Hospital ER Malpractice Is Often Caused by Bad Management Practices, Rather Than Mistaken Judgment Calls

When people think of the term “malpractice,” they tend to think of a doctor making a huge mistake while treating the patient, like a surgeon puncturing the patient’s bowel during an abdominal operation or a radiologist missing a spot on a patient’s mammogram. Many times, however, malpractice takes the form of a simple management failure. The problem is not that a physician made a mistake while treating the patient, but rather that the hospital or the outpatient center failed to properly monitor or follow-up with the patient. Many states call this "corporate negligence" if it was the result of inadequate policies.

The New York Times recently discussed a tragic situation in which a 22-year-old woman, an aspiring novelist who was working as a waitress to make her way through college, took Ephedra (a previously-legal stimulant banned by the FDA), had a few beers, and took an herbal sleep remedy. She ended up so ill that she called the poison control center, which told her to call an ambulance, which brought her to the hospital.

And that's where things went wrong: an emergency medicine physician gave her two anti-nausea drugs and to intravenous doses of a powerful sedative, butafter that there’s no record of her being checked for any of her vital signs for more than three hours. A nurse for the hospital apparently testified that the woman was being checked so frequently on her cardiac monitor, that there was no need to write down the vital signs - an absurd claim that even The New York Times thought was “too glib to be credible.” (It could also be an indication of negligence, because the standard of care is to fully document the patient’s vital signs.)

As a result of the hospital’s neglect, the woman was eventually found in severe tachycardia while foaming at the mouth; she suffered a brain injury and eventually died as a result. Her family filed a medical malpractice lawsuit against the hospital but, as we know all too well as malpractice lawyers, courts and juries are hostile towards malpractice claims, so that even strong cases can end up losing. In her case, the jury found against her, even though the evidence of negligence was so strong that, after the lawsuit was done, The New York Times sent her records to a highly respected former medical director from one of the best emergency rooms in the country, who concluded that she had not been properly monitored or treated, and should have been in intensive care the entire time.

For all the talk about bringing computers and electronic health records into medicine, the unfortunate problem is that all the computers in the world won’t make a difference if the nurses and doctors who are supposed to be putting information into those computers don’t end up using them. For years now "checklists" have been the rage in medicine, but many hospitals and outpatient centers just aren’t getting the message, and we see this problem over and over again with the patients and their family members who come to us for help. Until the federal or state governments start demanding medical facilities implement rigorous training and audits to ensure every patient is always put the system in the system has multiple layers of safety backups (sometimes called the “Swiss cheese” method) these types of preventable injuries and deaths are to keep occurring.

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