The point of the litigation is it is a medical error to provide too much treatment, just as it is to provide too little treatment. If it is clear patients did not want it, then clinicians should not provide it.
Clinicians make judgment calls every day that do not always turn out to be correct, even when they are made in good faith. A recent court decision regarding the medical necessity of hospice care could put clinicians and hospitals at risk of False Claims Act allegations when judgment calls turn out wrong.
A hospital’s executive and officers liability insurance usually will apply to peer review committee members. There also are protections under federal law providing immunity for participation, particularly the Healthcare Quality Improvement Act. There are state-level statutes to provide immunity, although those laws vary widely.
Emergency nurses and physicians may not understand the liability implications of using charts to air grievances. A unified defense is recognized as the best approach for all defendants in ED malpractice claims, but finger-pointing notes make it difficult. Physicians and nurses should meet briefly before each shift to discuss the importance of teamwork, not only regarding patient care but also documentation.
If a patient with psychiatric symptoms experiences a poor outcome shortly after discharge from an ED, allegations of inadequate medical screening are possible. Good documentation is the best protection against these allegations.
Before pediatric psychiatric patients are discharged from the ED, carefully document the visit and create a follow-up plan with a primary care physician or mental health professional. For patients presenting with suicidal ideation, a social worker or mental health clinician should develop a safety plan.