If the court finds that the physician`s choice of medication was below the expected standard of treatment, the plaintiff would still have to prove the third “D” that taking the drug “directly” caused the car accident. For example, if the facts clearly demonstrate that Mr. A was alert before starting treatment and was able to operate a motor vehicle safely, but had deficiencies in attention, concentration and alertness immediately after starting the drug, a court could find that the drug was the cause of a change in mental status. which led to the accident. However, if a second non-prescription intermediate event changes his or her mental state, the prescribing physician would not be held liable. This intermediate event may be, for example, sedation caused by taking an over-the-counter medication that was not disclosed to the physician, concomitant use of substances by the patient, or even weather conditions so severe that they were considered the “near” or definitive cause of the accident. The Philadelphia Medical and Surgical Reporter, citing the American Journal of Pharmacy, embodies a legal opinion whose heart seems to be the argument that the pharmacist needs the completed prescription as proof of his own protection or that of others, and therefore retains the document for convenience “to justify himself when a question arises as to the accuracy of the conduct.” “Obviously, the only dispute may be in a case where the doctor and the patient have disposed of possession of the paper and it has legally fallen into the hands of the pharmacist at the patient`s instigation.” Delivery to the pharmacy is practically not a bank transfer, and a new prescription is not required for every order. According to Mr McMurtrie, rapporteur of the opinion, “there should be no doubt that the pharmacist can do so when supervisory responsibility generally takes 2 forms: one most often claimed when senior clinicians supervise trainees (negligent supervision) and the other when supervisors are held accountable for the actions of other clinicians in a medical hierarchy (vicarious liability). In the case of managed care or other corporate practices, acting as a medical substitute or medical director can result in both forms of liability.18 For example, in our vignette, if Mr. A`s prescribing physician was supervised by a chief or associate physician or by a person in a position of contractual responsibility, Like the medical director, the supervisor can also be held legally liable for damages, caused by a negligent prescription. While a treatment relationship is a prerequisite to a professional liability claim, the term is interpreted broadly because a physician may have direct responsibility for a patient under treatment or indirect liability through joint practice or a supervisory relationship with another physician. A physician who supervises other providers is often held legally liable for the substandard practices of those under his or her supervision.3 There are 2 legal bases for this liability; One is based on tort law with the claim of negligent professional supervision, and the other is based on agency law, which claims it is superior or “asks the master to answer on behalf of the servant.” Regulatory responsibility may be proportional to the degree of oversight and control that the supervisory authority exercises over the clinician to be supervised;4 This is especially important for physicians who supervise multiple prescribers in managed care organizations. The responsibility of the agency, or the responsibility of those who are considered representatives of a physician, is generally determined hierarchically, regardless of the professional competence of the supervisor.
The next step in the investigation is to determine whether the decision to prescribe an atypical antipsychotic was consistent with good medical practice. If the physician can demonstrate that the choice of this drug was consistent with the standard of care, including the standard of care for informed consent for drugs, there is no breach of duty; Therefore, there would be no negligence. The physician could use authoritative texts, treatment guidelines from professional associations, scientific articles, and statements from experts in the field to determine that the prescription was appropriate for that patient with their underlying medical conditions. Keep in mind that an appropriate prescription in this case would have included a conclusion that the antipsychotic was appropriate and could not be combined unfavorably with medications already prescribed for coronary artery disease, high blood pressure, and chronic obstructive pulmonary disease. The legal adage “If you don`t write it down, it didn`t happen” prevails in the courtroom.1 Proper documentation of clinical interactions is essential to defending medical malpractice. Physicians must document the service provided, document when and by whom, and must document the medications prescribed, including the dose, instructions, and number of refills provided. In our vignette, for example, malpractice may have affected the appropriateness of the dose of antipsychotics prescribed and the patient`s instructions regarding their use. If the patient has been prescribed a very low dose of medication and instructed to take the drug just before bedtime, behavior that contradicts these instructions may relieve the physician of responsibility.
Similarly, instructions to abstain from alcohol simultaneously or to abstain from driving would make the patient`s failure to comply with treatment recommendations the direct cause of the accident. Some physicians give written instructions regarding the appropriate use of each prescribed medication and receive the patient`s signed confirmation of receipt of these written instructions. While this level of risk management is not necessary to document appropriate prescribing practices, the minimum level of documentation is a file note that reflects instructions to the patient. The schedules are described below. Note that all Schedule I drugs (except marijuana under a valid prescription and for a limited purpose) and many Schedule II drugs are illegal to possess. Your doctor may recommend an unapproved medication if they think it effectively treats your condition and the benefits outweigh all the risks. In our vignette, the use of an atypical antipsychotic was “off-label use” because atypical antipsychotics are currently approved by the FDA for the treatment of schizophrenia and bipolar disorder, but not for insomnia.10 In addition, in 2005, the FDA required manufacturers of atypical antipsychotics to issue a “black box warning” in package inserts about the increased risk of death in elderly patients with dementia. who have been treated with antipsychotic drugs.11 While this “off-label use” for an elderly patient with insomnia is an eligible course of action, this choice is under scrutiny in the courtroom due to caution regarding the use of this class of drugs in elderly patients, many of whom are taking other medications that may also impair attention and alertness. This is not to say that atypical antipsychotics should be avoided in this clinical setting, but rather that the choice should be made taking into account the risks, benefits and alternatives. Most physicians have been careful to weigh the reasons for choosing one drug over another; Unfortunately, they often fail to record these reasons in the patient`s medical record.
A well-reasoned decision by the physician goes to the heart of the evidence that he or she met the standard of care and is invaluable as evidence against professional negligence. In the vignette presented here, the final question would be whether the plaintiffs suffered compensable damage. In this case, if the patient has suffered a significant bodily or psychological injury, the responsibility may lie with the prescribing physician. In many States, the responsibility of the prescribing physician does not stop at the harm caused to the patient and may extend to all undesirable consequences of the accident, whether for the patient or for third parties. These damages may include compensation for physical and emotional harm, medical bills, statutory bills, and lost wages. Unless intervening factors are responsible for the consequences for third parties, the chain of liability may well extend to others affected by the accident.2 For example, in Coombes v. Florio2, a general practitioner was held liable if he did not warn a patient of the dangers of the side effects of the drugs and did not warn him not to drive. Liability extends to people who have likely been endangered by the physician`s failure to issue a warning.2 Most physicians know that they must obtain their patients` consent before starting any treatment or medication.
However, many are unaware that failure to obtain and document high-quality, informed informed consent or informed refusal of treatment can result in a professional negligence claim. Each state has its own requirements as to what constitutes reasonable informed consent, and it`s wise to review the standard in the state where you practice. Generally, however, a patient must make an informed, voluntary, and competent decision regarding their medical care, which includes the decision to accept or reject a medication.12 In terms of knowledge, a prescribing physician is typically tasked with telling their patient what a reasonable person would need to know to make the decision. or what a reasonable physician would say to a patient in similar circumstances.