Oklahoma Medical Negligence

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					                                                 Medical Negligence
                                                 Addressing Am bulatoy Health Care Negligence
                                                 :ian appointment and credentials review               monitor or discipline the doctor
                                                 hnctions. The credentials review process               . . . such episodes or informa-
                                                 includes not only clinical competence, but            tion of prior conduct might
                                                 the broader aspect of professional compe-              include the fact the doctor has
                                                 tence because a broad range of factors                previously been sued for mal-
                                                 impact health care delivery by physicians.             practice or experienced unto-
                                                 First and foremost, credentials review is             ward results in prior cases . . .
                                                 performed to protect the public from                   admissibility of such evidence
            L. Mark Bonner                                                                              can be analogized to the situa-
                                                 substandard physicians and health care
                                                 practitioners. Hospital and ambulatory care            tion where a person is sued for
       Health care services are increasingly     center standards require a mechanism to                negligently entrusting an auto-
provided without the patient being admitted      ensure that individuals provide services               mobile to a reckless or incompe-
to the traditional hospital setting. Ambula-     only within the scope of their privileges.             tent driver. . . .
tory care centers include ambulatory                    There is scant appellate authority in     Stnibhart, 903 P.2d at 273.
surgery centers, birthing centers, cancer        Oklahoma regarding ambulatory care center
centers, cardiac catheterization units, dialy-   liability. Hospital credentialing law would             The Court in Strubhart held that there
sis centers, MRI and CT centers, freestand-      appear to be applicable in the ambulatory        is a, "general duty of hospitals to exercise
ing clinics, and freestanding urgent and         care center setting based on industry            ordinary care and attention for the safety of
emergency care centers.           Services of    practices and industry standards. The            their patients," (Strubhart,903 P.2d at 275-
ambulatory care centers, hospital outpa-         Oklahoma Supreme Court adopted the               76) which places an obligation on the part of
tient departments, physicians' offices and       theory of hospital corporate negligence in       the hospital to monitor doctors:
home health care services fall under the         Strubhart v. Perry Memorial Hospital
ambulatory care heading provided that the        Trust Authority, 1995 OK 10,903 P.2d 263.             [A] hospital may satisfy the
patient remains at the facility less than 24     In Strubhart, a baby was allowed to bleed to          duty to the patient by taking
hours.                                           death after a negligent forceps delivery.             lesser steps than total or full
       The growth in ambulatory care is          Over the § 2404 objection of the Defen-               termination of staff privileges.
driven by a number of forces, primarily          dants, Plaintiffwas permitted to introduce at         Such steps may include limita-
financial in consideration.         Insurance    trial testimony about previous episodes of            tions or restrictions on the staff
companies favor ambulatory care because it       conduct by Dr. Seal which included failures           privileges in regard to certain
reduces hospital bills generated by over-        to transfer patients to other facilities,             medical procedures. The duty
night hospital stays. Some doctors prefer to     leaving surgery or breaking scrub, failures           might also be satisfied by
provide outpatient procedures in the             to appear on time at the hospital, failures to        requiring some type of over-
setting of a clinic because it gives them        prescribe antibiotics for an infection, and           sight of the physician in certain
more convenience and control. However,           failures to report sexual abuse of children.          situations or by requiring con-
the savings to the insurance company and         Strubhart, 903 P.2d at 267-68. The Court              sultation with other physicians.
the convenience to the doctor come at a          ruled that such testimony was admissible,        Strubhart, 903 P.2d at 277.
price. The patient is left to fend for himself   not to show the tendencies of the
or herself; when in the past, the patient        Defendant, but to show that the hospital               The Court intended to prohibit
would be monitored by trained nurses at the      knew or should have known of the poor            hospitals from removing themselves from
hospital during a recuperative period.           performance record. Strubhart, 903 P.2d at       the oversight of physician credentialing:
Predictably, injuries occur as a result.         272-74:
       According to the data collected by                                                              We believe failing to impose
the Department of Veterans Affairs, ambula-            In our view, testimony about a                  the above outlined duty on
tory care procedures generate about 12% of             doctor's prior conduct is ad-                   hospitals is to allow hospitals
negligence claims. Given the substantial               missible ifthe hospital, through                the ability to bury their heads in
number of claims generated by the ambula-              its personnel, knows or should                  the sand in the face of known
tory care process, and the continuing                  know with the exercise of                       incompetents and to put in the
growth of the ambulatory care industry,                ordinary care of the prior                      hands of incompetent physi-
questions about ambulatory care centers'               conduct, and the prior conduct                   cians the tools by which severe
duties arise.                                          of the doctor is such that a                    injury may be caused.
       Hospitals and clinics play a central            hospital exercising ordinary care          Strubhart. 903 P.2d at 278.
role in patient safety through their physi-            would take some steps to either

20       Third Quarter
        Provision of services in an ambula-           TX. 1 The patient care provided        but also to take steps to insure the
 tory care setting adds another dimension of          is appropriate to the patients'        provision of an acceptable level of medical
 liability in a medical negligence case               needs and severity of disease,         care to the patient.
beyond that for negligent credentialing.              condition, impairment, or dis-                Ambulatory care centers may be
 Ambulatory care centers are accredited by            ability.                               tempted to deny that JCAHO standards
 the Joint Commission on Accreditation of             TX.2 Each patient's anesthesia         apply to them, but it would be difficult to
 Healthcare Organizations pursuant to the             care is planned.                       argue against such basic standards as
 standards articulated in the Comprehensive           TX.2.2 Patients who have               those listed above. Further, the CAMAC
 Accreditation Manual for Ambulatory Care             received anesthesia are dis-           standards are scored on a five level scoring
 (CAMAC). In Oklahoma, a national                     charged in the company of a            system. Systematic failure to follow a
 standard of care state, the standards of the         responsible, designated adult.         standard would be classified at the lowest
preeminent national organization on the               TX.3.4 Preparing and dispens-          level of scoring. By arguing that the
 accreditation of healthcare organizations            ing medication(s) adhere to law,       CAMAC standards do not apply, the
 carry particular relevance.                          regulation, licensure, and pro-        ambulatory care center would be admitting
        CAMAC provides standards for                  fessional standards of practice.       that it would score in the lowest 20% of all
 management of human resources, which                 TX.5.2 Before obtaining in-            ambulatory care centers if evaluated by
 identifies and provides that an adequate             formed consent, the risks, ben-        JCAHO, the premier accreditation organiza-
 number of qualified, competent staff should          efits, and potential complica-         tion in the nation.
 be available to meet the needs of patients.          tions associated with the                     In conclusion, ambulatory care proce-
 CAMAC, however, goes beyond                          procedure(s) are discussed with        dures are likely to continue to increase in
 credentialing requirements to specify stan-          the patient and family.                number. The number of negligence claims
,dards for the assessment of patients, care of                                               will increase commensurately. Accord-
patients, and continuum of patient care,               Thus, the CAMAC standards place       ingly, ambulatory care centers should be
 among other things.          The following      significant obligations on the ambulatory   scrutinized to determine if they have
 standards are typical of the CAMAC              care center not only to make a reasonable   violated their standard of care as the case is
 standards:                                      inquiry before credentialing a physician,   investigated.