Halifax Medical Malpractice Lawyer Blog

I get several calls a week from patients, of family members of patients, who are concerned about the care that they, or their family member, have received from their doctor or hospital.

In most cases, a careful investigation of the facts reveals that there are no grounds for a medical malpractice claim (in other words, the doctor or hospital wasn’t negligent) or that there may have been negligence in the patient’s care, but the cost of filing a lawsuit would be more than the potential recovery.

Explaining these facts to my clients is one of the more frustrating aspects of being a medical malpractice lawyer. I hate telling patients that I believe there was negligence in the care they received but that I don't think they should pursue a compensation claim.

My colleague Ches Crosbie has posted about this problem at the Newfoundland Injury Law Blog. Ches is one of Newfoundland and Labrador’s finest medical malpractice lawyers. He points out that the decision to accept or reject a client who has a medical malpractice claim is always difficult.

College of Physicians and Surgeons

However, if you are not satisfied with the care that you or your family has received, you can file a complaint with the College of Physicians and Surgeons. Each province has a College of Physicians and Surgeons that is made up of a panel of doctors and lay persons (non doctors) who are responsible for hearing complaints about doctor’s conduct and administering discipline.

Discipline can range from something as simple as giving the doctor a warning to as serious as suspending the doctor’s license or taking away the doctor’s license to practice medicine in that province.

File a Complaint About the Doctor!

I encourage patients and family members who are concerned about a doctor’s conduct to contact the College of Physicians and Surgeons to express their concerns. Often the patients don’t follow through with the complaint. I think this is a real mistake.

There are certain doctors who I regularly receive calls about. However, if the patients don’t file a complaint with the College of Physicians and Surgeons, there is no way for the College to know about any potential concerns about the doctor’s conduct.

When a patient finally files a complaint the College may not take the complaint seriously because it is the first complaint received about a particular doctor. The Board members' reasoning may be something like: “Well, we have only received one complaint about his/ her conduct. Lets give the doctor a warning to make sure it doesn’t happen again”.

On the other hand, if the College has received a half dozen or more complaints about the same doctor they will be far more likely to take the complaint seriously and more likely to administer more severe discipline to the doctor.

Ches gives some good advice about what type of information should be contained in a complaint to the College of Physicians and Surgeons. I would recommend anyone considering filing a complaint to take a look at his post.

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How often does medical malpractice happen in Canada?

The short answer is that the law suits that are filed in court are just the tip of the iceberg when it comes to medical malpractice claims in Canada.

Medical malpractice claims in Canada tend to get a lot of attention in the media. Everyone is concerned about the quality of health care that they receive, and claims that raise concerns about problems with medical care naturally get reported in the newspapers or on television.

Most Malpractice Victims Don't File Law Suits

But the fact is that most victims of medical malpractice never file a law suit.

More Than Half of Medical Mistakes "Preventable"

A famous research study conducted by Harvard Medical School determined that more than half of all injuries caused by medical management (in other words, not caused by the patient’s initial injury or disease) were preventable, and another quarter of those incidents were caused by negligence.

24,000 Canadians Die Every Year

In May 2004 the Canadian Medical Association published: "The Canadian Adverse Events Study: the incidence of adverse events in hospital patients in Canada". The report confirmed findings of similar studies in the United States, Australia, the United Kingdom, Denmark and New Zealand.

The Canadian study concluded:

• As many as 24,000 patients die each year due to “adverse events” (code words for a bad result).

• 87,500 patients admitted annually to Canadian acute care hospitals experience an adverse event.

• 1 in 13 adult patients admitted to a Canadian hospital encounter an adverse event.

• 1 in 19 adults will potentially be given the wrong medication or wrong medication dosage.

• 37% of adverse events are “highly” preventable.

• 24% of preventable adverse events are related to medication error.

A report by the Canadian Institute for Health Information (CIHI) indicated that nearly one quarter of Canadian adults (5.2 million people) reported that they, or a member of their family, had experienced a “preventable adverse event” (medical error).

Only a Few Law Suits Filed Each Year

According to the annual report of the Canadian Medical Protective Association (the CMPA), the group that defends most lawsuits filed against doctors in Canada, about a 1000 legal actions are commenced against doctors in Canada each year.

But the Canadian Medical Association says that 24,000 people die each year due to medical errors and more than 87,000 patients in Canada experience an adverse event.

Why Don't More Canadians File Medical Malpractice Claims?

So why aren't their more medical malpractice law suits in Canada?

Part of it certainly has to do with the difference in attitude between Canadians and Americans when it comes to litigation. We just aren't as likely to file a lawsuit as Americans are.

It certainly isn't because the CMPA is settling the claims of victims before they file their lawsuits. Their annual report shows they settle less than 500 claims per year.

Is it because they can't find a lawyer willing to take on a complicated and expense medical malpractice claim? Perhaps. Medical malpractice claims are complicated, time consuming, risky and very expensive. There are few lawyers willing to devote the time and money it takes to prosecute medical malpractice claims.

I believe that a bigger problem is that most patients don't know they have been the victim of negligence!

There are no national standards regarding the disclosure of medical errors to patients.

Related posts:

Majority of Infant Deaths Due to Medical Error Preventable

Medical Malpractice Kills More Than 24,000 Canadians Each Year

Overworked Nurses Causing Medication Errors

Continue reading "How Often Does Medical Malpractice Happen in Canada?" »

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!"" »