After several hospitalizations for multiple medical conditions, Mr. Phillip Caruso was admitted to Pine Manor Nursing Center.
Question:
After several hospitalizations for multiple medical conditions, Mr. Phillip Caruso was admitted to Pine Manor Nursing Center. During his initial examination, the doctors found Phillip to be in stable condition; one notation indicated that he had good skin turgor (an indication of adequate hydration.) Mr. Caruso was provided with three meals a day plus three snacks a day, and he received medication four times a day. For each, he was provided some type of liquid, usually juice or water.
Seven days after he was admitted, he developed tremors, weakness, and confusion and was taken to the Emergency Room. The ER doctors noted that Mr. Caruso was severely dehydrated which partially contributed to his renal insufficiency. The family filed a medical malpractice lawsuit against Pine Manor. As part of that lawsuit, Pine Manor admitted that they did not document when and how much Mr. Caruso drank liquids.
ISSUE:The question before the court was whether the lack of documentation demonstrated that liquids were not provided.Documentation was provided that he was offered liquids, but not whether he drank them or how much.
RULE:"[T]he evidence presented showed a proximate cause of Phillip's dehydration as a result of his stay at Pine Manor; it was not unreasonable for the jury to conclude that Phillip did suffer dehydration and that Pine Manor's treatment of him caused his dehydration."
EMPHASIS:This case is provided to demonstrate the importance of documentation and the legal maxim that if it wasn't written down it wasn't done. While Mr. Caruso likely drank fluids, without the documentation indicating how much and when, Pine Manor was unable to testify to their claims.
- Even without documentation, couldn't the staff testify as to how much he drank and when? Explain your answer.
- Some long-term care facilities and nursing homes aren't required to document how much a patient eats and drinks; but should they be? Explain your answer.
Court Case TWO
FACTS:Dylan Keene was born on May 15, 1986 at 1:07 AM. A few hours after his birth, he developed respiratory problems and was transferred to the Neonatal ICU. At 6:25 AM, medical records indicated that blood tests were performed, including a blood culture to determine if he had an infection. He was then transferred back to the regular neonatal floor. The notes from the Neonatal ICU indicated that the nurses were to watch for signs of infection and to withhold antibiotics pending the blood culture results.On May 16, 1986 at 2:30 AM, Dylan started having seizures. Test results indicated that he had sepsis (a blood infection) and meningitis. Whether from the infection or the seizure, Dylan suffered severe brain damage.
ISSUE:At issue in this case was the care that was provided between 6:25 AM (May 15) and 2:30 AM (May 16). What actually occurred is unknown, because the medical records for that time-period were lost.
RULE:The court determined that "... any party who has negligently or intentionally lost or destroyed evidence known to be relevant for an upcoming legal preceding should be held accountable for any unfair prejudice that results."
EMPHASIS:The court in this case looked at the medical records as evidence. They ruled that because medical records are often used as evidence, healthcare institutions have the responsibility to maintain records whether or not an actual lawsuit has been filed.
- Do you think the medical records were actually lost, or were they intentionally lost?Explain your answer.
- Would it make a difference if they were or were not? Explain your answer.
Court Case THREE
FACTS:Dr. Stokes, a dermatologist practicing in Grand Rapids, Michigan was convicted of insurance fraud by submitting upcoded medical bills sent to Blue Cross and Blue Shield, Aetna, and Medicare.It was alleged that to save money, Dr. Stokes was reusing medical equipment that was supposed to be used on only one patient and performing medically unnecessary procedures in order to obtain more insurance payments. Some 13,000 patients had to be notified about Dr. Stokes' practices, with at least 12 diagnosed with Hepatitis C.
ISSUE:The question that the court was asked to address was, did the upcoding and unnecessary procedures constitute a crime or should it remain a civil action?
RULE:Dr. Stokes was convicted on 31 counts of insurance fraud and sentenced to 10 years in prison. He was also ordered to pay a $1.3M fine. Also, Michigan revoked his license to practice medicine.
EMPHASIS:This court case emphasizes how serious the issue is and how serious the courts are about the illegal practice of upcoding. Even though doctors' offices and hospitals might not be happy with the amount they are being reimbursed, upcoding isn't the way to address their concerns. [In addition to the criminal case, Dr. Stokes faced multiple civil lawsuits.]
- Dr. Stokes was sentenced to 10 years in prison. Sometimes, people who have been convicted of manslaughter receive only a 2-year prison sentence. Is that fair?Explain your answer.
- Dr. Stokes was ordered to pay a $1.3M fine to the State of Michigan.He likely lost the patient's malpractice lawsuits as well. Let's suppose that he was ordered to pay $1M to the patients. While he probably didn't have $2.3M, the courts would seize what he did have. Who should get paid first; the State of Michigan or the patients? Explain your answer.
Court Case FOUR
FACTS:Mrs. Hoffman had a renal angioplasty performed at Moore Regional Hospital. While Dr. Lina was performing the procedure, the patient suffered complications.Her condition deteriorated rapidly and resuscitative measures were unsuccessful.
Mrs. Hoffman's family filed a malpractice lawsuit against Moore Regional Hospital claiming that under respondeat superior, Moore Regional Hospital was vicariously liable for Dr. Lina's actions. Dr. Lina was not an employee of Moore Regional Hospital, but worked for Pinehurst Radiology Group. This group was an independent contractor which was hired by Moore Regional Hospital to perform most of their radiology procedures. The hospital argued that since Dr. Lina was not an employee of the hospital, they were not responsible for Dr. Lina's action. Instead, it would be Pinehurst Radiology Group who was Dr. Lina's employer.
ISSUE:The question before the court was whether the alleged employer has the right to supervise and control the details of the work performed by the alleged employee.
RULE:"We conclude that no genuine issue of material fact exists as to whether Dr. Lina was an employee of the Hospital.As a matter of law, he was not."
EMPHASIS:In deciding the case, the court looked at the law of respondeat superior and the ability to control Dr. Lina's actions. They decided that because Dr. Lina was not an employee of the hospital, they had little control over his actions. Instead, Dr. Lina was an employee of Pinehurst Radiology Group, who would be vicariously liable instead.
- Why do you think that the hospital was trying to get out of the lawsuit? Explain your answer.
- Why do you think that the patient's family sued the hospital instead of the radiology group? Explain your answer.