Which is Worse? Malpractice Case or Medical Board Investigation

The Black Cloud of a Medical Board Investigation is a must read for practicing professionals. The title speaks for itself. A referral to the medical board of your state can turn into a complex nightmare scenario in which you can be viewed as guilty until proven innocent.

To limit damages, targeted providers are forced to hire lawyers at their own expense to hopefully limit damages. Even though most cases are resolved quickly, even these can easily cost $20,000 and up in legal fees. In our experience, medical board actions have been as costly, as high a career risk, and as stressful as a malpractice suit.

The cases that go “south” can lead to summary suspension of license, difficulty in obtaining malpractice insurance, getting on certain insurance plans, dismissal from a hospital staff, and getting a “strike” in a 3 strike (3 strikes and your out) state like Florida.

Unfortunately, complaints are easy to file. The accessibility of filing by everyday individuals has made these actions much more common than malpractice suits. To make matters worse, accusations can morph over time and can be resubmitted multiple times if a patient or family does not get their desired result.

Medical boards receive many different kinds of complaints. Some are extremely serious (see below) but it has been found that most board actions are a result of poor communication and poor interpersonal relationships.

The most serious kind are designated sentinel events. According to the Joint Commission, a sentinel event is “and unexpected occurrence involving death or serious physical or psychological injury, or risk thereof.”  They are called sentinel because “they signal the need for immediate investigation and response. 

Ordinarily, these types of incidents get reported to the Medical Board by the critical incident committee of the hospital.  Although relatively minor events can qualify as sentinel, more frequently they are about major events and wind up being appropriately referred from the hospital to the board.  A significant proportion of these complaints are initiated by unhappy families who want “whatever they perceive has happened to their relative never to happen again”. Those who work with such cases know that perception and reality are not always identical in many situations.

While most providers are understandably paranoid about malpractice and/or liability issues, they nevertheless need to educate themselves about medical board practices in their states.  The potential adverse effects of a board investigation are not to be taken lightly. Both type of incidents, malpractice allegation and medical board referrals, are serious events that can be life-changing. Hire appropriate experienced counsel to help you survive the process.

Good patient communication, positive interpersonal relationship, and excellent documentation will help prevent both malpractice claims and board referrals. Good documentation does not have to lengthy, but when it is goal specific and captures the essence of clinical interactions, it can be life-saving (and career-saving) if confronted with either type of incident.

What to Do About PAIN in the ED?

The treatment of chronic pain has become a very complex and hot topic for providers. Little or no controversy exists about the treatment of acute pain; one just treats as necessary.  Acute exacerbation of chronic pain is also less clear.   

The goal is to treat patients humanely and appropriately without facilitating drug dependence and drug trafficking.

The pressures are complex and complicated. On the one hand, are those forces that make a physician more reluctant to prescribe pain medication, including:

1. States have created databases that keep, and make available online, records of all controlled medications prescribed, including the DEA number of the prescribing provider

2. Certain states, such as Florida, now require special licensure to treat non-cancer pain chronic pain.

3.Peer pressure from colleagues and support teams who feel everybody is a potential abuser. This puts certain patients with severe, painful conditions in the assumed category of “potential drug abuser”.

On the other hand, the real-time daily forces of clinical practice lead one to be less restrictive in administering pain medication. These include:

1.     CMS has made pain a de facto “vital sign” that must be addressed and documented.

2.     Patients request pain relief for a variety of complaints that are often very reasonable.

3.     Patient satisfaction scores like PRC and Press-Gainey emphasize pain relief. These scores affect contracts, RVU’s and levels of complaint to administrators. The #1 complaint in our ED is that the doctor was insensitive to pain relief and refused treatment.

What should one do? It is indeed a challenge to find a balanced, thoughtful approach trying to blend the various demands into a reasonable outcome. Our ED actually considered hiring its own pain specialist to deal with these endless problems.