扬州大学：《医学伦理学》课程教学课件（PPT讲稿）Chapter 5 Malpractice

CHAPTER5Malpractice

CHAPTER 5 Malpractice

Malpractice is a preventable error in care ofthe patient resulting in harm to thepatient.Malpractice is also dependent ondetermining if the patient's care deviatedfrom the standard of care in a localcommunityEvidence of harm is an important part ofestablishing malpractice

Malpractice is a preventable error in care of the patient resulting in harm to the patient. Malpractice is also dependent on determining if the patient’s care deviated from the standard of care in a local community. Evidence of harm is an important part of establishing malpractice

For example, a patient admits to thehospital for a knee replacement. The staffforgets to start the patient on deepvenous thrombosis (DVT) prophylaxis.The patient does not develop a DVT. Ontransferring care several months later thepatient obtains a copy of the chart andsees the omission. He files suit for adeviation of care. What is the most likelyoutcome?

For example, a patient admits to the hospital for a knee replacement. The staff forgets to start the patient on deep venous thrombosis (DVT) prophylaxis. The patient does not develop a DVT. On transferring care several months later the patient obtains a copy of the chart and sees the omission. He files suit for a deviation of care. What is the most likely outcome?

&NegligenceMalpractice

2.)Youare caring fornumerous patients on a busy inpatientservice at a regional Veterans Administration hospital.You arecalled at3ambynursing staffwhostatethat oneof yourpatients who was admitted for chest pains is suffering fromacute-onset watery diarrhea.In reviewing his chart, you findthatyouaccidentallyprescribean electrolytebowlpreparationfor your patient with chest pains rather thanfor the intendedpatient with a gastrointestinal bleed who is scheduled foracolonoscopyin themorning.The patient states hefeels goodbecausehehasnot hada bowel movement in the lasttwo daysebestourseofaction?a

CASEForexample,anactressdevelopsstageIVnon-Hodgkin's lymphoma. You inform herthat neither surgery nor local radiation willbe appropriate. She agrees to undergocombination chemotherapy and has beeninformed of all the potential adverse effectsincluding hair loss, sterility, and peripheralneuropathy. The usual and customary doseof the chemotherapy is given and the patientloses her hair and'develops neuropathy fromthe vincristine. She is not able to workbecause of her appearance. She files suitbecause of this. What will be the most likelyoutcome?

CASE For example, an actress develops stage IV non-Hodgkin's lymphoma. You inform her that neither surgery nor local radiation will be appropriate. She agrees to undergo combination chemotherapy and has been informed of all the potential adverse effects including hair loss, sterility, and peripheral neuropathy. The usual and customary dose of the chemotherapy is given and the patient loses her hair and develops neuropathy from the vincristine. She is not able to work because of her appearance. She files suit because of this. What will be the most likely outcome?

CASEFor example, a 60-year-old man comes to theemergency department with one hour of chest painand an ST segment elevation myocardial infarction.The patient is a recent immigrant who speaks Frenchand understands little English. You inform the patientthat the best therapy is angioplasty and possiblythrombolytics. You explain that they can developintracranial bleeding from the thrombolytics and ahematoma at the site of the catheter placement fromthe angioplasty. The patient, anxious to avoid thesecomplications, refuses both. You do not doublecheck the refusal with a translator. The patient diesand his family sues you for malpractice. In yourdefense you point out the clear fact that you offeredthe patient lifesaving therapy and he refused. Whatwill be the most likely outcome?

CASE For example, a 60-year-old man comes to the emergency department with one hour of chest pain and an ST segment elevation myocardial infarction. The patient is a recent immigrant who speaks French and understands little English. You inform the patient that the best therapy is angioplasty and possibly thrombolytics. You explain that they can develop intracranial bleeding from the thrombolytics and a hematoma at the site of the catheter placement from the angioplasty. The patient, anxious to avoid these complications, refuses both. You do not double check the refusal with a translator. The patient dies and his family sues you for malpractice. In your defense you point out the clear fact that you offered the patient lifesaving therapy and he refused. What will be the most likely outcome?

CASEFor example, a man is admitted for a possibleDVT. He denies any past medical history. Hedoes not inform you of his recent diagnosisof a gastric ulcer afterendoscopy for severeupper gastrointestinal bleeding. There is noprevious record at this hospital. You givehim heparin and he hemorrhages massively.He sues you for harming him. His lawyerknows you gave heparin to a patient with ahistory of bleeding that harmed the patient.What will be the most likely outcome?

CASE For example, a man is admitted for a possible DVT. He denies any past medical history. He does not inform you of his recent diagnosis of a gastric ulcer after endoscopy for severe upper gastrointestinal bleeding. There is no previous record at this hospital. You give him heparin and he hemorrhages massively. He sues you for harming him. His lawyer knows you gave heparin to a patient with a history of bleeding that harmed the patient. What will be the most likely outcome?