it takes is one $10 million jury verdict due to a medical error to cause irreparable harm to your agency’s reputation. A patient-focused attitude and preventive steps are the key to avoiding medical errors.

Administration and Leadership, Columns

Pro Bono: The Costs of Medical Errors

Issue 12 and Volume 39.

Medical errors can lead to harm to the patient and liability to the EMS agency and the individual EMS care provider. Most states provide some form of “qualified immunities” for the individual EMT or paramedic in the event that errors occur. Typically, to prove negligence against the individual EMT or paramedic, the plaintiff must show there was “gross negligence” by the care provider. Gross negligence is more than just a mistake; it borders on intentional misconduct or disregard for the patient. It’s likely those immunities will not apply to the EMS agency itself, which is often held to the standard of “ordinary negligence”—what a reasonable EMS agency has done in a similar situation. Negligence of your agency can be proven based on the field provider’s errors in treatment—even if the field provider wasn’t grossly negligent.

There are many ways to prevent medical errors in the field. The first step is to recognize and accept we’re each accountable to ourselves, our agency, and to the patient entrusted to our care. Patient care is a collaborative process—it involves a team effort. We must never forget that lives are at stake and that the patient’s outcome may well depend on what we do or don’t do. We’re accountable not only for our actions (e.g., administering the wrong dose of an IV medication), but our inactions as well (e.g., not carrying the oxygen in to the residence when the call was dispatched as shortness of breath). So every field provider has a duty to question his or her own performance, and to question the performance of others we work with in providing care to the patient. Healthcare must be transparent if we’re to avoid errors in the field—there should be no secrets and we can’t cover-up medical errors or mistakes!

Here are some tips for avoiding the legal consequences of medical errors:

  • Stay laser-focused on the patient. The patient should be the priority in all that we do, and we must always remember that fundamental premise of being a professional EMS provider. Avoid unnecessary distractions and extraneous activities (like checking messages on your smartphone) whenever you’re with a patient. Too many cases involving so-called medical errors are the result of a poor attitude or simply not paying attention to the patient at all times during an incident. Treat everyone as if they were your own loved one.
  • Check your equipment and document it. Numerous cases we have dealt with involving medical errors stemmed from not checking the equipment to make sure it was present and working properly. Case law is full of cases involving dead defibrillator batteries, empty oxygen tanks, and “failures” of medical equipment that led to patient care errors that could have often—and easily—been prevented. Make sure all your tools of the trade are present, are in working order, and document that you checked the equipment at the start of your shift!
  • Follow your treatment protocols. Increasingly, the standard of care is becoming your medically-approved treatment protocols. This is especially true in high risk areas, like treating patients with critical medical conditions or performing advanced procedures such as endotracheal intubation. Anytime you deviate from those protocols (like not properly assessing and documenting proper endotracheal tube placement) you run the risk of a negligence claim if the patient suffers a bad outcome as a result. Checklists are also a great tool to help ensure compliance with medical protocols. Recent research has shown that checklists can reduce medical errors. (See “The Value of a Checklist,” by Shaughn Maxwell, EMT-P, in the June issue). Of course, there may be good cause to not follow treatment protocols, but those occasions should be explained and clearly documented.
  • Thoroughly document on the patient care report (PCR). The PCR is the official record of the patient’s interaction. It must thoroughly document the patient assessment, the care provided to them and the results of that care. The PCR is also your “substituted memory” in the event you are called to account for your actions or inactions on a particular call—especially in courtroom testimony that might not take place until several years after the incident. Always make sure the PCR is complete and paints an accurate picture of the patient at every step of the incident.

As the public and the patient demand more transparency and accountability in the health care provided to them, everyone in the EMS agency must focus on ways to reduce medical errors and improve patient safety. All it takes is one $10 million jury verdict due to a medical error to cause irreparable harm to your agency’s reputation. A patient-focused attitude and preventive steps are the key to avoiding medical errors.