The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in a medical malpractice case present such issues to the court.
(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)
Dr. White was never an attending physician and merely signed Paul Brown’s chart, fulfilling his administrative duties to the hospital. Dr. White in his declaration in support of his moving papers, at 2:6, states quite plainly I am required to sign charts of a number of patients who were seen and treated by mid-level practitioners, who I did not see or treat myself. There is no requirement that the chart be reviewed in detail by the physician or that the physician make an independent evaluation of the patient’s diagnosis and treatment. Thus, Dr. White’s signature does not create a duty to see the patient or direct the medical treatment, all of which has already occurred. More so, page 1 of the Frequently Ask Questions Regarding Nurse Practitioner Practice states that “The Nursing Practice Act (NPA) does not require physician countersignature of nurse practitioner charts.”
However, other statutes or regulations, such as those for third party reimbursement, may require the physician countersignature. Additionally, some malpractice insurance carriers require physicians to sign NP charts as a condition of participation. Standardized procedures may also be written to require physicians to countersign charts.
Dr. Black sums up his opinions at 5:11-21, stating that plaintiff’s injuries “could have been avoided if appropriate nursing triage had occurred …” and “if Nurse Brown had accurately completed the history and physical…” These two portions of Black’s declaration are utterly irrelevant to Dr. White in this matter. Black then posits a hypothetical that “if Dr. White had read, critically reviewed, and appropriately responded, (as required by the emergency department supervisory procedures) to the submitted patient chart, the patient’s care would have met the standard of care …” Plaintiff was never at any point in time Dr. White’s patient, as the triage nurse directed plaintiff to nurse practitioner Paul Brown, and nurse Brown never consulted with Dr. White regarding plaintiffs care. Dr. White in his declaration at 1:25-2:3 describes that patients coming to the emergency room at XYZ Medical Center at that time (and now) are typically screened by a triage nurse, whose role includes determining the acuity (severity) of the patient.
The triage nurse directs patients to either the Prompt Care side of the department, or to the Emergency side. Typically, patients sent to the Prompt Care side are seen by nurse practitioners or physician’s assistants … mid-level practitioners have the option of consulting with physicians, if in their judgment, this is necessary or would be helpful. Thus, the decision as to who would treat plaintiff was completely out of Dr. White’s hands. (See Part 5 of 5.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.