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Professional liability: Not for physicians only
AORN J O U R N A L
JULY 1985, VOL 42, N O 1
Editorial Professional liability: Not for physicians only
’egligence. Malpractice. The very words conjure up a sense of foreboding doom and anxiety in health care workers. Every nurse has at some time worried about being sued for malpractice or negligence. How can I protect myself? Who will support me? What about unwritten policies? These are common questions nurses continue to worry about every time there is a report of another lawsuit. Although most physicians and nurses perform their professional duties confidently, .they also realize that medicine and nursing are not exact sciences and probably never will be. There are no guarantees for either patient or practitioner; at best, each takes a calculated risk. Lately, the risk of being the subject of a medical malpractice suit appears to be increasing.’ Like the teenager learning to drive defensively, we must practice nursing defensively. We must “look both ways,” and “anticipate problems,” as our driving instructor would caution. As the teenager becomes a more skillful driver, he/she tends to pay less attention to defensive driving tactics. Complacency sets in. We, as health care providers, can never become complacent. We must continue to practice the defensive techniques we learned as newly licensed practitioners, for although ethically questionable, some lawyers are directing television and newspaper advertisements to the most vulnerable people-those who are ill. One such ad asks, “Are you disabled due to medical malpractice?’ Another pictures a child in a wheelchair and asks, “If your child has cerebral palsy or brain damage
N
12
. . . could it have been prevented?” Both ads offer free consultationsand urge quick action-alluding to the statute of limitations. This type of advertising deliberately implants seeds of doubt; it implies that the cause of a disability is medical negligence rather than an unfortunate, natural occurrence. And so one can hardly blame the medical profession for retaliating. Spurred by the increasing threat of malpractice suits and burgeoning malpractice insurance rates, some surgeons are changing the way they practice and refusing to perform certain kinds of surgery.2 The newest defense by the medical profession is the emergence of a computerized information service that, for a fee, will screen a patient’s litigation history. This service, which by the end of 1985 will be available to physicians and hospitals in five major cities, will check a patient’s name against a list of those who have brought lawsuits against physicians. If a match occurs, the information service will alert the physician as to type of case and sources of related information? What physicians will do with this information is anyone’s guess, but at least they will be informed. It seems the war is on, and each side has chosen its weapons. And nurses may suddenly be drawn onto a new battlefield. Nurses need to be on guard and sharpen all available defenses. The best defense is good nursing care. Each nurse must understand the rules and regulations and hidher state’s nurse practice act. Each nurse must document all interventions, follow all hospital policies, and meet professional standards
AORN J O U R N A L
of patient care. Each nurse must read about the court decisions in specific cases as reported in “OR Nursing Law” each month and adjust nursing care accordingly. Even that is not enough. Only a foolish nurse practices without adequate malpractice insurance. The adversarialrelationshipbetween health care providers and lawyers may get worse before it gets better. But when it gets better, let’s hope it’s
JULY 1985, VOL 42, NO I
better for each profession. PAT NIESSNER PALMER, RN, MS EDITOR Notes 1. B M Manuel, “A surgeon’s perspective on professional liability,” The Bulktin of the American College of Surgeons 70 (March 1985) 6.
2. Ibid 3. “New service to track litigation histories of patients,” HospitarS 59 (April 1, 1985) 18.
Moderate Alcohol May Lower Heart Disease Risk Drinking moderate amounts of alcohol may reduce the risk of coronary heart disease by increasing blood levels of apolipoprotein A-I, which protects against atherosclerosis, according to Carlos Camargo, Jr, of Stanford (Calif) University Medical Center and his colleagues. The study included 24 healthy nonsmoking men between 30 and 60 years of age who regularly consumed two to three drinks per day. Twelve men were asked to continue t’leir alcohol consumption as usual over the 1Cweek study and served as the controls. The other 12 first were observed for a three-week baseline period, followed by six weeks of abstention from alcohol, and finally, five weeks when they were asked to resume their consumption of alcohol. All 24 were asked to eat and exercise as they would normally. “Elimination of alcohol from the diet of the treatment subjects significantly reduced their mean concentration of serum apolipoprotein A-I and apolipoprotein A-11, while resumed alcohol intake significantly increased apolipoprotein A-I and apolipoprotein A-I1 to concentrations consistent with . . . baseline levels,” according to the researchers. Although high density lipoprotein cholesterol and specifically, apolipoprotein A-I, has been strongly associated with reduced risk of heart disease, the relationship between apolipoprotein A-I1 and heart disease is less clear. The researchers warn against advocating alcohol to prevent heart disease, however. “Recommendations that everyone drink at even moderate levels must be seriously questioned in light of 14
the potential dangers associated with this level of intake and the likelihood of increased consumption by some individuals,” they said. The study is reported in the May 17 issue of the Journal of the American Medical Association.
Congress Corrections In the May Post-Congress Journal, Lew Bennett’s name inadvertantly appeared on page 844 under the description of the education session entitled Manage or Be Managed. Bennett did not speak at this session, but was a speaker at the session entitled “Purchasing Power of the OR Nurse.’’ Roberta Young of the Alameda (Calif) County Chapter is pictured on page 856 of the May Journal, and the caption says that she presented a resolution at Congress. She actually presented a statement. The Journal regrets these errors.
Three AORN Publications No Longer Available AORN is removing three of its publications from the market because the information is outdated. Those publications are “Introduction into Recovery Room,” “Peer Review,” and the MILS program entitled “Certification Series.” Because the information in the “Certification Series” is no longer current, AORN will not accept continuing education units earned from completing it.
JULY 1985, VOL 42, N O 1
Editorial Professional liability: Not for physicians only
’egligence. Malpractice. The very words conjure up a sense of foreboding doom and anxiety in health care workers. Every nurse has at some time worried about being sued for malpractice or negligence. How can I protect myself? Who will support me? What about unwritten policies? These are common questions nurses continue to worry about every time there is a report of another lawsuit. Although most physicians and nurses perform their professional duties confidently, .they also realize that medicine and nursing are not exact sciences and probably never will be. There are no guarantees for either patient or practitioner; at best, each takes a calculated risk. Lately, the risk of being the subject of a medical malpractice suit appears to be increasing.’ Like the teenager learning to drive defensively, we must practice nursing defensively. We must “look both ways,” and “anticipate problems,” as our driving instructor would caution. As the teenager becomes a more skillful driver, he/she tends to pay less attention to defensive driving tactics. Complacency sets in. We, as health care providers, can never become complacent. We must continue to practice the defensive techniques we learned as newly licensed practitioners, for although ethically questionable, some lawyers are directing television and newspaper advertisements to the most vulnerable people-those who are ill. One such ad asks, “Are you disabled due to medical malpractice?’ Another pictures a child in a wheelchair and asks, “If your child has cerebral palsy or brain damage
N
12
. . . could it have been prevented?” Both ads offer free consultationsand urge quick action-alluding to the statute of limitations. This type of advertising deliberately implants seeds of doubt; it implies that the cause of a disability is medical negligence rather than an unfortunate, natural occurrence. And so one can hardly blame the medical profession for retaliating. Spurred by the increasing threat of malpractice suits and burgeoning malpractice insurance rates, some surgeons are changing the way they practice and refusing to perform certain kinds of surgery.2 The newest defense by the medical profession is the emergence of a computerized information service that, for a fee, will screen a patient’s litigation history. This service, which by the end of 1985 will be available to physicians and hospitals in five major cities, will check a patient’s name against a list of those who have brought lawsuits against physicians. If a match occurs, the information service will alert the physician as to type of case and sources of related information? What physicians will do with this information is anyone’s guess, but at least they will be informed. It seems the war is on, and each side has chosen its weapons. And nurses may suddenly be drawn onto a new battlefield. Nurses need to be on guard and sharpen all available defenses. The best defense is good nursing care. Each nurse must understand the rules and regulations and hidher state’s nurse practice act. Each nurse must document all interventions, follow all hospital policies, and meet professional standards
AORN J O U R N A L
of patient care. Each nurse must read about the court decisions in specific cases as reported in “OR Nursing Law” each month and adjust nursing care accordingly. Even that is not enough. Only a foolish nurse practices without adequate malpractice insurance. The adversarialrelationshipbetween health care providers and lawyers may get worse before it gets better. But when it gets better, let’s hope it’s
JULY 1985, VOL 42, NO I
better for each profession. PAT NIESSNER PALMER, RN, MS EDITOR Notes 1. B M Manuel, “A surgeon’s perspective on professional liability,” The Bulktin of the American College of Surgeons 70 (March 1985) 6.
2. Ibid 3. “New service to track litigation histories of patients,” HospitarS 59 (April 1, 1985) 18.
Moderate Alcohol May Lower Heart Disease Risk Drinking moderate amounts of alcohol may reduce the risk of coronary heart disease by increasing blood levels of apolipoprotein A-I, which protects against atherosclerosis, according to Carlos Camargo, Jr, of Stanford (Calif) University Medical Center and his colleagues. The study included 24 healthy nonsmoking men between 30 and 60 years of age who regularly consumed two to three drinks per day. Twelve men were asked to continue t’leir alcohol consumption as usual over the 1Cweek study and served as the controls. The other 12 first were observed for a three-week baseline period, followed by six weeks of abstention from alcohol, and finally, five weeks when they were asked to resume their consumption of alcohol. All 24 were asked to eat and exercise as they would normally. “Elimination of alcohol from the diet of the treatment subjects significantly reduced their mean concentration of serum apolipoprotein A-I and apolipoprotein A-11, while resumed alcohol intake significantly increased apolipoprotein A-I and apolipoprotein A-I1 to concentrations consistent with . . . baseline levels,” according to the researchers. Although high density lipoprotein cholesterol and specifically, apolipoprotein A-I, has been strongly associated with reduced risk of heart disease, the relationship between apolipoprotein A-I1 and heart disease is less clear. The researchers warn against advocating alcohol to prevent heart disease, however. “Recommendations that everyone drink at even moderate levels must be seriously questioned in light of 14
the potential dangers associated with this level of intake and the likelihood of increased consumption by some individuals,” they said. The study is reported in the May 17 issue of the Journal of the American Medical Association.
Congress Corrections In the May Post-Congress Journal, Lew Bennett’s name inadvertantly appeared on page 844 under the description of the education session entitled Manage or Be Managed. Bennett did not speak at this session, but was a speaker at the session entitled “Purchasing Power of the OR Nurse.’’ Roberta Young of the Alameda (Calif) County Chapter is pictured on page 856 of the May Journal, and the caption says that she presented a resolution at Congress. She actually presented a statement. The Journal regrets these errors.
Three AORN Publications No Longer Available AORN is removing three of its publications from the market because the information is outdated. Those publications are “Introduction into Recovery Room,” “Peer Review,” and the MILS program entitled “Certification Series.” Because the information in the “Certification Series” is no longer current, AORN will not accept continuing education units earned from completing it.