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Improper heart monitoring causes stillbirth
A woman admitted to a hospital for delivery had spontaneous rupture of membranes. The mother was placed on a fetal monitor and given oxytocin. Fetal monitoring was reassuring for 48 hours. During that time the midwife, who had primary responsibility for the woman’s care, presented on only 1 occasion, even though hospital policy required examination every 24 hours, with more frequent exams after administration of oxytocin.
Two hours prior to delivery, the fetal monitor strip showed disturbing changes. The nurses were actually monitoring the maternal heart rate, not the fetal one. Once the fetal heart rate was located, a sinusoidal pattern was noted, but was not addressed for 40 minutes. Again, the nurses began to mistakenly monitor the maternal heart rate.
After the mother delivered a stillborn infant, pathology of the placenta revealed an abruption. The mother claimed the midwife was required by hospital policy to be present during labor. The defense contended that the child died from a viral syndrome.
- An $875,000 settlement was reached.
A woman admitted to a hospital for delivery had spontaneous rupture of membranes. The mother was placed on a fetal monitor and given oxytocin. Fetal monitoring was reassuring for 48 hours. During that time the midwife, who had primary responsibility for the woman’s care, presented on only 1 occasion, even though hospital policy required examination every 24 hours, with more frequent exams after administration of oxytocin.
Two hours prior to delivery, the fetal monitor strip showed disturbing changes. The nurses were actually monitoring the maternal heart rate, not the fetal one. Once the fetal heart rate was located, a sinusoidal pattern was noted, but was not addressed for 40 minutes. Again, the nurses began to mistakenly monitor the maternal heart rate.
After the mother delivered a stillborn infant, pathology of the placenta revealed an abruption. The mother claimed the midwife was required by hospital policy to be present during labor. The defense contended that the child died from a viral syndrome.
- An $875,000 settlement was reached.
A woman admitted to a hospital for delivery had spontaneous rupture of membranes. The mother was placed on a fetal monitor and given oxytocin. Fetal monitoring was reassuring for 48 hours. During that time the midwife, who had primary responsibility for the woman’s care, presented on only 1 occasion, even though hospital policy required examination every 24 hours, with more frequent exams after administration of oxytocin.
Two hours prior to delivery, the fetal monitor strip showed disturbing changes. The nurses were actually monitoring the maternal heart rate, not the fetal one. Once the fetal heart rate was located, a sinusoidal pattern was noted, but was not addressed for 40 minutes. Again, the nurses began to mistakenly monitor the maternal heart rate.
After the mother delivered a stillborn infant, pathology of the placenta revealed an abruption. The mother claimed the midwife was required by hospital policy to be present during labor. The defense contended that the child died from a viral syndrome.
- An $875,000 settlement was reached.
Should ovaries have been removed?
A woman with a family history of ovarian/cervical cancer discussed with her gynecologist her desire for a total hysterectomy with bilateral salpingo-oophorectomy. After obtaining informed consent, the gynecologist performed the procedure but did not remove the ovaries because, “they appeared normal when visualized during surgery.”
The woman later had severe abdominal pain that was diagnosed as ovarian cysts and adhesions around her ovaries. A different physician then performed a second surgery to remove the ovaries.
In suing, the woman faulted the first physician for failing to remove the ovaries during the initial surgery. The physician asserted that the medical indication for the hysterectomy did not extend to a medical need to remove the ovaries and that the development of adhesions was a known risk of the procedure. The physician also argued that the anatomical positioning of the ovaries made removal problematic without substantial risk.
- A confidential settlement was reached.
A woman with a family history of ovarian/cervical cancer discussed with her gynecologist her desire for a total hysterectomy with bilateral salpingo-oophorectomy. After obtaining informed consent, the gynecologist performed the procedure but did not remove the ovaries because, “they appeared normal when visualized during surgery.”
The woman later had severe abdominal pain that was diagnosed as ovarian cysts and adhesions around her ovaries. A different physician then performed a second surgery to remove the ovaries.
In suing, the woman faulted the first physician for failing to remove the ovaries during the initial surgery. The physician asserted that the medical indication for the hysterectomy did not extend to a medical need to remove the ovaries and that the development of adhesions was a known risk of the procedure. The physician also argued that the anatomical positioning of the ovaries made removal problematic without substantial risk.
- A confidential settlement was reached.
A woman with a family history of ovarian/cervical cancer discussed with her gynecologist her desire for a total hysterectomy with bilateral salpingo-oophorectomy. After obtaining informed consent, the gynecologist performed the procedure but did not remove the ovaries because, “they appeared normal when visualized during surgery.”
The woman later had severe abdominal pain that was diagnosed as ovarian cysts and adhesions around her ovaries. A different physician then performed a second surgery to remove the ovaries.
In suing, the woman faulted the first physician for failing to remove the ovaries during the initial surgery. The physician asserted that the medical indication for the hysterectomy did not extend to a medical need to remove the ovaries and that the development of adhesions was a known risk of the procedure. The physician also argued that the anatomical positioning of the ovaries made removal problematic without substantial risk.
- A confidential settlement was reached.
Woman suffers brain damage after birth
Undisclosed venue (Calif)
A 31-year-old woman, pregnant for the third time, was admitted on her due date to the hospital for delivery. She began to vomit blood during labor and, after she delivered a healthy baby, continued to bleed excessively from the uterus and the epidural injection site. The anesthesiologist and obstetrician diagnosed amniotic fluid embolism with disseminated intravascular coagulation (DIC). STAT testing confirmed the diagnosis, and the anesthesiologist ordered packed red blood cells and fresh frozen plasma. The woman was intubated, placed on a ventilator, and transferred to the ICU, where the internist on call was a rheumatologist unfamiliar with amniotic fluid embolism. Although the rheumatologist ordered transfusions of blood and clotting factors, the orders were carried out on a delayed basis or not at all.
During the next 4 hours, the woman received 4 of 6 ordered units of packaged red blood cells; 2 of 10 to 14 ordered units of fresh frozen plasma; and none of the 10 units of cryoprecipitate. The results of a STAT fibrogen were extremely low, requiring an emergency cryoprecipitate treatment, but this report did not reach the ICU for 2.5 hours.
After the woman’s blood pressure dropped, arterial blood gas results showed a pH of 7.15, indicating metabolic acidosis. An hour later the woman’s hematocrit was noted to have dropped from 36 at an earlier measurement to 16. The woman’s husband (a nurse) noticed abnormal beats on her cardiogram strip and alerted the ICU nurse.
The woman then had cardiac arrest and was in asystole for 10 to 11 minutes. She sustained kidney damage, which required dialysis for several months, and liver damage, both of which she recovered from fully. She also had hypoxic brain damage and requires constant custodial care. She can no longer care for her children or perform other ordinary household tasks.
The family claimed negligence by the hospital in assigning the woman’s care to a rheumatologist with no experience in managing amniotic fluid emboli and DIC. They also claimed that the failure to administer sufficient blood cells and fresh frozen plasma, not to mention cryoprecipitate, led to the cardiac arrest and brain damage. The hospital contended it had acted appropriately and observed that DIC is unpredictable regardless of the treatment given.
- The parties settled for $1.7 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Undisclosed venue (Calif)
A 31-year-old woman, pregnant for the third time, was admitted on her due date to the hospital for delivery. She began to vomit blood during labor and, after she delivered a healthy baby, continued to bleed excessively from the uterus and the epidural injection site. The anesthesiologist and obstetrician diagnosed amniotic fluid embolism with disseminated intravascular coagulation (DIC). STAT testing confirmed the diagnosis, and the anesthesiologist ordered packed red blood cells and fresh frozen plasma. The woman was intubated, placed on a ventilator, and transferred to the ICU, where the internist on call was a rheumatologist unfamiliar with amniotic fluid embolism. Although the rheumatologist ordered transfusions of blood and clotting factors, the orders were carried out on a delayed basis or not at all.
During the next 4 hours, the woman received 4 of 6 ordered units of packaged red blood cells; 2 of 10 to 14 ordered units of fresh frozen plasma; and none of the 10 units of cryoprecipitate. The results of a STAT fibrogen were extremely low, requiring an emergency cryoprecipitate treatment, but this report did not reach the ICU for 2.5 hours.
After the woman’s blood pressure dropped, arterial blood gas results showed a pH of 7.15, indicating metabolic acidosis. An hour later the woman’s hematocrit was noted to have dropped from 36 at an earlier measurement to 16. The woman’s husband (a nurse) noticed abnormal beats on her cardiogram strip and alerted the ICU nurse.
The woman then had cardiac arrest and was in asystole for 10 to 11 minutes. She sustained kidney damage, which required dialysis for several months, and liver damage, both of which she recovered from fully. She also had hypoxic brain damage and requires constant custodial care. She can no longer care for her children or perform other ordinary household tasks.
The family claimed negligence by the hospital in assigning the woman’s care to a rheumatologist with no experience in managing amniotic fluid emboli and DIC. They also claimed that the failure to administer sufficient blood cells and fresh frozen plasma, not to mention cryoprecipitate, led to the cardiac arrest and brain damage. The hospital contended it had acted appropriately and observed that DIC is unpredictable regardless of the treatment given.
- The parties settled for $1.7 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Undisclosed venue (Calif)
A 31-year-old woman, pregnant for the third time, was admitted on her due date to the hospital for delivery. She began to vomit blood during labor and, after she delivered a healthy baby, continued to bleed excessively from the uterus and the epidural injection site. The anesthesiologist and obstetrician diagnosed amniotic fluid embolism with disseminated intravascular coagulation (DIC). STAT testing confirmed the diagnosis, and the anesthesiologist ordered packed red blood cells and fresh frozen plasma. The woman was intubated, placed on a ventilator, and transferred to the ICU, where the internist on call was a rheumatologist unfamiliar with amniotic fluid embolism. Although the rheumatologist ordered transfusions of blood and clotting factors, the orders were carried out on a delayed basis or not at all.
During the next 4 hours, the woman received 4 of 6 ordered units of packaged red blood cells; 2 of 10 to 14 ordered units of fresh frozen plasma; and none of the 10 units of cryoprecipitate. The results of a STAT fibrogen were extremely low, requiring an emergency cryoprecipitate treatment, but this report did not reach the ICU for 2.5 hours.
After the woman’s blood pressure dropped, arterial blood gas results showed a pH of 7.15, indicating metabolic acidosis. An hour later the woman’s hematocrit was noted to have dropped from 36 at an earlier measurement to 16. The woman’s husband (a nurse) noticed abnormal beats on her cardiogram strip and alerted the ICU nurse.
The woman then had cardiac arrest and was in asystole for 10 to 11 minutes. She sustained kidney damage, which required dialysis for several months, and liver damage, both of which she recovered from fully. She also had hypoxic brain damage and requires constant custodial care. She can no longer care for her children or perform other ordinary household tasks.
The family claimed negligence by the hospital in assigning the woman’s care to a rheumatologist with no experience in managing amniotic fluid emboli and DIC. They also claimed that the failure to administer sufficient blood cells and fresh frozen plasma, not to mention cryoprecipitate, led to the cardiac arrest and brain damage. The hospital contended it had acted appropriately and observed that DIC is unpredictable regardless of the treatment given.
- The parties settled for $1.7 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Marlex mesh sutured to bladder, not vagina
An 82-year-old woman underwent a sacral colpopexy with Marlex mesh and a Moskowitz procedure. A total urethrovesical suspension was then performed and her vaginal and bladder prolapse was corrected.
Six months later, the woman had dehiscence of the vaginal cuff and prolapse of the small bowel, which was repaired by exploratory laparotomy, during which it was discovered that the Marlex mesh had been inappropriately sutured to the bladder rather than to the apex of the vagina.
The woman, who had pain and discomfort requiring 8 days of hospitalization, claimed negligence, which the defense denied.
- A defense verdict was returned.
An 82-year-old woman underwent a sacral colpopexy with Marlex mesh and a Moskowitz procedure. A total urethrovesical suspension was then performed and her vaginal and bladder prolapse was corrected.
Six months later, the woman had dehiscence of the vaginal cuff and prolapse of the small bowel, which was repaired by exploratory laparotomy, during which it was discovered that the Marlex mesh had been inappropriately sutured to the bladder rather than to the apex of the vagina.
The woman, who had pain and discomfort requiring 8 days of hospitalization, claimed negligence, which the defense denied.
- A defense verdict was returned.
An 82-year-old woman underwent a sacral colpopexy with Marlex mesh and a Moskowitz procedure. A total urethrovesical suspension was then performed and her vaginal and bladder prolapse was corrected.
Six months later, the woman had dehiscence of the vaginal cuff and prolapse of the small bowel, which was repaired by exploratory laparotomy, during which it was discovered that the Marlex mesh had been inappropriately sutured to the bladder rather than to the apex of the vagina.
The woman, who had pain and discomfort requiring 8 days of hospitalization, claimed negligence, which the defense denied.
- A defense verdict was returned.
Woman wants VBAC, but hypoxia results
After a previous cesarean section, a pregnant woman wanted a vaginal delivery and claimed she was told that VBAC was safe.
Arriving at the hospital in labor, she told hospital staff she had experienced uterine rupture at 5:56 am. Her physician was not told of the emergency when he was called at 6:02 am; he arrived at the hospital 23 minutes later. The infant, delivered by cesarean section 19 minutes after the physician’s arrival, had a catastrophic brain injury secondary to hypoxia and requires 24-hour care.
In suing the hospital and her physicians, the woman claimed she was not informed of the risk of uterine rupture. She also argued that a physician should have been at the hospital to perform a cesarean when she arrived, and noted communication delays with her doctor.
The physicians argued that the child’s condition was caused by a sudden acute ischemic event and that an earlier delivery would not have altered the outcome.
- The hospital settled with the plaintiff for $3.5 million; the jury returned a defense verdict for the physicians.
After a previous cesarean section, a pregnant woman wanted a vaginal delivery and claimed she was told that VBAC was safe.
Arriving at the hospital in labor, she told hospital staff she had experienced uterine rupture at 5:56 am. Her physician was not told of the emergency when he was called at 6:02 am; he arrived at the hospital 23 minutes later. The infant, delivered by cesarean section 19 minutes after the physician’s arrival, had a catastrophic brain injury secondary to hypoxia and requires 24-hour care.
In suing the hospital and her physicians, the woman claimed she was not informed of the risk of uterine rupture. She also argued that a physician should have been at the hospital to perform a cesarean when she arrived, and noted communication delays with her doctor.
The physicians argued that the child’s condition was caused by a sudden acute ischemic event and that an earlier delivery would not have altered the outcome.
- The hospital settled with the plaintiff for $3.5 million; the jury returned a defense verdict for the physicians.
After a previous cesarean section, a pregnant woman wanted a vaginal delivery and claimed she was told that VBAC was safe.
Arriving at the hospital in labor, she told hospital staff she had experienced uterine rupture at 5:56 am. Her physician was not told of the emergency when he was called at 6:02 am; he arrived at the hospital 23 minutes later. The infant, delivered by cesarean section 19 minutes after the physician’s arrival, had a catastrophic brain injury secondary to hypoxia and requires 24-hour care.
In suing the hospital and her physicians, the woman claimed she was not informed of the risk of uterine rupture. She also argued that a physician should have been at the hospital to perform a cesarean when she arrived, and noted communication delays with her doctor.
The physicians argued that the child’s condition was caused by a sudden acute ischemic event and that an earlier delivery would not have altered the outcome.
- The hospital settled with the plaintiff for $3.5 million; the jury returned a defense verdict for the physicians.
Did focus on HRT delay cancer diagnosis?
A woman was treated by a group of gynecologists for recurrent gynecologic bleeding and problems associated with hormone replacement therapy. After several episodes of nonstop bleeding she was advised to discontinue all hormone replacement and return in 6 months. According to her physician, he also advised her to return or call in 1 week if the bleeding continued or did not lessen. However, this instruction was not recorded on her chart.
The woman then moved to Arizona, where she consulted a different gynecologist, who diagnosed the rare cancer leiomyosarcoma. The woman died 2 years later.
In suing, the woman’s family claimed that the first group of gynecologists failed to diagnose and treat the cancer.
- The jury returned a defense verdict.
A woman was treated by a group of gynecologists for recurrent gynecologic bleeding and problems associated with hormone replacement therapy. After several episodes of nonstop bleeding she was advised to discontinue all hormone replacement and return in 6 months. According to her physician, he also advised her to return or call in 1 week if the bleeding continued or did not lessen. However, this instruction was not recorded on her chart.
The woman then moved to Arizona, where she consulted a different gynecologist, who diagnosed the rare cancer leiomyosarcoma. The woman died 2 years later.
In suing, the woman’s family claimed that the first group of gynecologists failed to diagnose and treat the cancer.
- The jury returned a defense verdict.
A woman was treated by a group of gynecologists for recurrent gynecologic bleeding and problems associated with hormone replacement therapy. After several episodes of nonstop bleeding she was advised to discontinue all hormone replacement and return in 6 months. According to her physician, he also advised her to return or call in 1 week if the bleeding continued or did not lessen. However, this instruction was not recorded on her chart.
The woman then moved to Arizona, where she consulted a different gynecologist, who diagnosed the rare cancer leiomyosarcoma. The woman died 2 years later.
In suing, the woman’s family claimed that the first group of gynecologists failed to diagnose and treat the cancer.
- The jury returned a defense verdict.
Bowel injury leads to long recovery
An elderly woman underwent a hysterectomy as treatment for endometrial cancer. During the procedure the bowel was injured. Two days later a second surgery was performed to repair the bowel, but was unsuccessful. After a third surgery, an abdominal infection and a fistula developed, requiring a lengthy recuperation.
In suing, the woman claimed the defendant negligently performed the first surgery. The defendant contended that the injury was a surgical complication due to dense adhesions encountered during the first procedure.
- The jury returned a defense verdict.
An elderly woman underwent a hysterectomy as treatment for endometrial cancer. During the procedure the bowel was injured. Two days later a second surgery was performed to repair the bowel, but was unsuccessful. After a third surgery, an abdominal infection and a fistula developed, requiring a lengthy recuperation.
In suing, the woman claimed the defendant negligently performed the first surgery. The defendant contended that the injury was a surgical complication due to dense adhesions encountered during the first procedure.
- The jury returned a defense verdict.
An elderly woman underwent a hysterectomy as treatment for endometrial cancer. During the procedure the bowel was injured. Two days later a second surgery was performed to repair the bowel, but was unsuccessful. After a third surgery, an abdominal infection and a fistula developed, requiring a lengthy recuperation.
In suing, the woman claimed the defendant negligently performed the first surgery. The defendant contended that the injury was a surgical complication due to dense adhesions encountered during the first procedure.
- The jury returned a defense verdict.
Medical Records: What to Keep
If your office is anything like mine, you have too many medical records and too little storage space. And since the laws in your state require that old records be kept for only a finite amount of time, you may be tempted to get rid of your oldest charts.
Unfortunately, regardless of your state's retention laws (a list of which can be found at http://pcarchiver.com/statelaws.html
▸ According to one malpractice insurance carrier, GE Medical Protective, 10% of medical claims are filed at least 5 years after the incident, and 5% are brought at least 10 years after—regardless of state laws and statutes of limitation. Without a record, there is only the doctor's word against the patient's word: a treacherous situation.
▸ Statutes of limitation are often indefinite, or greatly extended, when the patient is a child, especially when birth defects, mental retardation, or parental disputes are involved.
▸ There is no time limitation on state medical board actions. Patients have been known to file complaints with state boards decades after alleged improprieties. Without the medical record, your ability to defend yourself against such a complaint is severely limited.
▸ In most states, if a patient alleges that a doctor said an outcome was not the one expected—even if this is only the patient's recollection, true or not—the destruction of the record can be considered hiding evidence, a criminal offense.
▸ Medicare and the IRS have a 7-year limit on pursuing billing errors, but there is no time limit if fraud is alleged.
▸ Regardless of any statutes, the Medical Liability Monitor (http://www.medicalliabilitymonitor.com
So as much as you would like to dispose of old charts, in general it's not a good idea. But office space is limited and expensive. Where should old charts be stored? You have several options:
▸ Self Storage. The most obvious option is to physically move old records to another location. While your attic might be an obvious and cheap option, those records are a fire hazard, and chances are your spouse will not be happy. For a monthly fee you can stash old charts in a commercial self-storage facility. This is the least expensive method, but finding a specific record when you need it can be a chore. In addition, make sure the storage company is reputable—and the roof doesn't leak.
▸ Archiving. You can hire an archival firm to keep your old records. They will pick them up periodically, store them, and when you need to see an archived file, they'll deliver it back to you within a day or two.
▸ Microfilm. This method allows you to keep the records on site, but in a much smaller space. A microfiche company performs the transfer, and you buy the equipment necessary to read the films. When you need a hard copy of an old file, you simply print it out.
▸ Computerization. Clearly, the wave of the future is digital archiving. The simplest method of doing this is scanning the old records onto a hard drive with backups on disk. Many large clinics already are using such systems, and turnkey programs are now available for smaller offices. One popular system is called PCArchiver (http://pcarchiver.com
Once you've found a home for your old medical records, what about all those other records—business documents of all kinds—you've been meaning to do something with? Which of those need to be kept, and for how long? I'll talk about that next month.
If your office is anything like mine, you have too many medical records and too little storage space. And since the laws in your state require that old records be kept for only a finite amount of time, you may be tempted to get rid of your oldest charts.
Unfortunately, regardless of your state's retention laws (a list of which can be found at http://pcarchiver.com/statelaws.html
▸ According to one malpractice insurance carrier, GE Medical Protective, 10% of medical claims are filed at least 5 years after the incident, and 5% are brought at least 10 years after—regardless of state laws and statutes of limitation. Without a record, there is only the doctor's word against the patient's word: a treacherous situation.
▸ Statutes of limitation are often indefinite, or greatly extended, when the patient is a child, especially when birth defects, mental retardation, or parental disputes are involved.
▸ There is no time limitation on state medical board actions. Patients have been known to file complaints with state boards decades after alleged improprieties. Without the medical record, your ability to defend yourself against such a complaint is severely limited.
▸ In most states, if a patient alleges that a doctor said an outcome was not the one expected—even if this is only the patient's recollection, true or not—the destruction of the record can be considered hiding evidence, a criminal offense.
▸ Medicare and the IRS have a 7-year limit on pursuing billing errors, but there is no time limit if fraud is alleged.
▸ Regardless of any statutes, the Medical Liability Monitor (http://www.medicalliabilitymonitor.com
So as much as you would like to dispose of old charts, in general it's not a good idea. But office space is limited and expensive. Where should old charts be stored? You have several options:
▸ Self Storage. The most obvious option is to physically move old records to another location. While your attic might be an obvious and cheap option, those records are a fire hazard, and chances are your spouse will not be happy. For a monthly fee you can stash old charts in a commercial self-storage facility. This is the least expensive method, but finding a specific record when you need it can be a chore. In addition, make sure the storage company is reputable—and the roof doesn't leak.
▸ Archiving. You can hire an archival firm to keep your old records. They will pick them up periodically, store them, and when you need to see an archived file, they'll deliver it back to you within a day or two.
▸ Microfilm. This method allows you to keep the records on site, but in a much smaller space. A microfiche company performs the transfer, and you buy the equipment necessary to read the films. When you need a hard copy of an old file, you simply print it out.
▸ Computerization. Clearly, the wave of the future is digital archiving. The simplest method of doing this is scanning the old records onto a hard drive with backups on disk. Many large clinics already are using such systems, and turnkey programs are now available for smaller offices. One popular system is called PCArchiver (http://pcarchiver.com
Once you've found a home for your old medical records, what about all those other records—business documents of all kinds—you've been meaning to do something with? Which of those need to be kept, and for how long? I'll talk about that next month.
If your office is anything like mine, you have too many medical records and too little storage space. And since the laws in your state require that old records be kept for only a finite amount of time, you may be tempted to get rid of your oldest charts.
Unfortunately, regardless of your state's retention laws (a list of which can be found at http://pcarchiver.com/statelaws.html
▸ According to one malpractice insurance carrier, GE Medical Protective, 10% of medical claims are filed at least 5 years after the incident, and 5% are brought at least 10 years after—regardless of state laws and statutes of limitation. Without a record, there is only the doctor's word against the patient's word: a treacherous situation.
▸ Statutes of limitation are often indefinite, or greatly extended, when the patient is a child, especially when birth defects, mental retardation, or parental disputes are involved.
▸ There is no time limitation on state medical board actions. Patients have been known to file complaints with state boards decades after alleged improprieties. Without the medical record, your ability to defend yourself against such a complaint is severely limited.
▸ In most states, if a patient alleges that a doctor said an outcome was not the one expected—even if this is only the patient's recollection, true or not—the destruction of the record can be considered hiding evidence, a criminal offense.
▸ Medicare and the IRS have a 7-year limit on pursuing billing errors, but there is no time limit if fraud is alleged.
▸ Regardless of any statutes, the Medical Liability Monitor (http://www.medicalliabilitymonitor.com
So as much as you would like to dispose of old charts, in general it's not a good idea. But office space is limited and expensive. Where should old charts be stored? You have several options:
▸ Self Storage. The most obvious option is to physically move old records to another location. While your attic might be an obvious and cheap option, those records are a fire hazard, and chances are your spouse will not be happy. For a monthly fee you can stash old charts in a commercial self-storage facility. This is the least expensive method, but finding a specific record when you need it can be a chore. In addition, make sure the storage company is reputable—and the roof doesn't leak.
▸ Archiving. You can hire an archival firm to keep your old records. They will pick them up periodically, store them, and when you need to see an archived file, they'll deliver it back to you within a day or two.
▸ Microfilm. This method allows you to keep the records on site, but in a much smaller space. A microfiche company performs the transfer, and you buy the equipment necessary to read the films. When you need a hard copy of an old file, you simply print it out.
▸ Computerization. Clearly, the wave of the future is digital archiving. The simplest method of doing this is scanning the old records onto a hard drive with backups on disk. Many large clinics already are using such systems, and turnkey programs are now available for smaller offices. One popular system is called PCArchiver (http://pcarchiver.com
Once you've found a home for your old medical records, what about all those other records—business documents of all kinds—you've been meaning to do something with? Which of those need to be kept, and for how long? I'll talk about that next month.
Dilation & curettage fails to end pregnancy
A woman underwent a D&C at 7 weeks’ gestation because her ultrasound showed a suspected blighted ovum. Two months later the woman thought she was still pregnant and returned to her ObGyn, who confirmed the pregnancy and told the woman he could not verify the child would be without injury.
The baby was fine at birth, but the woman had anxiety and depression concerning her child that developed almost into a psychosis.
In suing, the woman claimed negligence in the doctor’s failure to perform additional testing before the D&C. The physician maintained that reliance on the ultrasound results was reasonable and that the plaintiff’s fears were unreasonable because her child was healthy.
- The jury awarded the plaintiff $372,000; posttrial motions were pending.
A woman underwent a D&C at 7 weeks’ gestation because her ultrasound showed a suspected blighted ovum. Two months later the woman thought she was still pregnant and returned to her ObGyn, who confirmed the pregnancy and told the woman he could not verify the child would be without injury.
The baby was fine at birth, but the woman had anxiety and depression concerning her child that developed almost into a psychosis.
In suing, the woman claimed negligence in the doctor’s failure to perform additional testing before the D&C. The physician maintained that reliance on the ultrasound results was reasonable and that the plaintiff’s fears were unreasonable because her child was healthy.
- The jury awarded the plaintiff $372,000; posttrial motions were pending.
A woman underwent a D&C at 7 weeks’ gestation because her ultrasound showed a suspected blighted ovum. Two months later the woman thought she was still pregnant and returned to her ObGyn, who confirmed the pregnancy and told the woman he could not verify the child would be without injury.
The baby was fine at birth, but the woman had anxiety and depression concerning her child that developed almost into a psychosis.
In suing, the woman claimed negligence in the doctor’s failure to perform additional testing before the D&C. The physician maintained that reliance on the ultrasound results was reasonable and that the plaintiff’s fears were unreasonable because her child was healthy.
- The jury awarded the plaintiff $372,000; posttrial motions were pending.
Was delayed cesarean cause of cerebral palsy?
A woman at 32 weeks’ gestation had been undergoing weekly nonstress tests for a suspected small-for-gestational-age fetus. This time the test, which had previously returned normal results, was nonreassuring. The woman also reported that the fetus had not moved for 2 days. She was then discharged and instructed to return the next day for a biophysical profile.
When she arrived, the test could not be performed because the technician was ill. With fetal heart tones still nonreassuring, she was admitted to a Level I hospital for a possible cesarean section. The cesarean section was performed and the baby was noted to be distressed at birth. The baby was transferred to another hospital and diagnosed with cerebral palsy.
In suing, the woman claimed that she should have been transferred to a higher-level hospital and that the delay in performing the cesarean section was unnecessary. She also claimed that steroids were improperly administered.
The defense contended that based on the lack of fetal movement reported earlier, the child’s injury occurred prior to hospital admission and that the woman refused suggested transfer to another facility.
- The parties reached a $3.4 million settlement.
A woman at 32 weeks’ gestation had been undergoing weekly nonstress tests for a suspected small-for-gestational-age fetus. This time the test, which had previously returned normal results, was nonreassuring. The woman also reported that the fetus had not moved for 2 days. She was then discharged and instructed to return the next day for a biophysical profile.
When she arrived, the test could not be performed because the technician was ill. With fetal heart tones still nonreassuring, she was admitted to a Level I hospital for a possible cesarean section. The cesarean section was performed and the baby was noted to be distressed at birth. The baby was transferred to another hospital and diagnosed with cerebral palsy.
In suing, the woman claimed that she should have been transferred to a higher-level hospital and that the delay in performing the cesarean section was unnecessary. She also claimed that steroids were improperly administered.
The defense contended that based on the lack of fetal movement reported earlier, the child’s injury occurred prior to hospital admission and that the woman refused suggested transfer to another facility.
- The parties reached a $3.4 million settlement.
A woman at 32 weeks’ gestation had been undergoing weekly nonstress tests for a suspected small-for-gestational-age fetus. This time the test, which had previously returned normal results, was nonreassuring. The woman also reported that the fetus had not moved for 2 days. She was then discharged and instructed to return the next day for a biophysical profile.
When she arrived, the test could not be performed because the technician was ill. With fetal heart tones still nonreassuring, she was admitted to a Level I hospital for a possible cesarean section. The cesarean section was performed and the baby was noted to be distressed at birth. The baby was transferred to another hospital and diagnosed with cerebral palsy.
In suing, the woman claimed that she should have been transferred to a higher-level hospital and that the delay in performing the cesarean section was unnecessary. She also claimed that steroids were improperly administered.
The defense contended that based on the lack of fetal movement reported earlier, the child’s injury occurred prior to hospital admission and that the woman refused suggested transfer to another facility.
- The parties reached a $3.4 million settlement.