Chapter 13: Medicolegal Issues in Pediatric Hospital Medicine

INTRODUCTION

Legal risks are common in the care of hospitalized children. Pediatric hospitalists care for complex patients of all ages with a variety of medical conditions.¹ Many are acutely ill with rapidly changing medical conditions. Hospitalists often find themselves juggling several ill patients simultaneously, and they must make critical decisions rapidly. The risk for error is high, and there is the possibility of a subsequent malpractice suit. In addition, certain hospital processes and situations pose a particular risk for lawsuits, including communication, informed consent, refusal of care, documentation, altering the medical record, use of consultants, treatment of incidental findings, patient confidentiality, and legal responsibility during discharge. The legal obligations surrounding each of these situations are described in this chapter.

The hospitalist movement is relatively new, and little information has been generated regarding claims against these specialists. In general, pediatricians are less likely to be sued than other specialists, but they have the highest average indemnity payments ($521,000/claim) of all specialties.² Evidence suggests that hospitalists reduce malpractice claims in the inpatient setting by improving quality of care and patient and parent satisfaction.^3,4 In addition to improved quality of care, hospitalists have demonstrated enhanced efficiency.⁵ They often become team leaders in their hospitals, attempting to optimize quality and continuity while delivering evidence-based care for acutely ill patients.^6,7

Hospitalists’ presence in the hospital enables the discovery and demonstration of best practices in detecting errors.⁵ Tenner’s retrospective study found that the quality of care of critically ill patients improved after hours, when more experienced physicians provided care at the bedside; more specifically, patients cared for by pediatric hospitalists (general pediatricians who had completed training) had improved survival rates compared with patients cared for by pediatric residents who were supervised from a distance by intensivists.⁸ Thus, the use of hospitalists may lead to safe care, fewer adverse outcomes, and fewer malpractice suits.

Like all physicians, hospitalists may face legal action when pediatric patients in their care have bad outcomes. When a lawsuit is instituted, the plaintiff must show that the physician had a duty to the patient, breached that duty, and did not meet the standard of care. The plaintiff must then show that this breach caused damage or injury to the patient.⁹

COMMUNICATION

Good communication between the hospitalist and the patient and family is essential to prevent lawsuits. Poor communication can lead to angry feelings, omission or distortion of important information, and subsequent injury to the patient. Effective communication between the primary care physician (PCP) and the hospitalist is also crucial.¹⁰

One study showed a direct relationship between physicians’ enhanced communication skills and fewer malpractice suits.¹¹ Another study of families that sued physicians (after infants suffered permanent injury or death) found that most were dissatisfied with physician-patient communication. They believed that the ...