The term „standard of care” is often discussed among physicians, yet the legal definition of the term is often not understood. Emergency physicians are at the forefront of medicine and are often involved in cases of medical malpractice. It is estimated that between 7 and 17 malpractice claims per 100 physicians are filed each year.1,2 The number of these claims that result in payment varies from state to state (Table 1).3 Therefore, it is important to know how the legal system sets the standard of care and what standards we are held to as physicians. A chronological approach to the evolving definition of the standard of care according to legal history will help to understand the current concept and nuances of the term. A final case that helped define the modern definition of the standard of care is Johnston v. St. Francis Medical Center from 2001.13 In this case, a 79-year-old man who suffered from abdominal discomfort was examined with X-rays and laboratories, but his investigation was inconclusive. Two doctors examined him during the day and found that he was in mild distress. Additional studies, including computed tomography and ultrasound, were ordered, but the patient became hypotensive and was referred to the intensive care unit (ICU). The ICU doctor thought he might have an aortic aneurysm, which was confirmed during the laparotomy. The patient died in the operating room. The plaintiffs argued that doctors should have diagnosed the aneurysm earlier.
All but one of the experts said it was a difficult diagnosis. The court ruled in favour of the doctors. More importantly, though; The court clarified that even if the aneurysm was evident on X-rays and labs once diagnosed, it cannot be used retrospectively to assess the physician`s behavior and judgment. In this case, the diagnosis of aneurysm was „possible” but difficult enough that the absence of the diagnosis did not mean that the standard of care should not be ensured. This is in stark contrast to the previous case of Helling v. Carey. Armed Forces Legal Assistance – Find nearby military facilities with legal aid offices. If you are a not-for-profit organization, pro bono referral service, or lawyer in private practice and would like to be on the list of pro bono legal service providers, please refer to the admission requirements and application procedures under 8 C.F.R. § 1003.61 et seq. (80 Fed. Reg.
59503). Please read the instructions carefully and follow them when filling out the form. Paper applications must be submitted to: Negligence is generally defined by law as „the standard of conduct to which one must comply. [and] is that of a reasonable person in similar circumstances. 4 In law, medical malpractice is regarded as a specific area in the general field of negligence. It presupposes that four conditions (elements) are met for the claimant to be able to claim damages. These conditions are: mandatory; Gap; damage; and causality. The second element, breach of duty, is synonymous with a „standard of care.” Prior to several important cases in the 1900s, the standard of care was defined by the legal concept of „custom.” Cited in Garthe v. 1934.
Ruppert, if „certain dangers have been eliminated by a habitual way of doing things safely, this custom may be proved that [the one accused of negligence] has fallen below the required standard.” 5 In other words, if other members of the company often practice a certain way of eliminating hazards, that practice can be used to define the standard of care. However, a jury has not yet decided whether this „custom” was appropriate and whether the deviation from this „custom” was so inappropriate as to cause harm. Again, the judge reiterated that the care provided by a physician is minimally competent, may differ from the care provided by other physicians, and that a poor outcome does not mean that the standard of care has not been met. The good news for medical practitioners is that in recent cases, there seems to be a desire to ensure that jurors understand that the standard of care is not synonymous with perfection. While older legal cases tend to be more powerful because they have stood the test of time, these new cases show a tendency to keep jury expectations realistic. Seniors Care Locator – Enter your postal code to find local offices for legal and senior care organizations. Emergency physicians should be aware of these landmark cases that set the standard of care. In addition, physicians should be aware of the content of the various clinical practice guidelines so that they can practice within them or document the reasons for deviations from them.
Each state will also have statues that define wrongdoing in very specific terms. Physicians should review relevant laws based on the state in which they practice. By practicing with these concepts in mind, an emergency physician can feel more confident in daily practice and in cases of malpractice. With this basic knowledge, the doctor facing a trial can help his legal team optimize his defense. The Executive Office for Immigration Review (EOIR), Policy Office, Office of Legal Access Programs (OLAP) maintains the list of pro bono legal service providers or the „List”. The list is published quarterly (January, April, July and October). The list is at the heart of EOIR`s efforts to improve the scope and quality of representation before its arbitrators and is an essential tool for informing individuals in EOIR proceedings of the pro bono legal services available. The rules for qualified organizations, pro bono referral services, and attorneys to be included in the list are found in the Code of Federal Regulations, 8 C.F.R. § 1003.61 et seq. (80 Fed.
Reg. 59503). A second case with a similar result occurred in 1995. In McCourt v. Abernathy, doctors lost again due to their substandard care. Wife. McCourt presented for several ailments over the three days, but was found to have a finger infection from a needle rod while working in manure. During those three days, she was seen by Dr. Abernathy and her partner, Dr. Clyde, who simply cleaned the wound. As she became increasingly ill, they gave her oral antibiotics, but she later became septic. An internist consulted diagnosed sepsis and the patient died despite aggressive care.
Again, the doctors acted below the standard of care, but the trial judge gave important instructions to the jurors. He explained that pro bono legal services are „unremunerated legal services provided to impoverished strangers or to the public good without expectation of direct or indirect compensation, including referral fees (excluding filing fees or photocopying and shipping costs).” 8 C.F.R. § 1003.61(a)(2). The list may not be used by organizations or lawyers to solicit paid legal services. Helling v. Carey set a disturbing precedent for medical malpractice. The court essentially held that, although standard practice at the time was followed, the physician was still liable.