Receiving transferred patient? Chart injuries — Timing is key in event of lawsuit

Healthcare reform might lead to a greater number of “handoffs” and interfacility transfers, as regions establish Centers of Excellence for oncology, cardiology, orthopedics, neurology, and other specialized areas of care, says Justin Keith, vice president of Hiscox, a Hamilton, Bermuda-based international insurance provider.

“The creation of accountable care organizations is intended to facilitate the movement of patients to the caregiver best equipped to handle a patient, both from a care standpoint as well as a cost standpoint,” he explains.

There will be more interfacility transfers, as a given geography consolidates specialized services under one organization or facility, predicts Keith. A heart patient, for example, might expect care from a particular region’s cardiac Center of Excellence. If a physician fails to transfer the patient in this example to the facility deemed as the cardiac Center of Excellence and injury occurs, due to negligence or not, a claim or suit could be brought against the facility or physician for failing to transfer, says Keith.

Who is liable?

Liability transfers when the patient is admitted to the receiving facility, or when a physician consult occurs prior to transfer, Keith says.

“Practically speaking, however, when an injury occurs can be difficult to determine. Multiple practitioners and facilities will be named if a claim or suit presents,” he says.

The extent to which an attending physician or facility is liable depends on the laws of the state or states in which the care is provided, says Keith, as well as the laws of contribution and vicarious liability.

Extent of injury

Keith commonly sees claims involving senior living facilities and decubitus ulcers.

“An admitting facility fails to properly document the extent of the injury at the time of the patient’s admission, and as result, opens itself up to costly negligence claims,” he says.

Similar claims have involved other post-acute settings when hospitals are transferring high-risk or very ill patients out of their facilities, adds Keith. “Risk management in this area has been quite effective, however. As a result, many long-term care facilities are adept at properly documenting existing injuries,” he says.

When admitting physicians are dealing with a complex set of illnesses and injuries, often critical and at various stages of development, claims alleging failure to diagnosis and treat can occur, adds Keith. “Clear communication and consistent documentation is the answer to avoiding liability,” he says. “The increased use of the electronic medical record should help in the integration of care. However, many facilities still lag in this area, particularly primary care practices that are often the frontline in early diagnosis.”

A recent claim involved a pediatric patient who was incorrectly diagnosed in the emergency department (ED) at an acute care hospital, but was properly treated following transfer to the children’s hospital. “It was found through the course of discovery that the time period between treatment in the ED and the admission to the pediatric facility was critical and significantly contributed to the resulting brain injury,” says Keith. “Documentation was poor on both ends.”

Ultimately, the receiving facility incurred most of the incurred financial loss, primarily because it was responsible for treatment at the time the extent of the injury was discovered, says Keith.

“If the receiving facility or physician helps to stave off additional injury or the patient improves under its care, liability may fall upon it anyway if it does not properly document the extent of injury already present upon admission,” he warns.