Clinical pathways get mixed results in court
Clinical pathways get mixed results in court
Guidelines used by plaintiffs, defense
The evidence of whether and how much clinical pathways and national guidelines help health care providers in court is mixed, and may remain so until more such cases arise, says Robert H. Goebel, MD, an oncologist at the Long Beach (CA) Community Cancer Center and a fellow at the Thomas Jefferson School of Law in San Diego.
One study revealed that, in a sample of 259 insurance claims, 17 involved the use of practice guidelines. In 12 of those cases, the guidelines were inculpatory, meaning they were used to establish the defendant’s liability. In four cases, the guidelines were exculpatory (exonerating the defendant), while the remaining case could not be classified (J Health Pol 1996: 289-313). A companion survey showed that 54% of malpractice lawyers had used national guidelines as evidence against defendants, while 23% had used guidelines on behalf of defendants.
In a 1995 study published in the Annals of Internal Medicine (122:450-455), researchers identified several cases where health care providers successfully defended against malpractice by using national clinical guidelines, including the following:
• Parker v. Southwest Louisiana Hospital Association (1989) concerned the sudden death of an infant in a hospital nursery. According to the study, the court accepted a national guideline’s recommendation that infants should be observed continuously, following the care plan of the individual nursery." An expert testifying on behalf of the defense introduced the guidelines, stating that "the hospital’s plan of care, which included a standard of checking infants every 10 to 15 minutes, was acceptable."
• In Comizio v. Hale, a New York case from 1990, the court ruled that the defendant, a physician, could "rely on findings of the International Reflux Study Committee in testifying on his own behalf as an expert."
• In Moore v. Baker (Georgia, 1991), "the defendants relied on the rejection of ethylenediaminetetraacetic acid chelation therapy by the AMA, the AHA, the American Academy of Family Physicians, the American College of Cardiology, and the American College of Physicians."
• In Miller v. Rhode Island Hospital (1993), a "severely intoxicated man" went to the hospital’s emergency department but "refused to consent to a diagnostic peritoneal lavage and tried to leave." Hospital personnel restrained the man and performed the procedure without his consent. The Rhode Island Supreme Court found in favor of the defendant, concluding that "the patient’s capacity to make a medical decision was not synonymous with sanity or legal competence." In its ruling, the court noted that an expert witness called by the defense had been prevented from testifying that "the standards of the American College of Surgeons obligate a physician to perform a peritoneal lavage on intoxicated patients who undergo trauma."
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