I’m not looking to give a lecture or deliver a lot of input on this one. I’m really uncertain how I feel about this and I’d like To hear what you all think.
What do you all think about medical caregivers receiving jail time for medical errors that contribute to bad patient outcomes? It’s not just conjecture. We have two recent cases on the books now of medical practitioners facing jail time for mistakes they made on the job.
First there was Julie Thao, the nurse who faced felony manslaughter charges for administering a high dose anesthesia to a pregnant 16 year old female (she thought it was a prescribed antibiotic) The patient died but the baby lived.
Now we have the case of Eric Cropp a pharmacist who signed off on an improperly mixed dosage of Chemo which later killed a young child. Eric pled guilty to involuntary manslaughter and his hasty signature on the bag will net him 6 months in prison, 6 months of probation and community service.
I can see both sides of this. Jail time is certainly going to affect voluntary admissions and investigations of medical errors. Would you come clean about a medical error if it meant that you might spend time in a jail cell?
When I wrote the article Fallible Medicine, I made a big deal out of the idea that seeking out flaws in the system is the most effective way to reduce human error. If the goal is to understand why we make these kinds of errors and improve the systems to avoid them in the future, criminal charges are going to be a major hindrance to the open communication necessary for that to happen.
On the other hand, people died here … young people. In Julie’s case, a young healthy person died. If I make a mistake driving my rig and kill someone I’m going to face criminal charges. Same goes for just about any other job. Should medicine be any different? Where do we draw the line?
Leave a comment. I’d like to hear what you think.
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Interesting post, bro.
It definitely poses a good question.
In my humble opinion, errors are made in every job. In our line of work, we just happen to deal with human lives. I don’t think “jail time” is a good consequence for med errors, etc, that take human lives, simply because it wasn’t pre-meditated and there were no intentions to do harm to the patient.
However, I am all for believing such things should be reported to the boards and stipulations should be placed on licenses.
That’s a real hard one. Yes there has to be accountability, but does it best serve us to incarcerate educated, well meaning people over a mistake? I by no means me to belittle the suffering of the families of the victims, however there was no intent to harm. Perhaps one mistake should ruin a career, I don’t know if I would push them into jail though.
Eitherway there is no clearcut answer to this one.
To err is to be human. Punitive justice only encourages medical professionals to disguise error, with the underlying reason for the error being veiled only to surface again at a later date. James Reason, a British anaesthetist proposed the Swiss Cheese Error Model, that discusses the underlying system flaws that result in medical error. Medical error is usually a result of a culmination of events that leads to a critical event. Much like, normalization of deviance concept. To hold one person at the end of a flawed systematic chain of events ultimately responsible is grossly unfair, and does not address the underlying cause.
In New Zealand, health professionals are immune from prosecution for medical negligence under criminal and civil law. We have legal statute that protects health professionals. However, The Health Practitioners Competence Assurance Act seeks to ensure that all professionals are safe and competent to practice within their scope of practice, with censure coming from each respective professions own regulatory body that governs right to practice. Disgraceful misconduct may result in loss of practicing certificate, and hence no job! A very powerful incentive to abide by good practice. Food for thought eh?
If it was up to me EMS would have an investigation service like the airline industry has the NTSB. The EMS Investigation Board (EMSIB) would automatically investigate any alleged death due to human error prior to completion of transfer of care including MVAs involving EMS units and false declarations of death. It would have the authority to throw HIPAA out the window and release a detailed no holds barred report to the public. There would be a system in place to prevent people from working in EMS ever again if justified. There would also be a system in place to deal with organizations that kill people/patients.
It would have the authority to throw HIPAA out the window and release a detailed no holds barred report to the public.
That worries me Timothy, as a father and EMT. If (god forbid) something happened to my family. If the responders honestly did the best they could, tried their hearts out to make the best outcome, I would prefer the entire event was kept where it should be. As training and between me and my family. I wouldn’t want 15 lawyers calling a day to make a quick buck.
Would I be upset if someone allowed my little girl to step in an ambulance because they thought she was fine, before having stabilization held? Of course. However there are times in emergency situations that call for a “best guess, as of now” scenerio. Anyone can find fault in any call 3 weeks later. I’m willing to bet you have looked back 2 hours later and said “I should have”. Smearing people and putting them in bad light because they responded to a situation that they did not cause, isn’t the answer (in my opinion of course).
For instance the call where the clerk was shot, not a bad word about the guys that actually caused the problem (by shooting him several times). Just complaints about the response. I’m not saying they deserve a free pass, but turning it into their fault is not the right course either.
Taundra, thank you for replying to my comment. The job of emergency personnel is to save lives. If they’re not doing that then we to find out why and fix the problems. How can EMS improve if it doesn’t figure why bad things happen?
Timothy,
I fully agree with you, there needs to be checks and balances and improvement whenever available. (please accept any conversation as conversation and not in an argumentitive manner). There also needs to be improvement across the board (fully agree). I don’t feel that us improving means slamming anyone else for substandard care. Sure we can say (purely speculative) “NPA’s are better than OPA’s” however does that mean we pick apart an on the spot decissions? (and throw them out there for armchair EMT’s to decide what was right).
We as a society decided that a basic EMT makes $10 an hour (in my area anyway). Guys like me aren;t going to give up 60K a year jobs to do it regardless of how much we enjoy it. Alot of the Darn good EMT’s (full time) I know have food stamps to pay for food for their kids.
Adding jail time for a poor decision (most work 2 or 3 jobs) hurts the industry in my opinion. Personally I want to know as much as possible, and I feel most EMT’s do as well, but sadly it’s a job worth poor pay, and if that continues, we will get the “what’s available group”.
I guess I am saying the answer is higher pay to attract higher talent (not meant to insult anyone currently doing it).
My husband is living through this nightmare right now. His mother was treated as someone else who had a cardiac problem for over 2 months in hospital. No one ever bothered to check her identity of either patient. My MIL treated as a cardiac pt, when all along, she had cancer that went unnoticed and untreated. The other pt, who is truly a cardiac pt, was being treated for cancer and not heart problems. Unfathomable! Doctors and hospitals are being sued. However, both pt’s are now terminal. Jail time? No, but hopefully severe dockets, punishments and possible loss of their licenses. Not to mention the rath from JCAHO.
To error is indeed human, however, not sure jail time is the answer. Loss of license maybe instead.
@trauma junkie, Yes but many jobs deal with human lives and carry heavy consequences for errors. The airline industry comes to mind. Or if a long-haul trucker kills a family of four, he can still be tried for manslaughter. Why should we be held above that? Is it the helping nature of ur prefession or the exposure to these risks that grants us immunity?
@Tundra I like the way you frame that question. Does it best serve us to incarcerate medical professionals. That may be the heart of it. The purpose of justice is to serve society. Does it do more harm than good to the medical establishment trying to prevent errors and serve the public to impose jail time? Well put.
@Graeme James Reasons work on this topic was pioneering for sure and he lays out the strongest case I can imagne for not imposing a system of punitive judgement that looks soely at the final act.
@Timothy “The job of emergency personnel is to save lives.” actually Timothy I’d like to think that our mission is far more broad than that.
You take a very hard line on this issue but I don’t think all medical errors .. even BIG errors are the product of bad caregivers. That’s one of the things that James Reason delved in to. We have to let go of the idea that medical mistakes are the product of poor caregivers making preventable errors that eed to be punished.
Part of being human is to error, no matter how competent you are. That’s what makes the whole issue defy a simple, regulated solution.
@Teresa I’m so sorry to hear about your families trials. Thank you for being willing to share that. You bring up the other critical side of the issue. When we medical professionals make real human mistakes, there are real human beings who pay dearly for our misjudgements. I wish your family the best.
@Steve I understand what you are saying completely re: other professions. But think about what happens when a pilot crashes a plane or a trucker gets into a wreck– an investigation occurs and if the driver/pilot is found not to be at fault, they carry on with their job as usual, of course sometimes with penalties or restrictions placed on their licenses or what have you for a period of time (if I’m not mistaken- correct me if I am wrong.) This is where I stand…I believe investigations should occur with any sentinel event, similar to what HIPAA does for hospital patients. If it wasn’t pre-meditated and the caregiver did not intend to do harm to his/her patient, I do not see how jail time would be adequate for such an event.
Well-educated, critically-thinking people make mistakes. We’re only human. It is VERY tragic when these mistakes can cost a life and by no means am I trying to belittle the suffering or pain that ensues a wrongful death d/t caregiver error. However, as opposed to jail time, I believe a better solution (in my humble opinion) would be things such as further, mandatory education so that such a mistake does not occur a second time. (IE- If a medic gives the wrong cardiac drug, they are mandated to take a course about medications, etc.)
I am just wondering. How many Doctors serve jail time? I can not find any statics. I know it happens, I found one doctor that ordered an IV drug to be infused in the CNS fluid. The death cost him 18 days time served.
@Trauma Junkie “Well-educated, critically-thinking people make mistakes. We’re only human.”
Which brings up another good point. Do our actions, our efforts o discipline or train or do anything in response to these evens actually prevent future events from occurring? As long as humans perform medical interventions there will be human mistakes. How many are acceptable as the cost of doing the job?
@metalegs I have no idea, but I see were you’re going with it. But this is truly an issue that crosses all medical disciplines.