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Four months in prison and a $2,000 fine to Huping Zhou, a 47-year-old cardiothoracic surgeon from China and a UCLA health care system employee, for violating the Health Insurance Portability and Accountability Act (HIPAA) should be a cause for concern for hospitals.
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Hospitals and provider networks lead the list of health care entities reporting breaches of unsecured protected health information (PHI), according to the Office for Civil Rights (OCR) breach notification website, which lists 166 entities as of Sept. 30.
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"It's too bad someone didn't give you thrombolytics, because you probably wouldn't be paralyzed now." Whether it's a nurse, doctor, or someone else making that statement to a stroke patient cared for in your ED, you could end up named in a lawsuit.
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"Why didn't my grandmother see a neurologist immediately in the ED?" is a question that may arise in the event of a malpractice lawsuit involving stroke care.
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Most emergency physicians will be sued during their career. Lawsuits can lead to interpersonal difficulties, loss of job satisfaction, and emotional distress. An understanding of the malpractice process and ways to reduce risk can help emergency physicians deal with this ever present threat.
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If you aren't going to give tPA and would like to avoid a lawsuit, you'll want to be very clear in your documentation as to why the patient didn't meet treatment criteria. "And if you do give it, you should be very clear why the patient did meet the criteria," says John Burton, MD, chair of the Department of Emergency Medicine at Carilion Clinic in Roanoke, VA.
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Although some ED physicians remain opposed to the idea of using tPA, the consideration of the use of thrombolytics such as tPA for stroke patients who are eligible candidates has become the public expectation
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"We look at a variety of things as most departments do, but I think we're trying to collect some data that there aren't good benchmarks for and can have significant variability from institution to institution or at least trying to look at our [department] numbers... to compare ourselves to our colleagues here at the hospital.
