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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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2x Speed
29. Malpractice
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When a doctor does go wrong, they are the best of criminals. The doctor has nerve and knowledge.
~ Arthur Conan Doyle
Surgical Sabotage
A Doctor’s Duty to Adhere to Standards of Care and the Patient-Practitioner Relationship
Dr. John Watson had been a practicing physician for over a decade when he received a call from his old friend and colleague, Dr. James Moriarty. Moriarty had a lucrative practice in the city and had built up a reputation as one of the best in the business. However, he had recently been accused of medical malpractice, and he was certain that he was being framed.
Watson was intrigued and agreed to help his friend. He knew that medical malpractice was a serious accusation and could lead to the loss of a medical license, hefty fines, and even imprisonment. They agreed to meet at Moriarty’s office to discuss the details of the case.
As soon as Watson arrived, he knew that something was off. Moriarty was agitated and kept pacing back and forth, muttering about how he was being set up. Watson asked him to calm down and explain the situation.
Moriarty explained that he had been sued by the family of one of his patients who had died during surgery. The family claimed that Moriarty had been negligent during the procedure, which led to the patient’s death. However, Moriarty was confident that he had followed all the proper protocols and had not deviated from the medical standards of care.
Watson decided to investigate the case further and began reviewing the patient’s medical records. As he delved deeper, he found several inconsistencies in the patient’s treatment plan. Moriarty had deviated from the standard medical practices and had not informed the patient of the risks involved in the procedure.
Watson confronted Moriarty with the evidence and asked him to explain himself. Moriarty broke down and admitted that he had made a mistake during the surgery, but he had not meant to harm the patient. He had been overworked and overstressed and had made an error in judgment.
Watson realized that Moriarty was in a difficult position. He had made a mistake, and his reputation was at stake. However, he had also violated the patient-practitioner relationship and had caused harm to the patient. Moriarty agreed to take responsibility for his actions and reached a settlement with the patient’s family.
As Watson left Moriarty’s office, he couldn’t help but reflect on the importance of adhering to medical standards of care and maintaining the patient-practitioner relationship. He knew that medical malpractice was a serious matter and could have far-reaching consequences for both the practitioner and the patient. It was essential for practitioners to stay up-to-date on the latest medical knowledge and skills to avoid negligent acts or omissions that could lead to medical malpractice.
Abstract
Medical malpractice occurs when a medical practitioner’s actions or omissions deviate from medical standards of care to the point of being considered negligent, causing injury to the patient. This definition requires both practitioner negligence and patient injury to be met. The statute of limitations for medical malpractice varies by state, but is typically 2-3 years for adults and 8 years for minors. Negligent acts or omissions occur when there is a breach of medical standards of care, which is based on the hypothetical practice of a reasonably competent practitioner in the same community. Examples of negligent acts include diagnostic errors, medication errors, and surgical errors, while examples of negligent omissions include failing to order proper testing or inform the patient of risks. Injury from medical malpractice can include physical harm, pain, and financial burden. Practitioner negligence violates patient autonomy, and medical malpractice also violates the professional principles of beneficence (doing good) and nonmaleficence (doing no harm) in the practitioner-patient relationship. The intention of the practitioner is not relevant in a medical malpractice case. Medical malpractice compensation is awarded to the patient to balance the unfair social distribution of burdens caused by injury, and also to motivate the medical profession and institutions to prevent future negligent events. Practical measures have been developed to reduce the risk of medical malpractice, and settlements may be awarded for treatment access rather than being solely based on practitioner culpability.
**
Think
[29:1] Within the context of a patient-practitioner relationship, medical malpractice occurs when:
- 1. a medical practitioner’s action or omission sufficiently deviates from the medical standards of care to be negligent, that results in
- 2. an injury to the patient.
Both criteria must be met to satisfy the definition of medical malpractice: thus, practitioner negligence without patient injury, or patient injury without practitioner negligence, are not grounds for medical malpractice. In addition, the statute of limitations varies from state to state but is usually between two to three years for adults and eight years for minors but before their 22nd birthday.
[29:2] The first part of the medical malpractice equation defines a negligent act or negligent omission. Negligent acts or omissions occur when there is a breach of a medical standard of care. Medical standards of care is a legal definition based on the hypothetical practice of a reasonably competent practitioner in the same or similar community that address the same medical condition of the malpractice claim. A reasonably competent practitioner is a medical professional who provides the patient with treatment options based on up-to-date, peer-reviewed, evidence-based medicine that the medical community has generally recognized. Using these definitions, it can be determined if a deviation from the accepted standard was a negligent act or omission.
[29:3] Examples of negligent acts include but are not limited to: making a diagnostic error, providing a medication error, or committing a surgical error.
[29:4] Examples of negligent omissions include but are not limited to: failure to order proper testing, failure to arrange appropriate follow-up for abnormal test results, failure to provide appropriate treatment options to the patient, failure to inform the patient of the risks involved in each treatment option, including no treatment, or not fixing defective medical equipment.
[29:5] The second part of the malpractice equation requires defining injury. Examples of injury include more than mere physical damages: disability; unusual pain, suffering, and hardship; significant past and future medical bills; and other adverse outcomes.
[29:6] Medical malpractice is when the practitioner’s negligent act or omission results in patient injury. Medical malpractice is a practitioner’s violation of the patient-practitioner relationship in which patients trust that their practitioner will practice due diligence. It is also a practitioner’s violation of society’s trust in the ability of the medical profession to be self-regulating.
Assess
Patient: 1) Autonomy
[29:7] A negligent act or omission by a practitioner is not something that a reasonable patient would autonomously consent to, and therefore practitioner negligence is a violation of patient autonomy (informed consent). Since a patient’s informed consent is the authorization of a specific treatment option, it follows that the practitioner who negligently does something different from what was authorized, resulting in patient injury, could be a form of battery, which in legal terminology is an unauthorized touching of a person without their consent. Since the negligent act or omission, resulting in patient injury, was not autonomously chosen by the patient, it follows that the patient’s informed consent was violated.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[29:8] Professionally, if the practitioner fails to maximize the patient’s best interests according to the patient’s reasonable goals, values, and priorities because of negligently deviating from standard medical practices, beneficence (do good) is violated. If the practitioner injures the patient because of negligently violating the medical standards of care, then that would violate nonmaleficence (do no harm). Since the negligent act or omission violates the professional principle of beneficence (do good) that then causes a violation of the professional principle of nonmaleficence (do no harm), it logically follows that both necessary conditions of negligence and harm have been met for justifying a medical malpractice suit.
[29:9] The practitioner’s intention is not part of this medical malpractice equation. Good intentions and bad intentions say a lot about the practitioner’s moral character, but intentions are independent of the legal status of a medical malpractice suit. A practitioner may have the best of intentions when they deviate from standard medical practice causing harm to the patient; however, good intentions will not absolve the practitioner accountability for violating the medical standards of care and the patient’s subsequent harm incurred because of that violation.
Public Policy: 4) Justice
[29:10] Justice or public policies for the fair distribution of benefits and burdens, tries to keep the weight of benefits and burdens in balance. The medical malpractice judge compensates the harmed patient to mitigate the unfair distribution of the patient’s burdens caused by the negligent injury.
[29:11] Medical malpractice compensation is awarded to the patient for two main reasons:
- 1. to even out the unfair balance of burdens caused by injury damages, and
- 2. to motivate the medical profession and the institution to perform a root cause analysis to identify what, how, and why a negligent adverse event occurred and implement practical measures to ensure that such negligent acts and omissions doesn’t happen again.
[29:12] Practical measures have been developed to avoid negligent acts and omissions: surgical checklists, wristband identifiers; having the patient point and mark the exact body part that needs surgery; and other risk mitigation procedures. Sometimes, medical malpractice settlements are awarded to the patient to make treatment options accessible to the patient, rather than solely on the culpability of the negligent practitioner, so that social burdens are more fairly distributed. This is mainly the case when a healthcare system causes the patient’s burdens because of systemic healthcare disparities resulting in unequal medical benefits and burdens.
Conclude
[29:13] Malpractice is a central concern for medical practitioners, the medical profession, institutions, and most importantly, patients. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) want to ensure that the practitioner understands that intention is not one of the necessary conditions for medical malpractice. Within the context of a patient-practitioner relationship, medical malpractice occurs when there is:
- 1. a negligent act or omission, that results in
- 2. patient injury.
Practitioner negligence without injury, and patient injury without practitioner negligence, are not grounds for medical malpractice.
[29:14] In summary, medical malpractice is a significant concern for medical practitioners, the medical profession, institutions, and patients. It occurs when a negligent act or omission results in patient injury. Medical malpractice suits serve to compensate the harmed patient and motivate the medical profession and institutions to prevent future negligent events by identifying root causes and implementing practical measures. Understanding the legal implications of medical malpractice is essential for practitioners to fulfill their professional obligations and maintain the trust of their patients and society as a whole.
(See 14.Doctrine Of Double Effect for more discussion on the issue of intent)
**
29. Review Questions
1. Medical malpractice occurs when:
2. Practitioner negligence without patient injury, or patient injury without practitioner negligence, are not grounds for medical malpractice.
3. Medical standards of care is based on the hypothetical practices of a reasonably competent practitioner in the same or similar community that address the same medical condition of the malpractice claim.
4. A negligent act or omission by a practitioner is not something that a reasonable patient would autonomously consent to, and therefore practitioner negligence is a violation of patient autonomy (informed consent).
5. The practitioner’s intentions are a significant factor in determining medical malpractice.
**
Wrong 😕
[29:1] Within the context of a patient-practitioner relationship, medical malpractice occurs when:
1. a practitioner’s action or omission sufficiently deviates from the medical standards of care to be negligent, that results in
2. an injury to the patient.
Both criteria must be met to satisfy the definition of medical malpractice: thus, practitioner negligence without patient injury, or patient injury without practitioner negligence, are not grounds for medical malpractice. In addition, the statute of limitations varies from state to state but is usually between two to three years for adults and eight years for minors but before their 22nd birthday.
CORRECT! 🙂
[29:1] Within the context of a patient-practitioner relationship, medical malpractice occurs when:
1. a practitioner’s action or omission sufficiently deviates from the medical standards of care to be negligent, that results in
2. an injury to the patient.
Both criteria must be met to satisfy the definition of medical malpractice: thus, practitioner negligence without patient injury, or patient injury without practitioner negligence, are not grounds for medical malpractice. In addition, the statute of limitations varies from state to state but is usually between two to three years for adults and eight years for minors but before their 22nd birthday.
CORRECT! 🙂
[29:1] Within the context of a patient-practitioner relationship, medical malpractice occurs when:
1. a practitioner’s action or omission sufficiently deviates from the medical standards of care to be negligent, that results in
2. an injury to the patient.
Both criteria must be met to satisfy the definition of medical malpractice: thus, practitioner negligence without patient injury, or patient injury without practitioner negligence, are not grounds for medical malpractice. In addition, the statute of limitations varies from state to state but is usually between two to three years for adults and eight years for minors but before their 22nd birthday.
Wrong 😕
[29:1] Within the context of a patient-practitioner relationship, medical malpractice occurs when:
1. a practitioner’s action or omission sufficiently deviates from the medical standards of care to be negligent, that results in
2. an injury to the patient.
Both criteria must be met to satisfy the definition of medical malpractice: thus, practitioner negligence without patient injury, or patient injury without practitioner negligence, are not grounds for medical malpractice. In addition, the statute of limitations varies from state to state but is usually between two to three years for adults and eight years for minors but before their 22nd birthday.
CORRECT! 🙂
[29:2] The first part of the medical malpractice equation defines a negligent act or negligent omission. Negligent acts or omissions occur when there is a breach of a medical standard of care. It is essential to understand that medical standards of care is a legal definition, not an actual medical standard. Accepted standards are based on the hypothetical practices of a reasonably competent practitioner in the same or similar community that address the same medical condition of the malpractice claim. Medical standards of care is not the usual evidence-based standards that medicine is so accustomed to; instead, medical standards of care is a legal definition of state and a local community standard for determining if a deviation from the accepted standard is a negligent act or negligent omission.
Wrong 😕
[29:2] The first part of the medical malpractice equation defines a negligent act or negligent omission. Negligent acts or omissions occur when there is a breach of a medical standard of care. It is essential to understand that medical standards of care is a legal definition, not an actual medical standard. Accepted standards are based on the hypothetical practices of a reasonably competent practitioner in the same or similar community that address the same medical condition of the malpractice claim. Medical standards of care is not the usual evidence-based standards that medicine is so accustomed to; instead, medical standards of care is a legal definition of state and a local community standard for determining if a deviation from the accepted standard is a negligent act or negligent omission.
CORRECT! 🙂
[29:7] Professionally, if the practitioner fails to maximize the patient’s best interests according to the patient’s reasonable goals, values, and priorities because of negligently deviating from standard medical practices, that would violate beneficence (do good). If the practitioner injures the patient because of negligently violating the medical standards of care, then that would violate nonmaleficence (do no harm). Since the negligent act or omission violates the professional principle of beneficence (do good) that then causes a violation of the professional principle of nonmaleficence (do no harm), it logically follows that both necessary conditions of negligence and harm have been met for justifying a medical malpractice suit.
Wrong 😕
[29:7] Professionally, if the practitioner fails to maximize the patient’s best interests according to the patient’s reasonable goals, values, and priorities because of negligently deviating from standard medical practices, that would violate beneficence (do good). If the practitioner injures the patient because of negligently violating the medical standards of care, then that would violate nonmaleficence (do no harm). Since the negligent act or omission violates the professional principle of beneficence (do good) that then causes a violation of the professional principle of nonmaleficence (do no harm), it logically follows that both necessary conditions of negligence and harm have been met for justifying a medical malpractice suit.
CORRECT! 🙂
[29:9] The practitioner’s intention is not part of this medical malpractice equation. Good intentions and bad intentions say a lot about the practitioner’s moral character, but intentions are independent of the legal status of a medical malpractice suit. A practitioner may have the best of intentions when they deviate from standard medical practice causing harm to the patient; however, good intentions will not absolve the practitioner accountability for violating the medical standards of care and the patient’s subsequent harm incurred because of that violation.
Wrong 😕
[29:9] The practitioner’s intention is not part of this medical malpractice equation. Good intentions and bad intentions say a lot about the practitioner’s moral character, but intentions are independent of the legal status of a medical malpractice suit. A practitioner may have the best of intentions when they deviate from standard medical practice causing harm to the patient; however, good intentions will not absolve the practitioner accountability for violating the medical standards of care and the patient’s subsequent harm incurred because of that violation.
29. Clinical Vignettes
1. Ms. Angela Johnson, a 35-year-old accountant, presents to the emergency department with severe abdominal pain and vomiting. She reports that she has had diarrhea for the past week and the symptoms have progressively worsened. Her clinical symptoms include abdominal tenderness, distention, and guarding. The differential diagnosis includes appendicitis, diverticulitis, and inflammatory bowel disease. A CT scan is ordered, but the the attending practitioner misinterprets the radiologist's report as showing normal results. Ms. Johnson is discharged with a diagnosis of gastroenteritis and prescribed over-the-counter medications. Her symptoms worsen, and she returns to the hospital within two days, at which time she is diagnosed with a perforated appendicitis. She requires surgery and spends several weeks in the hospital.
2. Mr. Nico Lopez is a 50-year-old salesman who presented to the emergency department with complaints of left arm pain and shortness of breath. He had a history of smoking and hypertension. The attending practitioner ordered an electrocardiogram, which was read as normal, and discharged Mr. Lopez with a diagnosis of musculoskeletal chest pain. Two days later, Mr. Lopez had a myocardial infarction and required emergency cardiac catheterization. The differential diagnosis for Mr. Lopez's initial presentation included an acute coronary syndrome, pulmonary embolism, and musculoskeletal chest pain. The two necessary conditions for medical malpractice are a negligent act or omission and patient injury.
3. Ms. Gwendolyn Davis, a 55-year-old teacher, presents to her primary care practitioner with a complaint of shortness of breath and a persistent cough. She reports that her symptoms have been present for several weeks, and over-the-counter medications have not provided relief. Clinical examination reveals decreased breath sounds in the left lower lobe of her lungs, and a chest X-ray is ordered. The radiologist reports the X-ray as showing no abnormalities. Despite the X-ray report, the practitioner suspects pneumonia and orders a CT scan, which confirms the diagnosis. Ms. Davis is treated with antibiotics and recovers well.
4. Mr. Alfred Wilson, a 52-year-old construction worker, was referred to Dr. Tanner Chen, an orthopedic surgeon, for chronic knee pain. Dr. Chen ordered an MRI, which showed a torn meniscus, and recommended surgery to repair the damage. Before the surgery, Dr. Chen asked Mr. Wilson to mark the knee that needed surgery with a pen, as a measure to avoid wrong-site surgery. On the day of the surgery, the operating team confirmed that they had the correct patient, and Mr. Wilson's marked knee was visible. They proceeded with the surgery, but during the procedure, Dr. Chen realized that he had misread the MRI and operated on the wrong knee. Mr. Wilson was left with two damaged knees, and he filed a medical malpractice suit against Dr. Chen. Clinical Differential diagnosis: Wrong-site surgery resulting in damage to both knees. Ethical Question: Should Dr. Chen be held liable for medical malpractice in this case, even though he followed practical measures to avoid wrong-site surgery, such as surgical checklists and patient marking?
5. Mr. Omar Larson, a 45-year-old software engineer, was diagnosed with a rare form of cancer. His practitioner, Dr. Johnson, recommended a new and experimental treatment that had only been tried in a handful of patients. Dr. Johnson, despite knowing the risks, administered the treatment to Mr. Larson, and the patient's condition worsened. After being admitted to the hospital, Mr. Larson's condition continued to deteriorate, and he eventually died. Should the practitioner's intentions be considered when evaluating whether medical malpractice occurred?
CORRECT! 🙂
Explanation: The attending practitioner was negligent in misinterpreting the radiologist's report, and Ms. Johnson suffered harm. In this case, the attending practitioner breached the medical standard of care by failing to identify and diagnose Ms. Johnson's appendicitis, which resulted in a delayed diagnosis and harm to the patient [29:1]. The other options are wrong because the intention of the attending practitioner is not relevant in a medical malpractice case, as the necessary conditions are practitioner negligence and patient harm [29:1], the patient didn’t have the responsibility of coming back sooner, and difficulty of the case is not the definition of negligence which is a breach of the medical standard of care.
Wrong 😕
Explanation: The attending practitioner was negligent in misinterpreting the radiologist's report, and Ms. Johnson suffered harm. In this case, the attending practitioner breached the medical standard of care by failing to identify and diagnose Ms. Johnson's appendicitis, which resulted in a delayed diagnosis and harm to the patient [29:1]. The other options are wrong because the intention of the attending practitioner is not relevant in a medical malpractice case, as the necessary conditions are practitioner negligence and patient harm [29:1], the patient didn’t have the responsibility of coming back sooner, and difficulty of the case is not the definition of negligence which is a breach of the medical standard of care.
CORRECT! 🙂
Explanation: In this clinical vignette, the attending practitioner deviated from the medical standards of care by failing to consider other possible diagnoses, order additional testing, or admit Mr. Lopez for observation, given his medical history and presentation. The attending practitioner's negligence resulted in Mr. Lopez's injury, which was a myocardial infarction that required emergency cardiac catheterization. Therefore, the attending practitioner is liable for medical malpractice because both necessary conditions, a negligent act or omission and patient injury, have been met [29:1, 29:2, 29:3, 29:6]. The other options are incorrect because the attending practitioner did not follow the appropriate medical standards of care, Mr. Lopez's injury was a result of the attending practitioner's deviation from the medical standards of care, and the electrocardiogram is not a definitive test for an acute coronary syndrome. The attending practitioner should have considered additional testing or observation given Mr. Lopez's medical history and presentation.
Wrong 😕
Explanation: In this clinical vignette, the attending practitioner deviated from the medical standards of care by failing to consider other possible diagnoses, order additional testing, or admit Mr. Lopez for observation, given his medical history and presentation. The attending practitioner's negligence resulted in Mr. Lopez's injury, which was a myocardial infarction that required emergency cardiac catheterization. Therefore, the attending practitioner is liable for medical malpractice because both necessary conditions, a negligent act or omission and patient injury, have been met [29:1, 29:2, 29:3, 29:6]. The other options are incorrect because the attending practitioner did not follow the appropriate medical standards of care, Mr. Lopez's injury was a result of the attending practitioner's deviation from the medical standards of care, and the electrocardiogram is not a definitive test for an acute coronary syndrome. The attending practitioner should have considered additional testing or observation given Mr. Lopez's medical history and presentation.
CORRECT! 🙂
Explanation: The practitioner was not negligent in ordering a CT scan based on their clinical judgment, which was supported by Ms. Davis's symptoms [29:2]. Medical standards of care are based on the hypothetical practices of a reasonably competent practitioner in the same or similar community that address the same medical condition of the malpractice claim [29:2]. In this case, the practitioner met the medical standard of care by ordering a CT scan to confirm their clinical suspicion of pneumonia, despite the radiologist's report [29:2]. The practitioner's clinical judgment was supported by Ms. Davis's symptoms, which warranted further investigation to ensure an accurate diagnosis and prompt treatment [29:2]. The practitioner was not negligent in ordering a CT scan based on their clinical judgment, as it complied with medical standards of care [29:2]. The radiologist was negligent in misreading the chest X-ray, but cannot be held liable because there was no resultant harm to the patient as there was no significant delay in the diagnosis [29:2].
Wrong 😕
Explanation: The practitioner was not negligent in ordering a CT scan based on their clinical judgment, which was supported by Ms. Davis's symptoms [29:2]. Medical standards of care are based on the hypothetical practices of a reasonably competent practitioner in the same or similar community that address the same medical condition of the malpractice claim [29:2]. In this case, the practitioner met the medical standard of care by ordering a CT scan to confirm their clinical suspicion of pneumonia, despite the radiologist's report [29:2]. The practitioner's clinical judgment was supported by Ms. Davis's symptoms, which warranted further investigation to ensure an accurate diagnosis and prompt treatment [29:2]. The practitioner was not negligent in ordering a CT scan based on their clinical judgment, as it complied with medical standards of care [29:2]. The radiologist was negligent in misreading the chest X-ray, but cannot be held liable because there was no resultant harm to the patient as there was no significant delay in the diagnosis [29:2].
CORRECT! 🙂
Explanation: In this case, Dr. Chen violated the professional principles of beneficence and nonmaleficence by operating on the wrong knee, causing harm to the patient due to his negligence. While Dr. Chen did follow practical measures to avoid wrong-site surgery, such as surgical checklists and patient marking, he still deviated from the accepted standard of care by misreading the MRI and operating on the wrong knee. As per [29:8], a practitioner violates beneficence if they fail to maximize the patient’s best interests due to negligence. In this case, Dr. Chen caused harm to the patient by operating on the wrong knee, which is a violation of nonmaleficence. The fact that Dr. Chen's error was unintentional does not absolve him of accountability for violating the medical standards of care, as per [29:9]. Therefore, option C is the correct answer. Options A and B do not accurately reflect the legal and ethical standards for medical malpractice, and option D only partially addresses the reasons for medical malpractice compensation, as per [29:11].
Wrong 😕
Explanation: In this case, Dr. Chen violated the professional principles of beneficence and nonmaleficence by operating on the wrong knee, causing harm to the patient due to his negligence. While Dr. Chen did follow practical measures to avoid wrong-site surgery, such as surgical checklists and patient marking, he still deviated from the accepted standard of care by misreading the MRI and operating on the wrong knee. As per [29:8], a practitioner violates beneficence if they fail to maximize the patient’s best interests due to negligence. In this case, Dr. Chen caused harm to the patient by operating on the wrong knee, which is a violation of nonmaleficence. The fact that Dr. Chen's error was unintentional does not absolve him of accountability for violating the medical standards of care, as per [29:9]. Therefore, option C is the correct answer. Options A and B do not accurately reflect the legal and ethical standards for medical malpractice, and option D only partially addresses the reasons for medical malpractice compensation, as per [29:11].
CORRECT! 🙂
Explanation: The relevance of a practitioner's intentions in a medical malpractice case is addressed in paragraph [29:9]. The paragraph explains that a practitioner's intentions are not part of the legal equation for determining whether medical malpractice occurred. In other words, even if the practitioner had good intentions when they deviated from standard medical practice, this would not absolve them of accountability for violating medical standards of care and causing harm to the patient. The other options are incorrect because the outcome of the treatment does not change the fact that a deviation from medical standards of care occurred, and of the practitioner's level of experience is not relevant to the issue of whether medical malpractice occurred.
Wrong 😕
Explanation: The relevance of a practitioner's intentions in a medical malpractice case is addressed in paragraph [29:9]. The paragraph explains that a practitioner's intentions are not part of the legal equation for determining whether medical malpractice occurred. In other words, even if the practitioner had good intentions when they deviated from standard medical practice, this would not absolve them of accountability for violating medical standards of care and causing harm to the patient. The other options are incorrect because the outcome of the treatment does not change the fact that a deviation from medical standards of care occurred, and of the practitioner's level of experience is not relevant to the issue of whether medical malpractice occurred.
**
29. Reflection Vignettes
1. Ms. Laura Johnson, a 35-year-old elementary school teacher, presents to the emergency department with severe abdominal pain, fever, and chills. She is diagnosed with a ruptured appendix and requires urgent surgery. The medical practitioner explains the risks and benefits of the surgical procedure to Ms. Johnson, including the risk of complications such as bleeding, infection, and anesthesia reactions. However, the practitioner fails to fully inform Ms. Johnson of the risks associated with not having the surgery, such as sepsis and death. Ms. Johnson is afraid of surgery and decides to decline the procedure. Unfortunately, her condition deteriorates rapidly, and she passes away due to complications from the ruptured appendix. This scenario represents a clear example of medical malpractice, as there are both practitioner negligence and harm to the patient. The medical practitioner failed to fully inform the patient of the risks of harm associated with not getting surgery, which is a breach of their duty to provide adequate informed consent. As a result, the patient made a decision based on incomplete information and suffered harm, including the eventual loss of life. The failure to properly inform the patient of the risks of not getting surgery is a clear act of negligence and could be grounds for a medical malpractice lawsuit.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
ConcludeThink
**
2. Mr. Jake Anderson, a 35-year-old elementary school teacher, presents to the emergency department with severe abdominal pain, fever, and chills. She is diagnosed with a ruptured appendix and requires urgent surgery. The medical practitioner explains the risks and benefits of the surgical procedure to Mr. Anderson, including the risk of complications such as bleeding, infection, and anesthesia reactions. However, the practitioner fails to fully inform Mr. Anderson of the risks associated with not having the surgery, such as sepsis and death. Mr. Anderson is afraid of surgery and decides to decline the procedure. Fortunately, the ruptured appendix was a misdiagnosis, and Mr. Anderson makes a full recovery. This scenario represents is not an example of a medical malpractice case, in that although there may have been practitioner negligence, that negligence did not result in harm to the patient. The medical practitioner failed to fully inform the patient of the risks of harm associated with not getting surgery, which is a breach of their duty to provide adequate informed consent. As a result, the patient made a decision based on incomplete information but in this case did not suffer harm, and the patient had a full recovery. The failure to properly inform the patient of the risks of not getting surgery is a clear act of negligence and could have been grounds for a medical malpractice lawsuit had the patient suffered harm.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
