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Bonus Short - Pandemic Malpractice Issues

Matthew DeLaney, MD and Mike Weinstock, MD
00:00
22:44

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Dr. Matthew DeLaney and Dr. Michael Weinstock sit down to discuss the threat of lawsuits in the midst of the COVID pandemic. The last thing anyone wants to think about is the risk of a lawsuit. Unfortunately, despite the extra challenges posed by our current pandemic, the threat of medicolegal consequences remains. In this segment, we evaluate the unique medicolegal risks that can occur during disaster situations and look at potential sources of medicolegal protection.

Released 4/24/20

References:

Cushman Esq D. When disaster hits, where does the standard of care go?. J Healthc Risk Manag. 2011;31(2):6–13. doi:10.1002/jhrm.20082

 

Altman RL, Santucci KA, Anderson MR, McDonnell WM; COMMITTEE ON MEDICAL LIABILITY AND RISK MANAGEMENT. Understanding Liability Risks and Protections for Pediatric Providers During Disasters. Pediatrics. 2019;143(3):e20183893. doi:10.1542/peds.2018-3893

 

https://www.natlawreview.com/article/employing-crisis-standards-care-response-to-covid-19-pandemic

 

Jeffrey B., MD -

Hi guys,

Thanks for your most recent medical legal updates! I am in urgent care doc in Maryland, and our shop does not have sufficient PPE such as N95 masks for staff providing direct clinical care nor viral HEPA filter on BVM bag. So my medical legal question is this: if I had a patient walk in the door highly suspicious for COVID-19 severely hypoxic and near respiratory failure that’s requiring Ambu bagging with our BVM which does not have a viral filter on the exhaust valve;; if we decided not to bag because all unprotected staff in the center would be exposed, where would we be medical legally?

Thanks

Mike W., MD -

Hi Jeffrey,
Matt and I have a big interest in the medical legal aspects of medicine, but neither of us are lawyers. If there is a patient who truly requires an ambu bag, I would have 911 called and one person w an N95 mask doing the bagging. You can put a cloth or plastic sheet over the patient and the ambu bag if you can ensure good chest rise and a good seal. Another alternative would be to put the patient on the highest flow oxygen and place them prone while awaiting EMS. I would not allow them to die without attempting resuscitation. Final note: you don't know for sure they even have Covid at this point!
M

Jeffrey B., MD -

Hey Mike,

Thanks for your timely and reasoned response! While I would normally, pre-Covid, never let a patient die in front of me without trying to do something, i’m very concerned about my staff who don’t have proper PPE in a relatively confined space.

In my shop I have now seen so many COVID-19 positive confirmed cases, it’s obvious to me who very likely has it when they walk through the door particularly if they have hypoxemia, fever, cough and shortness of breath.

So to solve this dilemma that I described for you guys, instead of waiting for my organization to purchase viral exhaust filters for the Ambu bags, I went on eBay and purchased one myself for $25.

Again thanks for your advice with the bag or sheet over a patient. That’s an option.

Thanks

Julie H. -

My employer has both older PAPRs and newer CAPRs. The ears are exposed with a CAPR, thus use of a stethoscope for listening to heart and lungs easy to do. However, with a PAPR, the user would be 'exposed' if a stethoscope is used.
My ER colleagues say this would not change the management of patient there - a CXR or CT readily available if patient not oxygenating well. Your thoughts, if only PAPR available to use, for someone who cannot use N95 for whatever reason?
And of course, we don't know if the patient has COVID yet in the urgent care......

Julie, NP

Mike W., MD -

Agree. Please see the covid channel and also a link to a study we just published on sensitivity of CXR findings (haha, your UC RAP team at work!!)
https://www.jucm.com/documents/jucm-covid-19-studyepub-april-2020.pdf/
M

Julie H. -

Mike,

Timely piece of research! I'll forward on to my ER and Urgent Care colleagues.
Much appreciated

Julie

Mike W., MD -

Thx Julie!!
M

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