This post is a follow-up to the subject of written discovery I talked about in the post JCI Standard MCI.20.1, ME 1 (Part 1) – risk management, in “The organization has a process to aggregate data in response to identified user needs.” (this link will open in a new tab of your current browser window).
I am writing from common knowledge and experiences and I must confess I am no legal authority but I have used facts in this post based on matters relating to public domain circulars and proceedings I had been part of.
In Malaysia and even in your country it is increasing common when individual healthcare providers and hospitals face a real threat of becoming defendants in malpractice lawsuits.
Some common potential-litigation warning signs of an impending malpractice lawsuit may include instances when (i) the hospital administration receives an executed patient authorisation for release of medical records produced by a lawyer and usually accompanied (if not at a later date) request for copies of medical records/medical report(s), ,films and billing records, (ii) when patient and/or family that is very upset about an unexpected or dramatic outcome sends in a written compliant or even heated verbal exchanges occur in the care area(s) or when the patient and/or family present themselves at the hospital administration, and (iii) when a letter is sent to the press and is published in the newspapers or a press conference is called by the aggrieved parties. Whatever the circumstances maybe, the requests for the production of documents and tangible items already signals that there is reasonable belief that a lawsuit may be filed.
I shall not cover a spoliation action, a type of action not yet a phenomenen in Malaysia when a patient can seek damages not for negligent medical care, but for a breach of the duty to preserve medical evidence from the loss of medical information like key medical records or films, medical devices or instruments used during the care and treatment, and even the loss of non-medical information such as phone records.
In preventing a spoliation action and in general, I think Health Information Management (HIM) / Medical Records (MR) practitioners should always maintain health information, and communication protocols for preserving health information with effective medical information maintenance policies and procedures through consistent and established policies. Your actions and practices will help control unnecessary hospital litigation losses and increase efficiency when answering inquires from legal, regulatory, or accreditation agencies.
Before I write more on my next post on written discovery, I think some knowledge on some law terms is necessary.
In a civil action like for a medical-malpractice lawsuit, a claimant (“plaintiff”) will state the defendant’s actions, or omissions, which caused the claimant’s loss and files a civil claim (“lawsuit”) against the defendant(s) who usually are individual(s) doctors, hospital(s), and doctor or medical practice group(s).
The claim is to seek recovery for injuries that the plaintiff believes were caused by the defendant’s failure to meet an established professional duty of care.
