Beyond the Signature – Strategies to Improve Informed Consent
This resource was made available to MIEC through our partnership with Candello. It was written by Hannah Tremont, MPH Following an unsatisfactory outcome from finger surgery, a 38-year-old patient filed a malpractice claim alleging the wrong procedure was performed. However, thorough documentation of informed consent discussions supported the surgeon’s care, leading to a defense verdict at trial. A 25-year-old patient underwent Gamma Knife radiosurgery and suffered post-operative hearing loss in the left ear. Initially planned for the right ear, the procedure was intentionally changed to the left, but no documentation of informed consent or discussions about this change was recorded....
Inconsistent Performance and Documentation of MD Orders
This case study was made available to MIEC through our partnership with CRICO. It was written by Kathy Dwyer, MSN, RN, CRICO Description A 56-year-old male admitted for repair of facial fractures suffered a fatal post-operative cardiac event. Key Lessons Failure to follow either orders or policy is indefensible without documentation of sound reasoning for a different course of action. An unchecked assumption for leeway in adherence to policy or protocol is an unnecessary risk. Clinical Sequence A 56-year-old male was admitted for surgical repair of multiple facial fractures suffered when a basketball backboard fell on his head. Following surgery,...
DEA Extends Covid-19 Telehealth Prescribing Flexibilities for Another Year.
The Drug Enforcement Administration (DEA) in concert with the Department of Health and Human Services (HHS) is issuing a third extension of telemedicine flexibilities for the prescribing of controlled medications, through December 31, 2025. A DEA-registered practitioner can prescribe a schedule II-V controlled substance to a patient using telemedicine without the need for an in-person medical evaluation, as long as the prescription(s) are for a legitimate medical need, and within the course and scope of the prescriber’s medical practice. As you may recall, the DEA extended the COVID flexibilities through 2024 while it worked on a revised set of rules, which were to...
Incomplete Patient Understanding of Risks Complicates Surgery
This case study was made available to MIEC through our partnership with CRICO. It was written by Kathy Dwyer, MSN, RN, CRICO Description A patient undergoing elective surgery suffered severe anoxic brain injury due to complications from a pre-existing condition. Key Lessons Elective surgery should not proceed when the team does not have a thorough understanding of the patient’s medical history. A patient's memory and understanding of complex clinical facts is not a substitute for reviewing the medical record or consulting with clinical colleagues. Clinical Sequence A 56-year-old female met with the anesthesia resident 10 days before she was scheduled...
Gaps in Clinical Workup Lead to Young Patient’s Missed Colorectal Cancer
This case study was made available to MIEC through our partnership with CRICO. It was written by Melissa DeMayo, CRICO Description A 33-year-old woman was diagnosed with colon cancer more than two years after her initial complaint of rectal bleeding. Key Lessons Gaps in clinical workup can lead to flaws in medical decision-making. Sub-optimal surgical/invasive procedures can lead to missed diagnoses. Clinical Sequence A 31 -year-old woman with no significant medical history complained of rectal bleeding to her primary care physician, a cardiologist. At this visit, she also described hard stools with hematochezia and possibly hemorrhoids. The cardiologist performed a...
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