Malpractice Charges Research Articles

Risk of malpractice in ultrasonography and POCUS

Background and aim. The Hippocratic oath that all physicians take when admitted to the Romanian College of Physicians starts from their obligation not to harm patients: primum non nocere. Non-maleficence is also one of the primary perceptions of bioethics that medical students learn from the first years of their studies. This review presents the current state of POCUs in Romania's neonatology and the physicians' challenges regarding the risk of malpractice in this field. Material and methods. The issues of malpractice focused on ultrasound, the challenges of the POCUs, and the process of training and obtaining informed consent for this procedure are analyzed. Also, the risks for liability related to this issue and the appropriate conduct in this field are presented. Results. Every physician must assume the consequences of his or her decisions, and when they are evaluated for the charge of malpractice, this evaluation is made by reference to the legal rules in force. POCUS is a branch of ultrasonography increasingly used in multiple medical specialties. Informed consent must be obtained before the ultrasound examination. No ultrasound examination of the newborn or POCUS assessment will be performed without prior informed consent of the legal guardian, who will also sign the consent. Although the benefits of POCUS are undeniable, this procedure can come with several risks for patients. Unfamiliarity with the legal aspects of performing this complex medical act can easily push the physician into the area of medical malpractice. Proper training in the field of ultrasonography, respect for the limits of competence, and compliance with all the requirements of the law regarding the medical act guarantee the safe performance of medical procedures, both for the patient and the physician. Conclusion. Based on the data mentioned above, in order to perform reliable POCUS examinations, it is recommended that a complementary ultrasonography curriculum from the existing national ultrasonography curricula be completed.

Assessing the Medico-legal Knowledge of Health Care Professionals: The Case of Konongo Odumasi Government Hospital

Introduction: There is growing public awareness regarding the ethical conduct of medical practitioners. Hence knowledge about medico-legal issues is as important to the practice of medicine as clinical skills. Method: A survey was conducted among some health care professionals at Konongo Odumasi Government Hospital, Ghana. A self-administered questionnaire was used to elicit information on informed consent, confidentiality and medico-legal issues. Data collected was analysed using SPSS version 20. Results: A total of 100 health care workers were enrolled on the study representing 100% response rate. The study revealed that 96% had knowledge or were aware of medico-legal issues; and 26% of the respondents indicated that disclosing a patient's medical information to someone else cannot lead to a medico-legal case. About 28% of the health care professionals had inadequate knowledge on physician-assisted suicide. 89% of the respondents indicated that taking precautions is very good as it can prevent a charge of malpractice and 80% of the health care professionals indicated that lacking medico-legal knowledge can affect you in your profession. Conclusion: Knowledge of health care professionals on informed consent, confidentiality and medico-legal issues is high and their perceptions are positive. However, regular training to update their knowledge will be necessary in order to ensure continuous improvement of the quality of health care delivery.

Evolutionary game theory and simulations based on doctor and patient medical malpractice under government regulation

Physicians-patients are the two crucial participants in medical malpractice. The government, as the central authority responsible for addressing medical malpractices, plays a pivotal role in this matter. Guided by governmental agencies, its regulations, administrative orders, and policies serve as the primary governance mechanisms to address medical malpractice, providing an effective means to balance the doctor-patient relationship and foster social harmony and stable development. A doctor-patient evolutionary game model developed based on the principles of information asymmetry and finite rationality. The study explores the strategic decision-making process of these two players within the context of medical malpractice. Through the manipulation of various parameters, the model's evolutionary equilibrium strategy is demonstrated using Vensim PLE Version 6.4 simulation. The findings reveal that government regulation, patient cognition, and the benefits associated with standardized medical practices are the pivotal factors influencing the doctor-patient evolutionary game system under government regulation. It is possible to mitigate medical malpractice through adjusting relative weights of differing strategic options, adding penalties for unlawful conduct, and normalizing malpractice charges on the basis of physicians' income from standardized practice. To effectively address medical malpractice, proposed measures include adjusting the regulatory framework, reasonably determining the strength of regulations regarding medical practitioners' illegal practices and patient medical malpractice behavior, diversifying regulatory approaches, establishing comprehensive physician–patient management systems for information to resolve medical malpractices.

Twin-to-Twin Transfusion Syndrome: Diagnostic Imaging and Its Role in Staving Off Malpractice Charges and Litigation.

The study aims to expound upon the imaging-based diagnostic methodologies aimed at identifying twin-to-twin transfusion syndrome (TTTS), a serious, somewhat rare prenatal condition that takes place in pregnancies where identical twins, or other multiples, share a placenta (monochorionic placenta), highlighting how medico-legal outcomes can be affected by provable compliance with consolidated diagnostic guidelines or best practices. It is of utmost importance to produce a prompt identification of TTTS instances; an early diagnosis is in fact critical in order to effectively treat and manage TTTS. By virtue of TTTS being a highly progressive condition, a delay in diagnosis can result in disastrous outcomes; just a few weeks delay in the diagnosis of TTTS can turn out fatal for one or both twins. Hence, most TTTS malpractice claims involve allegations of medical negligence, namely the failure to recognize the condition in a timely fashion, or to proceed with adequate diagnostic and therapeutic pathways. In that regard, case law databases have been pored over (Justia, Lexis, Leagle), and five significant court cases have been examined and discussed in an attempt to identify objective medico-legal standards and bring to the forefront relevant forensic dynamics. In fact, when health professionals are capable of proving adherence to guidelines or best practices, this can shield them from malpractice allegations and ensuing litigation.

Trisomy 21 in forensic autopsies: Review of a 20-year period

BackgroundTrisomy 21 is the most common human chromosomal abnormality. Its manifestation includes intellectual impairment and more or less typical anatomical malformations and functional deficiencies that can cause sudden or unexpected deaths. Typical medicolegal questions at autopsy are related to medical malpractice, improper care, neglect, or abuse, and, depending on the cause of death, whether the death might have been avoidable. The aim of this study was to examine whether the causes of death in individuals with trisomy 21 were linked to the known health risks for this condition and to consider how these deaths might have been prevented. Material and methodsA retrospective study was performed at the Institutes for Legal Medicine in Giessen and Frankfurt am Main, Hesse, Germany. All records for forensic autopsy cases within a 20-year period from 1998 to 2017 were reviewed for the diagnosis trisomy 21”, respectively, “Down’s syndrome”. ResultsTwenty-three cases complied with the inclusion criteria trisomy 21 and autopsy. The age of the deceased ranged from 23 days to 61 years. Infectious diseases, mainly respiratory, were the leading cause of death, followed by accidental deaths. ConclusionThe medicolegal relevance of the known health risks in Down’s syndrome could be illustrated by the autopsy findings and the results of the additional examinations. The known high susceptibility to infections, with an increased risk of a rapid course and lethal outcome, in individuals with Down’s syndrome could be confirmed in our study. A sound knowledge of the risks and abnormalities associated with trisomy 21 are helpful in medicolegal assessments, particularly, in relation to medical malpractice charges.

Gehört die Hand alleine in die Hand des Handchirurgen?

Background In Germany, Hand Surgery is an additional qualification that can only be obtained by a three-year training after a completed residency in General Surgery, Plastic Surgery or Trauma and Orthopaedic Surgery. Nevertheless, injuries and diseases of the hand are also treated by physicians without this particular qualification. It is questionable whether these treatments more often lead to medical malpractice. Material and Methods 376 charges of medical malpractice in surgical treatments of the hand and forearm that were closed in 2014 and 2015 were collected by the Arbitration Board for Medical Liability Issues of the Medical Association of North Germany.Cases with proven medical malpractice were classified by the qualification of the physician in charge and analysed. A statistical analysis was performed with the use of the program SPSS (IBM). Results Medical malpractice was proven in 42 of 113 cases with an attending physician who held the additional qualification for Hand Surgery (37.2 %). For physicians without this qualification, the figures were 79 out of 155 (51.0 %) in the group of trauma and orthopaedic surgeons and 54 out of 108 (50.0 %) in the group of general surgeons. The differences between the hand surgeons and the trauma and orthopaedic surgeons (p = 0.017) and between hand surgeons and general surgeons were significant (p = 0.037). Conclusions It was shown that physicians with an additional qualification in hand surgery had signifcantly fewer proven medical malpratice cases than physicians without this qualification. The following trends were observed in the cases of the physicians without the additional qualification in hand surgery: underestimation of the severity of trauma to soft tissues and infections of the hand, errors in the surgical examination of the hand, including functional tests of tendons and nerves, as well as in diagnostic findings after X-ray studies of the hand.

PERLINDUNGAN HUKUM TERHADAP JABATAN NOTARIS BERKAITAN DENGAN ADANYA DUGAAN MALPRAKTEK DALAM PROSES PEMBUATAN AKTA OTENTIK

A notary is a public officer who given sufficient authority by the state to make an authentic deed. If a party feels aggrieved over the deed of a Notary, then the party can sue the notary with the charges of malpractice in an authentic deed, although the notary has been working in accordance with the standards of an authentic deed. On this basis, it is need a legal protection for the notary, in this case, made ??by the Notary Honorary Council (MKN) as provided for in the Article 66 of paragraph (1) of Law No. 2 of 2014 on the Amendment of Law Number 30 of Year 2004 on the Notary Position (UUJN-P). There are no certain regulations on MKN positions and the kinds of legal protection given by the MKN to the notary, giving rise to legal issues namely, what the standards or requirements in the process of making an authentic deed and what the legal protection of the Position of Notary in relations to the allegations of malpractice in the making of authentic deeds.
 This thesis research is a normative legal research, which departed from the vacuum of norm. The legal materials collection techniques used were the study of literature and the card system. The analysis of the legal materials was conducted by using descriptive techniques, interpretations and arguments associated with the theories and concepts of law which relevant to the issues.
 The research findings of the problem under study, namely, that in making authentic deeds, notary must always pay attention to the validity of the agreement according to the terms of Article 1320 of the Civil Law (the Civil Codes), the requirement of making authentic deeds (Civil Code of 1868), Law on the Notary Position, as well as the Notary Code of Ethics. While MKN position as the Administrative agencies should be established in the regions of (city or regencies) in order that MKN can quickly respond to the case and provide an appeal to the parties who are not satisfied with the decision of MKN.

Survey of Obstetric Care and Cesarean Delivery Rates in Shanghai, China

China has one of the highest cesarean delivery rates in the world, with most cesareans done without indication. Observation of how perinatal care is delivered in a range of Shanghai hospitals was done to gain insight into the 50 percent cesarean delivery rate. A mixed methods approach combined a descriptive structured survey of obstetric services with standardized interview with obstetricians and qualitative observation of obstetric services in six different Shanghai obstetric facilities. The volume was extremely high: physicians in public hospitals routinely saw up to 80-120 prenatal patients per day. Frequent prenatal testing substituted for time spent in patient-doctor interactions. Family members were not allowed in delivery wards where women labored alone. Obstetrics services had low levels of nursing support and anesthesia for labor. Physical space favored rapid surgical turnover over longer labor. Physicians reported practical incentives to perform cesarean sections. Cesarean delivery was an efficient way to move patients through the systems observed, given the staffing and physical limitations of the public facilities. Physicians reported that patients and families perceived cesarean delivery as safer. Physicians also reported fear of charges of malpractice, for which they might be found to be financially liable or in physical danger. Societal expectations are high, and in a "one child" society, perception that cesarean section was safer may also have driven cesarean rates. Given the end of the One Child Policy, the preference for cesarean delivery may change.

Pediatric Chiropractic Care: The Subluxation Question And Referral Risk.

Chiropractors commonly treat children for a variety of ailments by manipulating the spine to correct a 'vertebral subluxation' or a 'vertebral subluxation complex' alleged to be a cause of disease. Such treatment might begin soon after a child is born. Both major American chiropractic associations - the International Chiropractic Association and the American Chiropractic Association - support chiropractic care for children, which includes subluxation correction as a treatment or preventive measure. I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice.

A oftalmologia no tribunal: avaliação das sentenças judiciais no âmbito do Tribunal de Justiça do Estado de São Paulo

A oftalmologia envolve tratamentos clínicos e cirúrgicos com um amplo espectro de patologias, é uma especialidade sujeita a processos judiciais em diversos campos. As ações contra médicos oftalmologistas e entidades médicas vão desde insatisfações com óculos a resultados de procedimentos cirúrgicos complexos. Sendo assim, o objetivo do trabalho foi avaliar os processos referentes a erro médico na área de oftalmologia julgados em segunda instância pelo Tribunal de Justiça do Estado de São Paulo (TJ-SP). Foi realizado levantamento de dados <em>online </em>das sentenças de acórdãos em segunda instância, através de pesquisa das jurisprudências disponíveis no site do Tribunal de Justiça do Estado de São Paulo (TJ-SP) entre 01/01/1997 e 30/09/2014, utilizando os termos “oftalmologista” e “erro médico” no campo disponibilizado para pesquisa. O levantamento resultou em um total de 100 acórdãos, sendo incluídos 55 de interesse para o estudo. Todas as ações apresentavam acusação por erro médico; 91% envolviam procedimentos cirúrgicos. Em 61,8% dos acórdãos o autor alegou cegueira e em 23,6%, dano estético. Na maioria dos casos (90,9%) houve perícia médica, e a decisão do juiz baseou-se no laudo pericial em 86% das vezes. Em relação à decisão judicial, 81,8% dos pedidos foram indeferidos em segunda instância, 9,1% deferidos e 9,1% obtiveram provimento parcial do pedido. Os dados apresentados mostraram, entre outros achados, o papel fundamental da perícia médica nos processos por erro médico, expondo a sua importância nas decisões judiciais.

Stories written by real life: A malpractice charge negotiated by a medical conciliation committee

A patient's complaint was chosen from a compilation of cases under review by various medical conciliation committees to demonstrate what might contribute to malpractice charges.

Arzneimittelinteraktionen

Drug-drug interactions (DDI) are a major topic in programs for continuous medical education (CME). Many physicians are afraid of being trapped into charges of malpractice; however, DDI cannot be avoided in many cases. They belong to routine medical practice and it is often impossible to avoid them. Moreover, they do not just occur between drugs but between any kind of foreign substance (xenobiotica), such as food (e.g. grapefruit juice, broccoli, barbecue) as well as legal (e.g. tobacco smoke, caffeine and alcohol) and illegal drugs. Therefore, the medical challenge is not just to avoid any interaction. Instead the physician faces the question of how to proceed with drug treatment in the presence of such interactions. Based on the medical education a physician has to judge first of all whether there is a risk for interactions in the prescription being planned for an individual patient. The classification of interactions proposed in this article (PD1-PD4, PK1-PK3) might help as a sort of check list. For more detailed information the physician can then consult one of the many databases available on the internet, such as PSIAConline (http://www.psiac.de) and MediQ (http://www.mediq.ch). Pharmacokinetic interactions can be easily assessed, monitored and controlled by therapeutic drug monitoring (TDM). Besides these tools it is important to keep in mind that nobody knows everything; even physicians do not know everything. So take pride in asking someone who might help and for this purpose AGATE offers a drug information service AID (http://www.amuep-agate.de). Just good for nothing, without being based on any kind of medical approach are computer programs that judge prescriptions without taking into account a patient's individual peculiarities. In case these types of programs produce red exclamation marks or traffic lights to underline their judgment, they might even work in a contrapuntal way by just eliciting insecurity and fear.

Choking Carries Significant Risk for Residents and Facilities

Choking Carries Significant Risk for Residents and Facilities

Evaluation of nursing students’ training in medical law

There is no co-ordinated focus on liabilities arising from nurses' medical interventions in terms of occupational, administrative, civil legal and criminal activities. However, the Turkish Criminal Code, the Turkish Medical Ethics Code of Practice, and guidelines for patients' rights offer some framework for the relevant ethical principles and responsibilities of nurses. The aim of this study was to investigate the evaluation of nursing students' training in their legal liabilities. The sample consisted of 309 students who were taking a course entitled 'Nurses' legal liabilities under Turkish criminal and civil law arising from medical interventions'. Data were obtained by means of self-administered questionnaires and McNemar's test was used to evaluate the answers. In conclusion, after their training, a great majority of the students demonstrated an improvement in terms of their percentage of correct answers relating to malpractice. This does not, however, mean that they will not face malpractice charges after graduating, but their increased awareness of the issue may encourage them to make more effort to reduce the risk of mistakes. It is recommended that nursing faculty carry out studies into medical malpractice, that they focus more on this subject in nursing education, and that all nursing schools review their curricula from the point of view of malpractice.

Under the Radar: Cancer and the Cold War , and: Contested Medicine: Cancer Research and the Military (review)

Reviewed by: Under the Radar: Cancer and the Cold War, and: Contested Medicine: Cancer Research and the Military Angela N. H. Creager Ellen Leopold . Under the Radar: Cancer and the Cold War. Critical Issues in Health and Medicine. New Brunswick, N.J.: Rutgers University Press, 2008. xi + 284 pp. Ill. $25.95 (978-0-8135-4404-5). Gerald Kutcher . Contested Medicine: Cancer Research and the Military. Chicago: University of Chicago Press, 2009. x + 247 pp. $35.00, £24.00 (ISBN-10: 0-226-46531-4, ISBN-13: 978-0-226-46531-9). Both of the books reviewed here address the role of the Cold War—and more specifically, the new technologies and politics associated with the atomic age—in shaping postwar medical practice and research. This is part of a larger historiographical trend toward assessing the civilian consequences of the Manhattan Project, including innovations in the life sciences from ecology to biochemistry as well as the development of new therapeutic and diagnostic tools.1 These two new works focus on the medical field most directly connected with both the military and civilian uses of atomic energy: nuclear medicine. More specifically, both address new radiation treatments aimed at treating cancer, which occupied a central node in the domestic politics of atomic energy. And both discuss human radiation experiments that have come to represent some of the worst abuses of military experimentation and government secrecy. Ellen Leopold's Under the Radar is a well-researched examination of how the Cold War distorted medical approaches to cancer both metaphorically, by framing cancer therapy in terms of war, and technologically, through the application [End Page 151] of newly available radiation sources with which to treat patients. At the center of Leopold's book is a lawsuit over the injuries that Irma Natanson sustained from treatment with cobalt radiation therapy following a mastectomy in 1955. Natanson suffered severe radiation burns that resulted in the removal of several of her ribs and chest tissue as well as extensive skin grafts. She sued her radiologist for failure to warn her of the risks of treatment and for failure to administer the treatment properly. The jury rejected the charges of negligence and malpractice, but on appeal, the court in 1960 found the doctor guilty of negligence in not having sufficiently disclosed the nature, consequences, and risks of (as well as alternatives to) radiation treatment. Natanson vs. Kline is usually cited for its importance to the emerging concept of informed consent,2 but Leopold uses it as the starting place for a much wider exploration of the collusion of military, industry, and government interests in expanding the medical uses of nuclear technologies. Chapters addressing the development of cobalt-60 radiotherapy (with so-called "cobalt bomb" machines), the fallout controversy, cancer research, radiation protection standards, and emerging notions of risk and individual culpability provide a richly detailed landscape for the interpretation of Natanson's treatment as emblematic rather than merely tragic. But Leopold's ultimate interest is moral, not historical, and she adopts a prosecutorial tone. She relies on a contemporary ethical framework to indict the U.S. government, particularly the Atomic Energy Commission (AEC), as responsible for the endangerment of Natanson and other civilians through its weapons testing and biomedical program. The government's promotion of radioactivity as a way to combat cancer was driven by the "imperatives of postwar industrial expansion" (p. 56) on one hand and its "military mindset" (p. 74) on the other. Physicians, already "practiced prevaricators" when it came to dealing with terminal illness (p. 94), failed to protect their patients, eagerly exploiting the experimental technologies made available by the AEC. Instead, Leopold observes, the public figures who raised questions about the hazards of radiation exposure and whether the environmental dissemination of radioactivity would lead to increased cancer rates were considered dissident scientists. In the last chapter, she expands the litany of the ills of the Cold War to include industrial carcinogens and clinical trials. Leopold's critiques of the AEC continue a long tradition of investigative journalism, Congressional hearings, and scholarship on this agency.3 Nuclear medicine provides a valuable and understudied locus for assessing the role played by the AEC in the trajectory...

Medical malpractice as reflected by the forensic evaluation of 4450 autopsies

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.

Medical malpractice charges in Germany – A survey

Since decades, studies concerning medical malpractice charges in Germany were published, written by forensic pathologists and regarding lethal courses and the question of causality. Previously published studies comprise higher numbers of medical malpractice charges and determine who e.g. informed the prosecution, which clinical subjects are involved, the kind of charges and whether such allegations can be appropriately assessed by means of a forensic autopsy. A survey is given, focusing on the results of studies from German Institutes of Forensic Medicine.

Pulmonary embolism diagnosis: Remember the history and physical exam

Thromb Haemost 2009; 101: 7–8 The trickiest part of detecting acute pulmonary embolism (PE) is remembering to consider PE as a diagnostic possibility. But this does not mean that every patient in whom the diagnosis is considered should undergo chest computed tomography (CT) scanning with contrast or ventilation-perfusion lung scanning. Such an approach would cram our CT and Nuclear Medicine imaging laboratories with hundreds of thousands of unnecessary tests, expose patients to unnecessary irradiation and contrast agent, precipitate cases of renal failure and anaphylaxis from contrast, and slow our clogged Emergency Departments to a virtual standstill. Ordering a chest CT with contrast as a reflex, as soon as the diagnosis of PE is added to the differential diagnosis, is becoming common practice even though it is not the ideal way to practice medicine. The motivations for this wayward approach may be difficult to figure out. Is it the new way to practice “defensive medicine” and avert the charge of medical malpractice as our society becomes more litigious? Is it a mistaken belief that imaging almost anyone with possible PE will lead to a hastier or more efficient workup? Is it a genuine belief that we can best advocate for our patients by ordering PE imaging even when the likelihood of PE is rare, so that we “leave no stone unturned”? A more orderly and thoughtful approach to the PE work-up adheres to classical teachings and tradition. Namely, take a directed history, perform a relevant physical examination, establish a differential diagnosis, and then decide upon D-dimer testing versus PE imaging based upon the likelihood of finding PE. If the likelihood of PE is low, then order a D-dimer test and rule out PE if the D-dimer test is normal. If the likelihood of PE is not low, or if the D-dimer is elevated, then PE imaging usually makes sense. But in most Emergency Departments, the majority of patients in whom the diagnosis is considered have a low clinical probability of PE. How do we standardize our definition of “PE clinical probability”? The best way, proven time and time again in clinical trials, is to use the Wells criteria for clinical probability assessment of PE (1). These criteria are used successfully in clinical trials. But in the real world of daily clinical medicine, Wells criteria are almost never employed to make clinical decisions. It is unclear why the Wells criteria are not utilized. Each criterion requires a clinical skill set, as shown in Table 1. And there exists a broad consensus that clinical evaluation is important, as well as maintaining the fundamental approach of history, physical examination, and differential diagnosis. The Wells criteria are awkward to employ. There are three different point scores assigned to the seven criteria: 1 point for two criteria, 1.5 points for three criteria, and 3 points for two criteria. And when summing the point score, it is difficult to remember how many points constitute low probability, intermediate probability, and high probability for PE. So, we have a set of clinical probability criteria that work but that are rarely used outside of clinical trials. Simplification of the Wells criteria is in order (2). And validation of the simplification, even as done retrospectively in the current study by Douma et al. (3), provides reassurance and guidance.

Complications of Vascular Access Device Terminal Tip Placement: A Case Study and Review of Subsequent Legal Action

A patient experienced complications following insertion and use of 2 similar vascular access devices with tip termination apparently in the subclavian veins. The thrombotic complications that developed were identified and reported in the first incident (a) as an occluded catheter, and then (b) as bleeding complications with delayed reporting for 8 days with the second catheter. The result was symptomatic deep vein thrombosis, thoracic outlet syndrome, and permanent nerve damage in both right and left extremities used for the venous catheter. The patient brought charges of malpractice against the hospital, the home care company, one nurse, and the manufacturer, alleging permanent nerve damage, venous occlusion, and chronic pain syndromes associated with both upper extremities. During the subsequent trial, evidence of permanent loss of function to the patient's left arm and chronic pain to both arms was presented through documentation of loss of fitness and inability to perform actions necessary to his chosen career as a pilot. The pain and loss of function were directly related to terminal tip placement of the catheter and care provided in conjunction with the venous catheter. The jury trial awarded the patient a final judgment of $7.15 million, with the hospital 55% liable and 45% liability among the other defendants. The jury also added some hospital physicians to the liability of the treatment and resulting patient harm. Nurses caring for patients have a duty to assess and evaluate the patient for complications on an ongoing basis, administer the prescribed therapy, and consistently provide communication with the primary physician specific to the assessment findings. A specialized nurse or certified intravenous nurse (CRNI) is held to a higher level of knowledge, understanding, and function. In this case, a CRNI was providing care for the patient both through hospital and outpatient home care services. Medical professionals and hospitals can reduce the likelihood of liability related to adverse events with venous catheters by acquisition of current education on the devices they insert and maintain; by updating and adhering to policies and procedures based on Standards of Practice and manufacturer instructions for use; by thorough documentation of care; and by conscientious reporting of patient clinical signs and symptoms. The goal of achieving safe patient care with vascular access devices is only possible through consistent education processes with all associated clinical staff.

Power Failure

Physicians have long viewed nurses as subservient, second class citizens in their hierarchy of health care, and now they've assigned them an even more ludicrous role: public health threat. That's what the American Medical Association (AMA) wants the public to believe with its warnings of the “confusion, injury, and breakdown of quality medical care” that nurse doctoral programs are about to unleash. At the AMA annual meeting in June, delegates adopted Resolu-tion 211—“Need to Expose and Counter Nurse Doctoral Programs Misrepresentation.” (See AJN Reports on page 25 for details.) Why should the AMA see more education as a problem? The AMA claims that nurses will misrepresent themselves as “doctors” and subsequently “create confusion, jeopardize patient safety, and erode the trust inherent in the true patient–physician relationship.” Yet year after year, nurses are ranked in Gallup polls as the most trusted professionals. And a recent metaanalysis published in the Cochrane database showed that advanced practice nurses (APNs) provide safe, high-quality, cost-effective care, often receiving higher ratings in patient satisfaction than their physician counterparts. The AMA resolution has nothing to do with protecting patients but is a thinly disguised effort on the part of physicians to safeguard their power and money. As long as APNs provide care to populations largely neglected by MDs—the poor, immigrants, the uninsured—the AMA is quiet. When it sees nurses as climbing out of this niche, the AMA roars down from its perch at the top of the hierarchy. It did so in 1997 when Columbia Advanced Practice Nurse Associates opened its practice in an affluent neighborhood in Manhattan, gaining hospital-admitting privileges as well as insurance reimbursement equal to that of physicians. It did so again in 2000 with a petition to the Health Care Financing Administration, demanding oversight of, and limitations on, Medicare payments to APNs.Figure: Kennedy and Roush.Yet there is no evidence, nor has there ever been, that APNs overstep the bounds imposed on them by law or misrepresent themselves to patients. Boards of examiners oversee licensed practitioners, investigate reports of possible practice violations, and handle charges of malpractice. In addition, certification boards require rigorous examinations for advanced or specialty practice. These safeguards have protected the public for years. It would be easy enough for the AMA to look at the standards and criteria our discipline uses to regulate its practice. Instead, at last year's annual meeting it passed Resolution 814, committing more than $171,000 to take on the spectrum of “limited licensure healthcare providers”—those who're not physicians or osteopaths. These resolutions are a misguided attempt to hold onto an antiquated and dysfunctional model of medical imperialism. Instead of spreading apprehension among a public already unnerved by the too-real threat of medical error, the AMA could foster a partnership with nursing and other health professions, in which a variety of approaches to care are afforded respect. The United States has the most expensive health care system in the world, and it's failing its citizenry. We spend twice what other developed nations spend per capita, and still our disability-adjusted life expectancy (the number of years a person can expect to live in full health) is one of the lowest among wealthy nations and our infant-mortality rate is the among the highest. Nursing and medicine should unite to address the flaws in the system: out-of-control costs, shameful disparities in illness and death rates in poor and minority populations, and for many, severely limited access to care. Perhaps a better subject for the AMA to research is why more and more patients are choosing nurses over physicians. It's clear that the hierarchal system isn't serving anyone but physicians.