The Legality of Risk Management

The Legality of Risk Management

Vicki Johnson

University of Phoenix

DHA/712 Risk Management in Complex Organizations
Professor Gerald Griffin

February 9, 2012

On a Friday afternoon a 46-year-old female veteran with a persistent cough, raspy breathing, and fever came into the Veteran Affairs Medical Center Emergency Department. The physician on staff examined the female veteran, and did not find any specific abnormalities. The physician still ordered chest radiography and reviewed the radiographs once she received the radiographs. The emergency physician on staff released the female veteran with a diagnosis of an upper respiratory infection and asked the female veteran to call her primary care physician if her symptoms did not cease. The emergency physician chose not to call the radiologist who was on call but at home and could be reached by telephone. The following week day, the radiologist was on duty after he read the radiographs and recorded a report that stated, “Chest is most likely normal. However, there is a small ill-defined density in the right upper lobe, most likely representing a scar. If no previous films are available for comparison, CT scan should be considered for further evaluation.” During the time he read the radiographs, the emergency physician had already read the radiographs as normal. One year later, the same female veteran was referred by her primary care physician to the Veteran Affairs Medical Center’s radiology department for chest radiography because of an ongoing cough. The radiologist who read the chest radiographs a year ago read the new radiographs. The new radiographs showed a 2.5 cm lesion on the female veteran’s right upper lobe, same area to where the radiologist had seen the density on the previous radiographs. Moderated mediastinal lymphadenopathy was also present. The findings were evident and suspect for carcinoma, and the diagnosis of a small cell carcinoma was confirmed three days later, after bronchoscopy. The radiologist out of concern consulted the medical center Chief of Staff. The Chief of Staff contacted the primary care physician of the female veteran and found that the initial chest radiographs were never entered into the female veteran’s medical records. Paperwork or records of the emergency room visit was never entered into the female veteran’s medical chart for her primary care physician to review. The female veteran was never informed of the questionable chest radiograph and the failure to communicate with the medical center staff or the female veteran was evident. A meeting was held with the Director of the Medical Center, the Chief of Staff, the Emergency Department, the female veteran, and her husband, and the medical centers risk management team because of the failure to communicate. The standards, policies and regulations of the Veteran Affairs Medical Center had been violated. The communication line had been dropped and the procedures of informing providers of the status of his or her patients were violated. Standards and procedures are in place so the medical center can operate smoothly and patient care is not jeopardized.
Facts of the Case 1. Female veteran came to Veteran Affairs Medical Center Emergency Department 2. Emergency Physician ordered chest radiographs but failed to get radiologist opinion 3. Emergency Physician did not follow-up on radiographs next working day 4. Radiologist did not communicate to female veteran’s primary care doctor his concerns earlier of radiographs, even though Emergency Physician failed to do job 5. Radiologist should have contacted Emergency Physician of his suspicions immediately. 6. Female veteran should have been notified by Emergency Physician or Radiologist of suspicions and brought back in immediately for CT. 7. Veteran Affairs Medical Center Emergency Department failed to provide quality medical care for the female veteran. The burden of the process was left to the radiologist because of the Veteran Affairs Medical Center’s regulations, procedures, and policies. The radiologist has the burden of interpreting the radiographs and informing the emergency department physician. The emergency physician on duty, however; never contacted the radiologist that day. When the radiologist came on duty the following work day the burden fell on the radiologist to inform the emergency physician. This was the first failure of communication. Nothing could be passed on to the female veteran’s primary care’s provider from this point. The Veteran Affairs Medical Center’s quality of care is usually above average but this incident was one of high significance and cannot be overlooked. This incidence will affect the female veteran’s life and her family’s life.
The Outcome The standard of care at the Veteran Affairs Medical Center was breached when the radiologist failed to communicate the abnormality of the chest radiographs to the emergency physician. The attorneys and professional liability insurance claims managers representing the codefendants came to the conclusion that the lawsuit could not be defended successfully and with the approval of the defendant physicians and Veteran Affairs Medical Center started settlement negotiations with the female veteran. The lawsuit was resolved with the total payments to the female veteran being $1 million with the emergency physician and the Veteran Affairs Medical Center each paying $200,000, and the radiologist paying $600.000.
Executive Summary The Patient Representative concludes that Veteran Affairs Medical Center has done their best to compensated the plaintiff for the incident and the quality of care that was afforded to her on the noted date above. The female veteran cannot be compensated for impact that this will have on her life and her family’s life from this time forward and for that the Veteran Affairs Medical Center deeply apologizes. In the future the Veteran Affairs Medical Center will have a radiologist on staff during the weekends to review all radiographs. All radiographs will be entered into every veteran’s medical records without hesitancy during emergency department visits. All radiographs ordered by emergency physicians must be read by a radiologist also, not just by the emergency physician on call. The emergency physician on staff will communicate with the veteran’s primary care physician if there is a concern reference the veteran’s health during an emergency department visit via telephone, computer, or in person. This will be entered as a part of a new regulation, procedure and policy for the Veteran Affairs Medical Center. Funds for compensating veterans for malpractice errors are in place, however; the facility will look into other avenues of providing funds for these types of errors. The risk management team will take a look at other possibilities.

Reference
Vicki Johnson, 2012 http://www.vaww.va.gov”The Case”