Halifax Medical Malpractice Lawyer Blog

Cape Breton Doctor Incompetent

The College of Physicians and Surgeons of Nova Scotia found Dr. Stani Osif guilty of professional misconduct and professional incompetence under the Nova Scotia Medical Act. I posted about the charges a couple of months ago: Cape Breton Doctor so "Incompetent" no Training Program can Help: College of Physicians.

Osif Ordered to Retrain

I see that the College has ordered Dr. Osif to undergo retraining and pass the Canadian College of Family Physicians certification test. According to a report by the CBC, if Osif doesn't complete the retraining, and pay the College $200,000.00 in legal fees, her license to practice medicine in Nova Scotia will be revoked. You can read the entire College decision here.

Osif Appeals

The CBC has now reported that Dr. Osif has appealed the College's decision to the Nova Scotia Court of Appeal.

Accuses Witnesses of Perjury

Osif has accused witnesses that testified at her hearing of giving false testimony. In other words, she has accused the people that testified against her of committing perjury!

Public Doesn't Understand Role of College

I found some of the comments posted on the CBC site interesting (and unfortunate) because they confirm the misunderstanding that the public has about the oversight/supervision that doctors have in Nova Scotia (and the rest of Canada).

One reader commented:

Maybe the College of Physicians and Surgeons of Nova Scotia should be censored by the government for not intervening sooner. How could something this harmful have gone unknown for so many years. Time for the College to be replaced too.

The College of Physicians and Surgeons in each province is the body that is responsible for licensing and disciplining doctors. Over the past 18 years that I have spent representing victims of medical malpractice, I have found that most members of the public misunderstand the role of the College.

Once a doctor is licensed to practice medicine they are assumed to be competent by the College unless shown otherwise. But the College does not engage in ongoing oversight of doctors. The College does not engage in ongoing testing of doctors to ensure that their skills are up to date. Most important; the College does not initiate disciplinary investigations unless it receives a complaint!

Patients Responsible

In other words, a great deal of the responsibility for the oversight and discipline of doctors lies with patients.

Patients Not Told About Medical Errors

The problem with this approach is that there is no legislation, no law, in Nova Scotia that requires doctors and hospitals to tell patients when they have made a mistake, or when the patient has been the victim of medical error.

Furthermore there are no national standards for disclosure of medical errors.

In fact, every province in Canada has legislation that says that Hospital's internal investigations into medical errors are privileged and confidential. In Nova Scotia, Section 60 (2) of the Evidence Act reads:

(2) A witness in any legal proceeding...is excused from answering any question as to any proceedings before, or producing any report, statement, memorandum, recommendation, document or information of, or made by

(a) a research committee of a hospital;

(b) a hospital committee established for the purpose of studying or evaluating medical or hospital care or practice in a hospital; or

(c) a research committee recognized by the Minister of Health and Fitness and approved for the purpose of this Section,

and that is used in the course of, or arising out of, any study, research or program carried on by a hospital or any such committee for the purpose of education or improvement in medical or hospital care or practice.

Thousands Die Every Year

According to the Canadian Medical Association Journal, medical errors kill more than 24,000 Canadians each year.

So if the patient has died, or if the patient or his or her family isn't told that their doctor made a mistake, how are the patients or their family supposed to know if they have the grounds for a complaint to the College of Physicians and Surgeons?

Doctor Filed Complaint

The Osif case is unique because the original complaint that launched the investigation came from one of her colleagues, another doctor. In my experience, that is very unusual. I expect many doctors feel that if they made a mistake they wouldn't want their colleagues to be filing complaints about them. Doctors are, understandably, reluctant to file complaints about their co-workers.

How Do We Improve Health Care?

So what can be done to improve health care by improving the oversight of doctors? In my view there has to be legislation that requires hospitals, doctors and nurses to report medical errors to patients.

I have no doubt that this type of legislation would be vigorously opposed by the medical profession (or I should say, by their lawyers). But if the ultimate goal is improving health care and patient safety then shouldn't everyone, patients included, have all the facts?

What do you think?

Continue reading " "Incompetent" Doctor Ordered to Undergo Retraining Appeals: Cape Breton " »

Altering medical records does not happen as often as it appears to happen on television or in the movies. However, it happens enough that experienced medical malpractice lawyers develop a sense of when further investigation into the legitimacy of a medical record or chart is warranted.

One of my favourite movies of all times is The Verdict with Paul Newman. I love the scene where he finally realizes that he can prove that the defendant doctor altered the medical files of the woman who was left in a coma because of the doctor’s negligence.

Lessons Learned From Past Cases:

Over the past 18 years, I have learned some lessons about when to suspect that a medical file may have been altered.

Notes on one report, not on another:

In one case I was involved in the specialist’s report that was received by my client’s family physician did not have (exculpatory) handwritten notes that appeared in the report in the specialist’s file.

Lesson:
Look for all copies of the record and compare them.

Different Versions of reports:

In one case the surgeon dictated three different versions of the operative report. The family doctor received the first version days after my client’s surgery. After my client’s condition deteriorated, he dictated a second version (which was found in the Hospital chart). After my client became comatose and was transferred to another hospital for corrective surgery he dictated a third version of the report which was in his office copy of my client’s chart.

Lesson:
Get the records, and get them fast.

Were they working?

In a claim involving allegations of nursing negligence, the nursing notes contained statements that the patient’s condition had been communicated to the attending physician. However the date of the entry was for a day that the nurse in question wasn’t working!

Lesson:
Compare staffing sheets/time cards with the medical chart to detect entries/notes by staff members that were not present/on duty that day.

Medication Errors:

Medication errors are a common mistake among nurses who are overworked or inexperienced.

In a claim involving a fatal overdose, the nursing notes indicated that the deceased had received the proper dosage of medication. However, the medication administration records, which were not supplied by the hospital when the chart was originally requested, showed that the medication had been administered to the patient twice.

Lesson:
Compare the medication administration records with the nursing notes and physicians orders.

Destroying Records:

In an anesthesia negligence claim the anesthesiologist tore up the original anesthesia record and prepared a new record with different data. One of the nurses involved in the operation retrieved the original record and scotch taped it together.

Lesson:
Interview everyone, including retired employees.

White out = Suspicious Records

In a birth injury claim two of the babies APGAR scores had been whited out and changed from a 0 to a 2 (normal).

Change the Numbers - Change the Result:

In a fatality claim the deceased’s blood pressure reading had been changed from 170/90 to 120/80 by using a different colour pen to alter the numbers 7 and 9. The change couldn’t been seen on the photocopy of the patient’s chart, but was reasonably obvious on examination of the original chart.

Lesson:
Whenever I have a reasonable suspicion that the medical files have been altered, I make an appointment to attend at the Hospital or the doctor’s office to view the original chart.

What to Look For:

Some “red flags” that I look for, based on past experience, that may indicate the possibility of altered medical records are:

• Crowding or squeezing entries above a signature, or between lines;
• Erasures, crossed out entries or white-out corrections;
• Changes in slant of handwriting;
• Using different pens or computer typeface to write one entry;
• Notes on different dates in the same colour ink from same pen;
• Notes in different colour ink (different pen) in the same chart note;
• A typed entry following handwritten entries, or vice versa;
• Missing original records that have replaced by photocopies;
• Entries that are self-serving;
• Half sheets instead of the standard size page (page cut in half);
• Additional notes on the original document, not on copies received by client;
• An unusually late date of dictation of a consult report;
• Any handwritten entry made by someone who erred significantly in treatment.

Continue reading " Altered Medical Files: "I think my records have been tampered with!" " »