EMS LAWSUITS: A TOP 10 LIST TO STAY OFF OF THOMAS H. WILSON, ESQ. PARTNER, HEPLERBROOM, LLC LIEUTENANT, EMT-P, CHATHAM FIRE DEPARTMENT

Transcription

1 EMS LAWSUITS: A TOP 10 LIST TO STAY OFF OF THOMAS H. WILSON, ESQ. PARTNER, HEPLERBROOM, LLC LIEUTENANT, EMT-P, CHATHAM FIRE DEPARTMENT

2 OBJECTIVES

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5 EMERGENCY MEDICAL SERVICES LIABILITY LITIGATION IN THE UNITED STATES: FIRST NATIONWIDE EFFORT TO IDENTIFY LAWSUITS AGAINST EMS PROVIDERS Source: Prehospital and Disaster Medicine 9 (4): December 1994

6 76 LAWSUITS 50% VEHICLE ACCIDENTS 50% PATIENT CARE ISSUES 40% EMS PROVIDER WON 5 CASES WITH A VERDICT/SETTLEMENT OVER $1 MILLION

7 TORT CLAIMS AND ADVERSE EVENTS IN EMERGENCY MEDICAL SERVICES 2 YEARS ( ) 326 CLAIMS SUBMITTED TO ONE INSURANCE COMPANY Source: Annals of Emergency Medicine 2008:52:

8 Table 1. Adverse event categories Adverse Event No. (%; 95% CI) Emergency vehicle crash or movement* 122 (37; 32-43) Emergency vehicle crash 115 Emergency vehicle movement 12 Patient handling 118 (36; 31-41) Personnel dropped patient 36 Stretcher or wheelchair tipped over 30 Patient injured during stretcher/wheelchair 21 movement Patient fell 14 Clinical management 40 (12; 9-16) Airway management 14 Adverse drug reaction 5 Other medical management events 15 Lack of or failure to bring equipment on 5 scene Failure or malfunction of equipment 7 Response or transport event 25 (8; 5-11) Response, dispatch or navigational events, or 15 delay of care Transportation events 12 Other events 33 (10; 7-14) CI, Confidence interval. Total of 326 events. Select incidents were classified with more than 1 adverse event category. *Includes only emergency vehicle crashes or movement events with greater than $10,000 in estimated total incurred costs

9 Table 1. Adverse event categories Adverse Event No. (%; 95% CI) Emergency vehicle crash or movement* 122 (37; 32-43) Emergency vehicle crash 115 Emergency vehicle movement 12 Patient handling 118 (36; 31-41) Personnel dropped patient 36 Stretcher or wheelchair tipped over 30 Patient injured during stretcher/wheelchair 21 movement Patient fell 14 Clinical management 40 (12; 9-16) Airway management 14 Adverse drug reaction 5 Other medical management events 15 Lack of or failure to bring equipment on 5 scene Failure or malfunction of equipment 7 Response or transport event 25 (8; 5-11) Response, dispatch or navigational events, or 15 delay of care Transportation events 12 Other events 33 (10; 7-14) CI, Confidence interval. Total of 326 events. Select incidents were classified with more than 1 adverse event category. *Includes only emergency vehicle crashes or movement events with greater than $10,000 in estimated total incurred costs

10 Table 1. Adverse event categories Adverse Event No. (%; 95% CI) Emergency vehicle crash or movement* 122 (37; 32-43) Emergency vehicle crash 115 Emergency vehicle movement 12 Patient handling 118 (36; 31-41) Personnel dropped patient 36 Stretcher or wheelchair tipped over 30 Patient injured during stretcher/wheelchair 21 movement Patient fell 14 Clinical management 40 (12; 9-16) Airway management 14 Adverse drug reaction 5 Other medical management events 15 Lack of or failure to bring equipment on 5 scene Failure or malfunction of equipment 7 Response or transport event 25 (8; 5-11) Response, dispatch or navigational events, or 15 delay of care Transportation events 12 Other events 33 (10; 7-14) CI, Confidence interval. Total of 326 events. Select incidents were classified with more than 1 adverse event category. *Includes only emergency vehicle crashes or movement events with greater than $10,000 in estimated total incurred costs

11 Table 1. Adverse event categories Adverse Event No. (%; 95% CI) Emergency vehicle crash or movement* 122 (37; 32-43) Emergency vehicle crash 115 Emergency vehicle movement 12 Patient handling 118 (36; 31-41) Personnel dropped patient 36 Stretcher or wheelchair tipped over 30 Patient injured during stretcher/wheelchair 21 movement Patient fell 14 Clinical management 40 (12; 9-16) Airway management 14 Adverse drug reaction 5 Other medical management events 15 Lack of or failure to bring equipment on 5 scene Failure or malfunction of equipment 7 Response or transport event 25 (8; 5-11) Response, dispatch or navigational events, or 15 delay of care Transportation events 12 Other events 33 (10; 7-14) CI, Confidence interval. Total of 326 events. Select incidents were classified with more than 1 adverse event category. *Includes only emergency vehicle crashes or movement events with greater than $10,000 in estimated total incurred costs

12 Source: Firefighterclosecalls.com

13 Source: Firefighterclosecalls.com

14 Source: Firefighterclosecalls.com

15 Source: Firefighterclosecalls.com

16 Source: Firefighterclosecalls.com

17 Source: Firefighterclosecalls.com

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25 EMS MYTH #4: LIGHTS AND SIRENS SAVE A SIGNIFICANT AMOUNT OF TRAVEL TIME AND LIVES RESEARCHERS IN NORTH CAROLINA COMPARED LIGHTS AND SIREN TRANSPORT TO NON-LIGHTS AND SIREN TRANSPORT IN AN URBAN SETTING WHERE TRANSPORT TIME TO A UNIVERSITY MEDICAL CENTER INVOLVED DISTANCES OF EIGHT MILES OR LESS. THEY FOUND THAT LIGHTS AND SIREN TRANSPORT ONLY AVERAGED 43.5 SECONDS FASTER THAN NON-LIGHTS AND SIREN TRANSPORT. THEY CONCLUDED, ALTHOUGH THE MEAN DIFFERENCE IS STATISTICALLY SIGNIFICANT, IT IS NOT CLINICALLY SIGNIFICANT, EXCEPT IN RARE CIRCUMSTANCES. A SIMILAR STUDY CONDUCTED IN SYRACUSE, NY, FOUND THAT LIGHT AND SIREN RESPONSE REDUCED RESPONSE TIMES BY AN AVERAGE OF 1 MINUTE, 46 SECONDS. THEY CONCLUDED, ALTHOUGH STATISTICALLY SIGNIFICANT, THIS TIME SAVING IS LIKELY TO BE CLINICALLY RELEVANT IN ONLY A FEW CASES. Source: Bryan Bledsoe, EMS World, December, 2003

26 EMS MYTH #4: LIGHTS AND SIRENS SAVE A SIGNIFICANT AMOUNT OF TRAVEL TIME AND LIVES RESEARCHERS IN NORTH CAROLINA COMPARED LIGHTS AND SIREN TRANSPORT TO NON-LIGHTS AND SIREN TRANSPORT IN AN URBAN SETTING WHERE TRANSPORT TIME TO A UNIVERSITY MEDICAL CENTER INVOLVED DISTANCES OF EIGHT MILES OR LESS. THEY FOUND THAT LIGHTS AND SIREN TRANSPORT ONLY AVERAGED 43.5 SECONDS FASTER THAN NON-LIGHTS AND SIREN TRANSPORT. THEY CONCLUDED, ALTHOUGH THE MEAN DIFFERENCE IS STATISTICALLY SIGNIFICANT, IT IS NOT CLINICALLY SIGNIFICANT, EXCEPT IN RARE CIRCUMSTANCES. A SIMILAR STUDY CONDUCTED IN SYRACUSE, NY, FOUND THAT LIGHT AND SIREN RESPONSE REDUCED RESPONSE TIMES BY AN AVERAGE OF 1 MINUTE, 46 SECONDS. THEY CONCLUDED, ALTHOUGH STATISTICALLY SIGNIFICANT, THIS TIME SAVING IS LIKELY TO BE CLINICALLY RELEVANT IN ONLY A FEW CASES. Source: Bryan Bledsoe, EMS World, December, 2003

27 PATIENT HANDLING IT S PRETTY SIMPLE

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29 REFUSALS A COMPETENT INFORMED PERSON HAS THE RIGHT TO REFUSE ANY AND ALL MEDICAL CARE

30 REFUSALS A COMPETENT INFORMED PERSON HAS THE RIGHT TO REFUSE ANY AND ALL MEDICAL CARE

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32 911CALL FOR MALE COMPLAINING CHEST PAIN & DIFFICULTY BREATHING PARAMEDIC & EMT DIAGNOSED ACID REFLUX & RECOMMENDED MAALOX & OBTAINED REFUSAL NEXT DAY CALLED BACK WITH COMPLAINTS OF CHEST PAIN, SHORTNESS OF BREATH, DIAPHORESIS & NAUSEA

33 TRANSPORTED TO HOSPITAL AND DIAGNOSED WITH PE CAUSING CARDIAC ARREST AND DIED THAT AFTERNOON

34 YOU NEVER WANT TO GET CALLED BACK TO A RESIDENCE YOU JUST LEFT! MUST ENSURE THAT THE PATIENT IS FULLY INFORMED OF ALL THE RISKS AND CONSEQUENCES OF REFUSING CARE

35 FOLLOW ALL APPLICABLE PROTOCOLS WHEN DEALING WITH REFUSALS CONSULT MEDICAL CONTROL ON LINE IN DIFFICULT CASES OR THOSE THAT DON T FEEL RIGHT MAKE SURE REFUSAL FORM IS COMPLETELY FILLED OUT AND FULLY EXPLAINED

36 HOW WILL YOUR ACTIONS/INACTIONS BE EVALUATED?

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38 MISSOURI RECOGNIZED OFFICIAL IMMUNITY FOR EMERGENCY RESPONDERS PERFORMING A DISCRETIONARY ACT USE OF DISCRETION IN AN EMERGENCY WHEN YOU HAVE TO MAKE A SPLIT SECOND DECISION DOES NOT APPLY IF YOU HAVE TIME TO THINK ABOUT WHAT YOU ARE GOING TO DO REFUSAL DOES NOT APPLY WHEN YOU HAVE SPECIFIC PROTOCOL GUIDING TREATMENT GCS 8 INTUBATE

39 HOW DO WE MINIMIZE THE CHANCE OF BEING SUED? COMPLACENCY

40 WRITE IT DOWN ALL OF IT SO WHERE DOES IT SAY THAT IN YOUR REPORT? IT S NOT WHAT HAPPENED IT S WHAT YOU CAN PROVE HAPPENED

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42 ON JULY 14, 2002, SHIRLEY JOHNSON EXPERIENCED AN ANAPHYLACTIC REACTION TO PEANUT OIL AFTER EATING CHINESE FOOD BEGAN HAVING TROUBLE BREATHING HER HUSBAND TOOK HER BY CAR TO AN IMMEDIATE CARE CENTER (ICC) ICC CALLED 911 IMMEDIATELY

43 EMS ARRIVED ON SCENE IN 3 MINUTES UPON ARRIVAL, FOUND PT SEATED IN PASSENGER SEAT OF HER CAR, IN SEVERE RESPIRATORY DISTRESS

44 PARTIES DISAGREE OVER KEY ASPECTS OF THE PT S CONDITION EMS SAYS PT S JAW WAS CLENCHED, PLAINTIFF SAYS IT WASN T PLAINTIFFS SAY THAT THE ICC DOCTOR TOLD EMS THAT PT NEEDED IMMEDIATE INTUBATION AND THAT THE DOC OFFERED TO INTUBATE, EMS DENIES THESE ALLEGATIONS

45 PARTIES ALSO DISAGREED ON SEVERAL KEY FACTS ABOUT THE LOADING AND TRANSPORT OF THE PT FAILED IV ATTEMPTS FAILED INTUBATION ATTEMPTS AMOUNT OF TIME BEFORE INTUBATION WAS ATTEMPTED WHETHER THE TUBE WAS MISPLACED

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48 UPON ARRIVAL, PT WAS IN CARDIAC ARREST, ABDOMEN DISTENDED E.D. PHYSICIAN DETERMINED THAT E.T. TUBE WAS IN THE ESOPHAGUS INSTEAD OF THE TRACHEA

49 EMS ASSERTED THAT TUBE BECAME DISPLACED WHEN HER HEAD JOSTLED WHILE TAKING PT OUT OF THE AMBULANCE PLAINTIFFS ASSERT THAT THE 60 SECONDS OR SO FOR OFFLOADING WOULD NOT BE ENOUGH TIME FOR A MISPLACED E.T. TUBE TO CAUSE MARKED ABDOMINAL DISTENTION

50 IN ILLINOIS, EMS PROVIDERS ENJOY QUALIFIED IMMUNITY FROM CIVIL LIABILITY NO CIVIL LIABILITY AS LONG AS THE PROVIDERS ACT IN GOOD FAITH, AND NOT WITH WILLFUL AND WANTON MISCONDUCT ISSUE: WHAT IS WILLFUL AND WANTON?

51 ILLINOIS SUPREME COURT: MUST HAVE BEEN INTENTIONAL, OR THE ACT MUST HAVE BEEN COMMITTED UNDER CIRCUMSTANCES EXHIBITING A RECKLESS DISREGARD FOR THE SAFETY OF OTHERS

52 COURT DENIED THE SUMMARY JUDGMENT MOTION BY THE EMS AGENCY THE CASE LAW STRONGLY SUGGESTS THAT A FACT- FINDER CAN FIND THAT A DEFENDANT S CONDUCT IS WILLFUL AND WANTON IF THE DEFENDANT FAILS TO FOLLOW APPLICABLE GUIDELINES AND PROCEDURES

53 ALL INTERVENTIONS MUST BE DOCUMENTED WHETHER SUCCESSFUL OR UNSUCCESSFUL ABSENT DOCUMENTATION, THE AFTER THE FACT TESTIMONY CAN APPEAR TO BE SELF-SERVING AND AN ATTEMPT TO COVER UP

54 COMMON SENSE

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