Policy Not Followed? Explain Reason Why

Ryan R. Domengeaux, JD, vice president of risk management at Schumacher Group in Lafayette, LA, says, "Policies and procedures are not only driven by statutory requirements, they are also necessary to memorialize service expectations."

Legal risks related to ED policies are primarily driven by how well they're put together and how well people actually abide by them, he says. "They should always be as specific as possible, without being overly detailed," says Domengeaux. "I don't think any policy or procedure should ever be vague. The person who's going to pick it up and read it, quite often, is trying to understand what they should be doing."

An EP may have a justifiable reason for going outside a policy, he adds, but his or her documentation must support this. "If I have a policy in front of me and I decide it's not in the patient's best interest in that instance to follow that policy, then I have to be able to support my reasoning for that," says Domengeaux.

"Is it in the patient's best interest to go outside the policy?" and "Have I well documented my reasons?" are the two questions EPs should answer, he says.

If there is good documentation to support the EP's decision-making process to clearly explain why following the policy was not in the patient's best interest, this is a very defensible position for an EP, says Domengeaux. "What a jury looks for is common sense, and an explanation," he says. "Absent both of those, you will have a tough time defending why you didn't follow a policy."

Domengeaux says that in his experience, high-risk areas involving ED policies involve failure to follow policies for diagnostic overread discrepancies, such as when an EP doesn't see a fracture on a patient's X-ray but the radiologist later identifies one, and policies related to monitoring a patient who was administered narcotics.

If a patient is given a narcotic for pain and a bad outcome results, the issue is whether there was a procedure that the nurse or doctor should have followed, but didn't, in monitoring the patient. "In most instances, there is a policy in place for monitoring a patient being administered a strong narcotic, but these aren't always followed," he adds.

It's already difficult to defend a case when a breach in the standard of care has occurred involving requirements from the Joint Commission or other organizations, says Domengeaux. "If you don't follow your own policies and procedures, it becomes even tougher to defend," he says.


For more information, contact:

• Ryan R. Domengeaux, JD, Vice President of Risk Management, Schumacher Group, Lafayette, LA. Phone: (337) 354-1255. Fax: (337) 262-7425. E-mail: risk@schumachergroup.com.