Seemingly simple errors at the front desk can have devastating effects on patient safety and may expose the hospital to litigation that is more damaging than malpractice lawsuits, warns a lawyer who has studied the issue. The lawsuit resulting from a front-desk error may be viewed by the courts as ordinary negligence, which brings the possibility of larger jury awards.
Risk managers should ensure that front-desk personnel are properly trained and follow strict protocols, says Alex Stein, JD, professor of law at the Cardozo Law School in New York City. It is easy to forget that front-desk staff can influence medical care and patient safety even though they are not clinicians, he notes.
These protocols should tell exactly what should be done at the registration process and at the front desk, but Stein cautions against developing your protocol from scratch. Even if you are eager to devise the perfect protocol, you are better off using one that is already available.
“The best strategy is to copycat. See exactly what the industry does, and then do exactly that,” Stein says. “If those protocols reflect what is going on in the industry, and if you follow those protocols very closely, that will practically preclude liability for the hospital because negligence is defined as a deviation from what is going on in the industry.”
The Georgia Court of Appeals recently addressed a malpractice allegation that illustrates how errors in the admissions process can threaten patient safety and lead to liability.
In that case, the court determined that a clinic staff member’s failure to communicate a patient’s complaints to a doctor is ordinary negligence rather than medical malpractice, as the plaintiff contended. (The case is Wong v. Chappell, 773 S.E.2d 496 [Ga.App. 2015].) Stein explains that an unlicensed medical assistant employed by the clinic took a phone call in which the patient said she was experiencing pain radiating from her flank and back, changes in her bowel movement, and was bleeding. Court records indicate that the assistant suspected the patient was having a urinary tract infection and inquired about the typical symptoms.
The assistant did not relay the patient’s concerns to any doctor, nurse practitioner, or physician’s assistant because, she stated, she did not think the symptoms were sufficiently serious. The patient developed a life-threatening complication and died.
“The lesson that jumps out at you is how this is such a crucial link in the system, that person who answers the phone or greets people at the door,” Stein says. “If that person fails to act responsibly, especially if critical information about a patient is not conveyed to the clinician, it can be a disaster.”
In addition to demonstrating how an insufficiently trained front-desk employee can jeopardize the safety of patients, the court’s ruling has important lessons regarding how such cases are likely to be viewed by the legal system, Stein says. Treating the allegation as ordinary negligence rather than malpractice means that the plaintiff can file suit and go to trial without first obtaining a certificate of merit and expert testimony, he notes. Also, ordinary negligence can give plaintiffs an edge because many states have limitations and caps on damages for medical malpractice.
One of the most important differences is that the plaintiff can use a much broader jury instruction regarding ordinary negligence, instead of a jury instruction that speaks to the specific and narrow definition of medical malpractice, Stein explains.
“The big takeaway lesson from this case is that being sued for negligence in the registration process, or whatever happens at the front desk, is the worst-case scenario,” Stein says. “You won’t be entitled to all the protections that doctors and hospitals get when sued for medical malpractice rather than this negligence.”