Colorado Medical Society

Case analysis review

Friday, May 01, 2015 12:26 PM

The CMS Spring Conference was built around the theme of “breaking down barriers to better patient care,” and one of its main goals was to develop ideas to address the critical issues facing physicians. One such issue is medical liability.

“If you look at national data, 99 percent of surgeons will have a lawsuit by the time they are 65,” said COPIC CEO Ted Clarke, MD. “If you’re in primary care, it’s about 77 percent.”

COPIC panel

COPIC CEO Ted Clarke, MD, center, introduces the panel of CMS physician members and COPIC physician risk managers who lead the interactive case review session.

To give physicians insight into the case analysis process, CMS and COPIC collaborated to present an interactive case review session. Defense attorneys presented fictitious medical liability cases based upon current medical trends and incidents. Then a large panel of CMS physician members and COPIC physician risk managers simulated a case review by asking questions to analyze the cases. Attendees broke out into small groups for discussion facilitated by COPIC risk managers, focusing on the cases in terms of appropriateness of care, medico-legal issues, patient behavior and other related aspects. These discussions presented attendees with the unique opportunity to interact with health law defense attorneys who partner with COPIC.

At the end of the session, the defense attorneys gave their insights on the biggest changes in health care they’ve seen over the past five years.

Steve Hensen, JD, identified the rising use of the electronic medical record as a barrier to communication. “I think it’s fair to say [EMR usage] has a lot of advantages; however, one disadvantage we see from patients when they start talking about what the problem was, is perceived lack of attention. If you sit behind a computer screen or have some physical barrier between you, you don’t have good eye contact, you don’t have good interaction. One thing we hear a lot is ‘the doctor never talked to me, the doctor didn’t listen to me or look at me. Instead the doctor was sitting there typing on a computer,’” he said.

Hensen also talked about the rising use of scribes in medical settings. This process enables the physician to speak directly to the patient while another person records the encounter, but may open up the opportunity for error. “One problem we see is whether the scribe accurately wrote it down and whether the doctor actually reviewed it afterward because the plaintiff’s attorneys are using those medical records.”

What can happen is the scribe either didn’t hear the doctor ask a question or didn’t record the answer correctly and the doctor never checked the record, Hensen said. Then two, three or four years later, the physician has no independent recollection and the chart shows an error.

COPIC panel 2

Attendees broke out into small groups for discussion facilitated by COPIC risk managers. From left to right, Leto Quarles, MD; Alfred Carr, MD; and Karen Davis, MD.

Steve Michalek, JD, said he has seen significant changes in the cases that are brought because of the complexity of medicine and all of the different specialties and midlevels that get involved in care. “Most of the cases we see are filed against more than one health care provider,” he said. “Continuity of care, I think, is something that may break down in certain situations. It’s those handoffs that we have to make sure get done smoothly so that things don’t fall through the cracks.”

“I’ve seen more and more of the midlevel cases with the PAs and the NPs where sometimes the folks don’t know who their supervising physician is at that time,” he continued. “Is it the one who’s registered at the medical board? Is it the one who happened to be on call? And when do they need to exercise their own judgment to elevate this clinical situation to get input from the supervising physician?”

Jeff Varnell, MD, a COPIC physician risk manager, said one of the ways to overcome those barriers is to have a very clear understanding of when you feel comfortable with a midlevel seeing the patient, when he or she should have a consultation with you, or when you want them to contact you to direct the care of the patient. “That varies for each practice and you have to decide that ahead of time so that they have a clear understanding of when to contact you. That’s a clear communications barrier you can work on.”

Additional defense attorneys involved in this process included Kay Rice serving as a speaker and Barb Glogiewicz and Doug Wolanske as case presenters.

The case review session garnered positive feedback because it engaged attendees in the conversation and allowed them to examine care from all angles – medical, legal and ethical. And while the review followed a structured format, unplanned discussions emerged that led to interesting questions and innovative ideas that will help attendees examine their own concerns and provide further understanding of the medical liability challenges health care providers face.