Blog - Brown Law Office

Malpractice Claims are on the Rise with Electronic Health Records

January 9, 2020 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

According to The Doctor’s Company, a medical malpractice insurance company, more and more claims are being filed as a result of Electronic Health Records (EHR). Because of drop down menus and lack of alerts, patients are getting harmed.

In one example, a physician intended to order 15mg of Morphine. The drop-down menu gave him the choice of 15mg or 200mg. The physician mistakenly ordered the 200mg. The patient took the 200mg Morphine with Xanax and became somnolent and spent the night in the hospital.

There are numerous problems with copy and paste. In one case, a 38-year-old man presented to his PCP with symptoms of shortness of breath and dizziness. The man died 5 days later of pulmonary embolus, the Plaintiff’s Attorney was able to show that the physician copied and pasted his previous note into the visit just prior to his death. Not only is this information available in the audit trials to show everything which was done to the EHR, but the same exact vital signs were copied, and numerous spelling errors were noted in the previous note and copied with the same errors. The allegation was failure to properly assess this man. Had he been properly assessed; the physician would have been able to identify signs and symptoms of a pulmonary embolus.

Risk management strategies include:

Do not copy and paste anything except patient’s past medical history if you are sure it is accurate.
If your EHR auto populates information, ask that that feature be removed.
Be extra careful in selecting items from a drop-down menu and make sure it is correct.
Make sure you read and review prior medical records, so you have an accurate history.
If you use a scribe, you are responsible for the entry so double check to make sure it is accurate.
It is easy to save your charting for later and even do it at home but how do you remember the information? Remember attorneys can find out what time the patient’s visit was scheduled and what time the entry was made.

What do you do to avoid malpractice with EHR? I would love to hear your comments below.

Top 10 Blogs Of 2019

January 2, 2020 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

This is one of my favorite things with each New Year. I look at my top 10 blogs to see which ones you really enjoyed. In 2018, the favorite ones were based on license protection so in 2019, I chose to do more articles on that same subject.

Just like with the New Year’s Eve countdown, let’s go down the list starting with number 10 and head to number 1. By the way, you can read the original blog by clicking on the bolded number for each one.

NUMBER 10: PYXIS AND YOUR NURSING LICENSE – Probably among the most important of my videos because day after day I see where nurses are not properly following policy with medication management which is of concern to administration due to our opiate crisis.

NUMBER 9: THE PERILS OF TRAVEL NURSING – This blog discussed the top 8 ways travel nurses can get into trouble and advises how they can protect themselves.

NUMBER 8: WILL NURSES BECOME OBSOLETE – Is new and advancing technology creating a more automated world that is taking the place of nurses?

NUMBER 7: MED ERRORS AND CRIMINAL CHARGES – Tennessee nurse RaDonda Vaught accidentally gave a patient vecuronium instead of Versed resulting in the patient’s death. Vecuronium is used to intubate patients by repressing respiration. While in a PET scan, the patient arrested and died. The issue was not identified until an audit by the Center for Medicaid and Medicare Services (CMS) was done over a year after the incident. After the investigation, nurse Vaught was charged criminally in this matter. While she did commit malpractice, it is my opinion that it should not have risen to the level of a crime albeit for making a horrible mistake.

NUMBER 6: REFUSAL TO DRAW BLOOD – Jonathan Moore was involved in an auto crash killing a former city council woman and her daughter. When Moore was hospitalized, police wanted the nurse to draw blood without an order and without patient consent. The nurse told the officer that a warrant would be needed to make the draw. Crystal clear policies should be in place so nurses know when they can do certain activities.

NUMBER 5: FATAL MEDICATION ERROR UPDATE – This was another article dealing with of nurse RaDonda Vaught who accidentally administered vecuronium to a patient [See NUMBER 7]. Criminal charges were filed against nurse Vaught and the Tennessee Board had initially excused her actions but then decided to take action against her license.

NUMBER 4: NURSES IN TROUBLE WHEN PHYSICIAN OVERPRESCRIBES – A physician was actually practicing “end of life” measures by prescribing 20 times the normal dosages of fentanyl. Nurses who carried out those orders were all fired and reported to the Board. There was one wrongful death lawsuit that settled for $4,500,000.

NUMBER 3: NURSES WITH ADDERALL – This item discusses a Louisiana Board’s concerns about nurses who take the controlled substance Adderall. In fact, it shows a statement by the Board about how Adderall is the most widely abused prescription drug in America and how Boards can take action if a nurse takes any controlled substance.

NUMBER 2: UNUSUAL NURSING BOARD CASE – A nurse received an unfavorable decision by the Delaware Division of Professional Regulations to the Supreme Court which overturned the Delaware agency’s ruling. Two nurses were on duty and required to count medications just as if they were controlled substances. During the count, the supply of hepatitis C medication, costing $1,000.00 per pill, was accidentally spilled to the floor. The nurse put the 12 pills in the sharps container, but the pharmacy ordered them to be retrieved for later distribution to this patient/prisoner. The nurse’s license was placed on probation for 90 days and required her to take continuing education. But she disagreed with the decision and took the matter to the Delaware Supreme Court … and WON! It is unusual for nurses to appeal a case, let alone be successful.

NUMBER 1: PATIENT KILLS NURSE – A nurse accosted by a patient who, before others could restrain him, violently slammed the nurse’s head onto a desk. Lynne Truxillo subsequently succumbed to blood clots in her leg leading to a pulmonary emboli. Though the patient was charged with manslaughter, the obvious truth was that the charge could never bring back nurse Truxillo.

MY PERSONAL FAVORITE: My personal favorite blog was an interview with nurse Yolene Lofton who lost her license simply for recording the wrong date on some documents. It was sad that she lost her license over that error. But it does show just how important your license is and how even a minor error could result in loss of your license and livelihood.

My hope is that you can learn from these blogs and do everything you can to protect your most valuable asset: your license.

What was your favorite blog in 2019? Was it any of the above or perhaps a different one? Let me know in the comments below.

Privacy Matters To Patients

December 26, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

I often hear of nurses who made HIPAA violations, none of whom intended to breach privacy but either curiosity or carelessness got the best of them.

Here are ten such examples:

EMR – If you forget to log out of a computer terminal, someone else can follow you to access anything under you log in. Computers are smart and everything you do on the device can be tracked. Every keystroke you make, every chart you look at, everything! Even if you accidentally pull up a wrong patient’s chart, that is a HIPAA violation. Should this occur, immediately notify your supervisor.
HANDWRITTEN NOTES – When I was practicing, I had a clipboard with all my patients’ names and what I was to do with each one. Many times, I forgot to throw away my sheets and brought them home where I discarded them in the trash. If these notes are thrown away rather than placed in a secure shred bin, you are violating patient privacy and HIPAA.
PROTECTED INFORMATION – If you have a coworker who has had a procedure and you want to find out how they are, you CANNOT access their records. In that position, you are just like everyone else who is not allowed access to this person’s information. If you want any information on the coworker, you will have to go through the normal way of finding out, just like any family member or friend.
PATIENT FAMILY AND FRIENDS – Be cautious about any information you give to a patient’s family member or well-meaning friend. Make sure the patient has signed a HIPAA release or authorization giving you permission to share information with that particular person.
SHARING INFORMATION – Be careful not to share information outside protected channels. If you text a doctor from your personal cell phone, you have violated HIPAA. Any such text or email must be secured through approved software and channels.
SELFIES – As much as you would love to be friends with your patients, anything you share on your Facebook page or other social media, such as a selfie with the patient, is a HIPAA violation. Frankly you should never take a picture with a patient, but a patient may take a picture with you. I would not even be friends on Facebook with a patient because that too is a HIPAA violation of boundaries. However, if the patient takes the selfie and they post it on their own social media, no violation has occurred. The violation occurs it YOU post it.
REPORTING HIPAA VIOLATIONS – You can self-report any HIPAA violation but that does not necessarily mean you will not get in trouble but to NOT self-report can make the situation worse. However, if you note another’s HIPAA violation and fail to report it, you can make the situation worse as you can be considered an accomplice in the violation.
PUNITIVE MEASURES – HIPAA violations can result in a variety of legal responses that go beyond just being terminated from your job. A UCLA surgeon was sentenced to 4 months in jail and fined $2,000 after he illegally accessed medical records over 300 times of his supervisor, coworkers and celebrities.
ELEVATOR CHATS – In one case, a nurse was trying to reach a physician about a patient but he had not called back when she ran into him in an elevator. She promptly began a discussion with the doctor to get an order. This is a violation of HIPAA because the disclosure of the patient’s situation was not in a secure place
FAXING – If you are extremely busy and need to fax medical information, take the few seconds to confirm it is going to the proper recipient. If you accidentally send medical information to the wrong place, you have violated HIPAA.

A HIPAA violation is an extremely serious offense and can result in huge fines and even imprisonment, as noted in No. 8 above.

In ABC’s reality show, NY MED, they inadvertently filmed two hospital patients without consent. The hospital paid a settlement of $2,200,000 and was instructed to implement a corrective action plan.

HIPAA violations are extreme and saying “it was an accident” is not an acceptable excuse. There is zero tolerance for such and 100% compliance of HIPAA regulations is required at all times.

Please careful to protect your patient’s confidentiality.

Interview with Yolene Lofton, former nurse and founder of Nurse’s Court

December 5, 2019 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

Lorie Brown, R.N., M.N., J.D. interviews Yolene Lofton, former nurse and entrepreneur, about her problems when she had to appear before the Board of Nursing and advice to Nurses that may be going through similar problems. Also, the devastation that losing her nursing license caused and how she was able to find her way back and is now thriving with her businesses, Nurse’s Court and Nursing Events Management Production, LLC.

Nurse’s Court provides support and counseling for Nurses who have to appear before the Nursing Board. The website, www.NursesCourt.com, should be operational shortly.

Nursing Events Management Production, LLC which plans events for health care organizations such as job fairs, is currently planning a big event for 2020. 2020 Year of the Nurse and Midwife Worldwide Celebration with take place on April 30, 2020 in Miami, Florida. Tickets will go on sale in January, 2020 through TicketMaster or you can get information by emailing NursingEventsManagementPro@gmail.com.

Keeping Your Nurse Practitioner License Safe

November 27, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

Recently I attended the Nursing Service Organization Annual Summit where they discussed the results of their annual statistical analysis of claims against nurse practitioners. They look at things such as area of practice, resultant injuries, alleged breaches in the standard of care and on their license protection claims.

Here are some of the risk management strategies that they recommended.

Professionalism is the key. Nurse practitioners have an amazing way of developing a great rapport with their patients. Establishing the rapport and complying with your employer’s standards, policies and procedures is a great step in reducing your risk as a nurse practitioner.
You will “live and die” by your documentation. Therefore, document, document, document! It is important to note in your chart your reasons for your clinical decision making process and rationale. If your reasoning is supported in the chart, that goes a long way to protect you. There has never an attorney who has said, “I wish they didn’t document so much.” It has always been: “I wish they would have documented more!”
Additionally, it is important to document all discussions, consultations, clinical information along with the risk benefits and alternatives to treatment options. If you hand out any educational materials, that also should be noted.
If the patient it is not compliant, it is important to note that fact in the medical record. You should also document any efforts you have made to encourage compliance. Simply stating that the patient was noncompliant is not enough. As a health care professional, you have a duty to warn the patient of the risks of their noncompliance and the benefits of their being compliant.
You do not have to provide care to patients who are not compliant. If you have concerns about continuing to provide care to a noncompliant patient, bring that concern to your employer’s attention and consider terminating the care for that patient. Unlike nursing, as a nurse practitioner, we can somewhat choose our patients. If you have a concern that a patient may sue you or is not compliant, you can discontinue services by giving them 30 days notice and send the letter by certified mail. You are required to provide emergency care for the 30 days, and it is helpful to refer them for other care.

Do you have any suggestions for other risk management strategies? I’d like to read them in the comments below.

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