Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff...
Transcript of Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff...
![Page 1: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/1.jpg)
Legal Perils In Sleep Medicine
”Protect Thy Patient To Protect Thyself”
© Copyright 2017. George F. Indest III. All rights reserved.
Presented by:
www.TheHealthLawFirm.com
![Page 2: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/2.jpg)
George F. Indest III, J.D., M.P.A., LL.M.Board Certified by the Florida Bar in the Legal
Specialty of Health Law
Website: www.TheHealthLawFirm.com
![Page 3: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/3.jpg)
Main Office:1101 Douglas Avenue
Altamonte Springs, Florida 32714
Phone: (407) 331-6620Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
![Page 4: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/4.jpg)
Objective• Practice effective safety monitoring in
sleep labs for proper monitoring of patients to avoid risk of injury or death.
4
![Page 5: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/5.jpg)
Objective• Know the elements of a negligence claim• Know the applicable standard of care for sleep centers• Understand application of res ipsa loquitur in
healthcare settings• Identify methods to reduce exposure to negligence
claims• Identify methods to mitigate damages
5
![Page 6: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/6.jpg)
Negligence• Elements of a negligence claim: duty,
breach, causation, and damages.
6
![Page 7: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/7.jpg)
Duty• How does the duty arise? (statutes,
regulations, common law)• Who owes the duty?• When can your duty be delegated to
another?
7
![Page 8: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/8.jpg)
Breach• Failure to meet the applicable standard of
care• What is the applicable standard of care?
– Industry Standard• Special circumstances related to the standard
of care( superior knowledge or expertise)
8
![Page 9: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/9.jpg)
Causation• Proximate cause - the tortfeasor's breach
must be the proximate cause of the injury/damage
• Doctrine of res ipsa loquitur - it speaks for itself
9
![Page 10: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/10.jpg)
Damages• Must have bodily injury or property
damage to maintain negligence claim• Economic damages, noneconomic
damages, punitive damages
10
![Page 11: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/11.jpg)
Defenses to Negligence Claims
• Must consider defenses to each element of the claim
11
![Page 12: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/12.jpg)
Duty• No duty• Delegation of duty
– Agents and employees - vicarious liability– Independent contractors
• Non delegable duty arises where a contract or statute imposes a duty - usually on a hospital (anesthesia)
• Assumption of risk
12
![Page 13: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/13.jpg)
Breach – No Breach in the Standard of Care
• Proving the standard of care - expert witness• Rebutting the standard of care - expert
witness• Applicable standard of care• Contributory Negligence - absolute bar to
recovery (abandoned 1973)
13
![Page 14: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/14.jpg)
Causation• The action of the provider was not the
proximate cause of the injury/damage• Intervening cause
– Must be completely independent and not set in motion by tortfeasor
– Intervening cause cannot be foreseeable
14
![Page 15: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/15.jpg)
Damages• Speculative damages not recoverable• Limits on noneconomic damages
15
![Page 16: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/16.jpg)
Case Studies
16
![Page 17: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/17.jpg)
Case 1• 25 year old mentally challenged male (mental
capacity of 10-year old) with history of congestive heart failure, cardiomyopathy, diabetes, hypertension, and obesity. Patient lives with his parent. Physician orders a sleep study due to symptoms of sleep apnea.
17
![Page 18: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/18.jpg)
Case 1• Q: Is a free standing sleep center
appropriate for this patient?• Q: Should a parent of family member
accompany patient?• Q: Did patient's insurance carrier dictate
the facility to perform study?
18
![Page 19: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/19.jpg)
Case 1• Patient scheduled for freestanding center and
arrives for study at 11:00 p.m. At approximately 4:15 a.m. the patient waived at camera to get the attention of the staff. Patient waived at the camera several times over the course of 3 minutes to get the staff’s attention. At approximately 4:18 a.m. the patient began coughing heavily and waived to the camera to get the staff’s attention.
19
![Page 20: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/20.jpg)
Case 1• At approximately 4:23 a.m. a staff member asked
over the intercom if patient needed assistance. A minute later a staff member entered the room and disconnected the monitor leads. The patient left the room presumably to go to the restroom.
• At around 4:29 a.m. the patient re-entered the room; a staff member reconnected the monitors. At 4:30 a.m. the patient stated he felt really sick; the staff member left the room.
20
![Page 21: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/21.jpg)
Case 1• At around 4:31 a.m. a staff member entered the room
again and the patient stated he could not breathe while lying down. At approximately 4:32 a.m. the staff member left the room, the patient sat up and was told not to get up. The patient again said he could not breathe.
• At approximately 4:34 a.m. the patient sat on the side of the bed gasping and coughing.
• At approximately 4:34 a.m. three staff members entered the room and administered oxygen.
21
![Page 22: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/22.jpg)
Case 1• Q: Was the patient Oxygen Saturation
low?
• Q: What did the other monitors show?
22
![Page 23: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/23.jpg)
Case 1• At approximately 4:36 a.m. a staff member said
you are doing better; the patient continued to complain of severe pain.
• At approximately 4:37 a.m. a staff member administered an inhaler.
• At approximately 4:38 a.m. the patient asked the staff to call his parent.
23
![Page 24: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/24.jpg)
Case 1• At approximately 4:40 a.m. the patient
complained he was coughing up blood. • At approximately 4:46 a.m. a staff member
entered the room, turned on the lights and began gathering the patient's belongings.
24
![Page 25: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/25.jpg)
Case 1• Q: Was the test complete?• Q: Were the staff members getting the patient
ready for discharge?• Q: Were the staff members getting the patient
ready for transport to another facility or for discharge?
• Q: Did the staff remove the monitors?
25
![Page 26: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/26.jpg)
Case 1• At approximately 4:48 a.m. a staff member offered to let
the patient call his parent himself. The patient collapsed on the bed; a staff member assisted him to sit up; the patient collapsed again. At this point there were three staff members in the room.
• At around 4:50 a.m. a staff member asked the patient if he was awake, could he talk and could he open his eyes.
• The staff member asked what to do and another staff member said to put the patient on the floor.
26
![Page 27: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/27.jpg)
Case 1• EMS arrived shortly thereafter and began CPR
at 4:54 a.m.• Q: When was EMS initiated?• Q: Did facility have resuscitation equipment and
training?
27
![Page 28: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/28.jpg)
Case 1• The patient was transported to the hospital at
approximately 5:20 a.m.• The patient was pronounced dead at
approximately 5:55 a.m.• Cause of death listed as respiratory arrest, with
underlying causes of obstructive sleep apnea and congestive heart failure
28
![Page 29: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/29.jpg)
Case 2• 9-month-old infant with Prader-Wili Syndrome
was scheduled for sleep study. During the study, the mother complained the infant was having trouble breathing. The staff member advised the mother the infant was fine.
• Q: Appropriate facility?
29
![Page 30: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/30.jpg)
Case 2• Later (unspecified time) the mother
noticed the infant was turning white and was cold to the touch.
• Q: What did the monitors record?• Q: Did the staff check on the patient
periodically?
30
![Page 31: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/31.jpg)
Case 2• The infant was rushed to the PICU where
resuscitation began. • Q: Did the sleep center have the proper
resuscitation equipment?• Q: Was the staff trained to resuscitate an
infant?
31
![Page 32: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/32.jpg)
Case 2• Infant was removed from life support two
days later on April 12, 2014. • April 14, 2014, petition filed to preserve
video from sleep study. May 5, 2015, case voluntarily dismissed (settlement).
32
![Page 33: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/33.jpg)
Case 3• Adult female patient scheduled for sleep study.
Staff initiated study. At one point during the study a lead became dislodged and a staff member reattached the lead. Later, at the patient's request, the monitors were removed so the patient could use the restroom. The staff member reattached the monitors when the patient returned from the restroom.
33
![Page 34: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/34.jpg)
Case 3• Approximately 6:00 a.m. the staff member removed
the monitors because the sleep study was complete. The patient complained about the loud noises she heard throughout the night.
• On the drive home from the sleep study the patient began to experience vaginal discomfort. Shortly thereafter, the patient claimed she was sexually assaulted during the sleep study.
34
![Page 35: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/35.jpg)
Case 3• Three years after the patient filed suit, the court
dismissed the case because there was no evidence to substantiate the patients allegations.
• The six hour sleep study video simultaneously recorded the patients vital signs and the sleep study. The video did not show any sexual assault.
35
![Page 36: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/36.jpg)
Case 3• Q: Did the record exonerate the sleep
center staff?
• Q: What would have been the outcome if the record and video was incomplete?
36
![Page 37: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/37.jpg)
Main Office:1101 Douglas Avenue
Altamonte Springs, FL 32714
Phone: (407) 331-6620Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
![Page 38: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/38.jpg)
Orlando Office (By Appointment):
37 North Orange Avenue, Suite 500Orlando, Florida 32801
Phone: (407) 331-6620Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
![Page 39: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/39.jpg)
Pensacola Office (By Appointment):
201 East Government StreetPensacola, Florida 32502
Phone: (850) 439-1001Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
![Page 40: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/40.jpg)
Denver, Colorado Office (By Appointment):
155 East Boardwalk Drive, Suite 424Fort Collins, Colorado 80525
Phone: (970) 416-7454Fax: (866) 203-1464
Website: www.TheHealthLawFirm.com
![Page 41: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/41.jpg)
SM The Health Law Firm is a registered service mark
of The Health Law Firm, P.A., Altamonte Springs, Fla.
![Page 42: Legal Perils In Sleep Medicine Perils in Sleep... · Case 3 • Approximately 6:00 a.m. the staff member removed the monitors because the sleep study was complete. The patient complained](https://reader036.fdocuments.net/reader036/viewer/2022071015/5fcddf3c5ddb6d25e2168033/html5/thumbnails/42.jpg)
© Copyright 2017. George F. Indest III. All rights reserved.(No rights claimed for any property or images of others.)