Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

We resume the discussion started last week regarding preparing for in-office emergencies. If you missed Part 1, check it out by visiting this link: https://medicaljustice.com/bullet-proofing-your-medical-practice-against-unexpected-in-office-emergencies-part-1/

It is critical doctors prepare their practices to address in-office emergencies. You must keep your practice stocked with potentially life-saving equipment. How much equipment you should stockpile and what kind will vary from practice to practice. For example, if you treat many patients with heart conditions, prepare accordingly.  

The bare necessities for most practices include ambu-bags and masks, oxygen and tubing, a pulse oximeter, epinephrine auto-injectors, blood glucose monitors, nebulizers, epistaxis sponges, peak flow meters, IV catheters and tubing and solutions and, if you are trained in intubation (see below), an intubation set and laryngoscope. These are just suggestions. Every practice will be different.  

When weighing your options, also consider the following: 

Your patient population: This will determine which emergencies are the most likely to occur. A doctor who treats diabetic patients should prepare for related emergencies. A doctor who treats many patients with heart conditions should prepare to address emergencies specific to the heart. 

The skills of you and your staff. Be mindful of their competencies and limitations. If no one in your office is proficient in advanced airway techniques, don’t stockpile related supplies. We’ll discuss this in more detail below, but the absence of such equipment is meant to control risk. Stockpiling equipment your staff is not prepared to use is a recipe for negligence. You don’t want someone implementing a tool they are not trained to use, only to worsen the patient’s prospects. As it is said, “a fool with a tool is still a fool.”

Any minimum recommendations for emergency medications and equipment made by your specialty society. For example, the American Academy of Pediatrics has issued guidelines, including recommended supplies, to assist offices in establishing an emergency plan. This will go far in establishing you met or exceeded the Standard of Care. You want future attorneys to find evidence of a plan of action.

Keep your emergency supplies in an accessible location – ideally a traditional crash cart. Make sure your supplies are properly labeled. In the heat of an emergency, you don’t want a staff member grabbing the wrong equipment (or material) and injuring the patient.

Once you have set up an emergency kit, assign a trained staff member to check the equipment, supplies, and medication regularly. They must verify that the equipment is in working order and medications have not expired. And keep a record of these inspections. If you are sued, that kind of record may save your neck. One recent case was associated with an AED that would not charge. This fact was not discovered until the AED was needed. Yikes.  

Devices like AEDs are noteworthy because of their close relationship to discussions of associated liability. Some doctors suggest the presence of AEDs in the office makes a doctor more liable in the event of an emergency; if the AED were to malfunction (or fail to charge), this opens to door to charges of negligence. We believe the opposite is true. An AED only comes into play when the alternative is death. Therefore, the notion that the presence of an AED contributed to a patient’s death makes no sense. 

If you have an AED in the office, ensure there is always at least one person in the office who is trained to use the device. Otherwise, it is worthless – a bandage made of smoke. More than worthless, it represents an exposure of risk. Failure to train staff to properly use a life-saving device may propel a claim against you.   

Again, consider your patient population as well as your practice’s location. If you treat an older patient population or a patient population dense with diabetics and smokers, an AED is a solid investment against bad patient outcomes and liability. Returning to the question of geography – a practice located in a rural environment (far away from the closest emergency center/hospital) should likewise invest in an AED.  

And don’t forget to run the purchase of an AED by your carrier. Here’s why: We recently received a question from a pediatrician. She wanted to keep an AED in her office. But her carrier noted such an addition would “expand the scope of her practice.” Under such circumstances, a carrier may disavow a doctor’s coverage. This attitude is often the exception, however, not the rule. If your carrier protests, ask about purchasing a rider/surplus line of coverage. 

One more perk of keeping an AED in the office. It may save YOUR life. It may save your staff’s life. It may save your neighbor’s life. 

The icing on the risk-reduction cake: Produce or obtain a written protocol. Make this protocol accessible. Make it visible.  And when you revise it, memorialize all changes. The role of each staff member in an emergency should be made clear. Many offices drill their staff regularly. If you adopt this habit, make a detailed record every time you do so. In the event of a lawsuit, such documentation may protect you from the worst outcome. 

We mentioned at the beginning that emergencies come out of nowhere – they are emergencies, after all. But you can control this risk by teaching your staff how to recognize the signs of an oncoming crisis. Prioritize staff working at the front desk. Patients will likely interact with them first when a crisis strikes. 

Documentation should continue after the emergency is over – regardless of the outcome. Be detailed. Pinning your reputation/compliance on a few scribbles penned by the paramedics creates risk. 

Be particular about when (time) events took place. Note when the patient complained of a problem, when emergency services were contacted when they arrived at the practice, and when they took ownership of the patient’s care.  

Sometimes patients are uncooperative. If they refuse emergency care, make a note of this, and be certain to explain to the patient the risks of refusing emergency treatment. Obviously, make a note of this, too. Note their clinical status (vitals) before they departed. These details seem negligible, but they are critical. Why? They prove the patient could leave the practice unaided. They also prove the patient’s judgment was not compromised by the state of their health.  

Something else to keep in mind: Emergency care will take place within your office, where you have an implied duty to render care. You likely have an existing doctor-patient relationship with virtually all of these patients. Therefore, your state’s Good Samaritan statutes won’t save you.  

Regardless, don’t shy away from rendering emergency care in your office. The protections supplied by the Good Samaritan laws are designed to function in the outside world – where resources are limited, and care environments are unpredictable. They assume that there is no equipment present and that doctors are likely acting alone. 

You are bound to do what is reasonable, given your setting. If you call 911, supply accurate clinical information so those on the receiving end can prioritize. Work with your staff according to your protocol, and do not over-extend your abilities while you wait for emergency care. 

Doctors must plan for emergency situations. But you need not plan alone. Expert counsel can turn this critical labor into an exercise that is a) teachable and b) can reduce your practice’s liability and c) can increase the likelihood a patient will experience a positive outcome.

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.