Medical Malpractice Resulting from Early Discharge from the Hospital

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If you or a loved one has ever been in the hospital, you know that finally being able to go home is one of the greatest feelings, but do you know that early discharge is one of the most common causes of medical malpractice? Early hospital discharges are increasing at an alarming rate. Hundreds of thousands of patients are being sent home before they are ready.

You might be thinking, “Why would doctors rush their patients’ treatment?” The answer is because of money. The hospital gets paid more when they bring in new patients. Therefore, every day a patient remains in the hospital they are taking the bed of a new patient and costing the hospital money.

According to a recent study, 20% of patients experience preventable adverse medical events within three weeks of being prematurely discharged from the hospital.

When a patient is sent home too early after a serious illness or injury, doctors are not available to respond to the patient if problems occur. The patient is no longer being monitored as closely as they should be, and they become vulnerable to dangerous side effects.

The most common complications associated with early discharge are:
1. Adverse Drug Events
2. Hospital-Acquired Infections
3. Discharge Prior to Receiving Negative Test Results

There are things you can do to prevent post-discharge complications.

  • Pay attention to your prescriptions. If you were put on new medication while you were in the hospital, make sure you understand what you’re taking and how to take it. Monitor your reactions to new medications. If you notice a problem, talk to your doctor immediately.
  • Be clear on all of your follow-up care plans. Double check any pending tests and ask your primary care physician to explain your diagnosis, treatment plan, and what any test results mean for your continued care.
  • Be aware of possible complications and pay close attention to any and all symptoms.

If you or a family member believe you may have been harmed by an early hospital discharge, you have to call me right away at 1 (877) 944-4373.

I will help you prove that your doctor was negligent in sending you home. I will investigate whether the doctor performed all necessary tests, monitored your vital signs, scheduled follow-ups, and correctly diagnosed your condition.

I will also help you prove that the damage you suffered would have been prevented if you stayed in the hospital. Medical malpractice can be extremely difficult to prove, and that is why you shouldn’t try to do it alone. As your Ohio Medical Malpractice Lawyer, I’ll be there for you, and I’ll Make Them Pay!®

Author: Tim Misny | For more than 33 years, personal injury lawyer Tim Misny has represented the injured victim in birth injurymedical malpractice, and catastrophic injury/wrongful death cases, serving “Cleveland, Akron/Canton, Columbus & Cincinnati, Ohio.” You can reach Tim by email at tmisny@misnylaw.com or call at 1 (877) 944-4373.

 

 

 

 

 

 

 

critical issue is whether the negligence actually caused harm. It is insufficient to show that a patient suffered harm after a mistake was made.

For example, imagine a doctor discharged a cancer patient after a round of chemotherapy. The patient died shortly after being discharged. Even though the death occurred shortly after the patient was released from the hospital, it may have been perfectly reasonable for the release to take place, and the patient’s family would not necessarily have a medical malpractice case against the doctor. The family would have to show that the discharge was inappropriate, AND that it contributed to the patient’s death. If the death would have occurred even if the patient had still been in the hospital, the doctor would not be liable for medical malpractice. Learn more about Proving Damages in Medical Malpractice Cases.

 

Adverse drug events are the most common postdischarge complication, with hospital-acquired infections and procedural complications also causing considerable morbidity. More subtle discharge hazards arise from the fact that nearly 40% of patients are discharged with test results pending, and a comparable proportion are discharged with a plan to complete the diagnostic workup as an outpatient, placing patients at risk unless timely and complete follow-up is ensured. As nearly 20% of Medicare patients arerehospitalized within 30 days of discharge, minimizing post-discharge adverse events has become a priority for the US health care system.The two most common types of early discharge are:

Infant early discharge.  The common hospital stay for an infant is 48 hours after birth.  The american academy of pediatrics recommends a 16 point list of indicators for a healthy discharge.

Elderly Early discharge.  Older patients occupy a majority of hospital beds and this could cause the hospital to discharge the patient too quickly . When an elderly person is admitted to the hospital the doctors should immediately plan for discharge. Nurses and doctors should evaluate  the patient and take notice that they are actively improving.  Family members should make sure they are involved in the discharge decision.  Elderly patients may not be able to convey exactly how they feel. If the family member feels that the patient is being pressured then be sure to speak up.

 

Preventing Adverse Events after Discharge 
Ensuring safe care transitions requires a systematic approach. Three key areas must be addressed prior to discharge:

  • Medication reconciliation: The patient’s medications must be cross-checked to ensure that no chronic medications were stopped and to ensure the safety of new prescriptions.
  • Structured discharge communication: Information on medication changes, pending tests and studies, and follow-up needs must be accurately and promptly communicated to outpatient physicians.
  • Patient education: Patients (and their families) must understand their diagnosis, their follow-up needs, and whom to contact with questions or problems after discharge.

No consensus exists on how to ensure patient safety after hospital discharge, but some evidence indicates that comprehensive, multi-modal interventions may be more effective at preventing rehospitalization than targeting individual components of the discharge process. Two notable interventions used specially trained staff to meet with patients before (and sometimes after) discharge to reconcile medications, instruct patients and caregivers in self-care methods, prepare patient-centered discharge instructions, and facilitate communication with outpatient physicians. These studies, the Care Transitions trial and the Project RED study, both successfully reduced readmissions and emergency department visits after discharge. By contrast, medication reconciliation alone does not appear to reduce rehospitalization risk (but likely prevents medication errors), and other strategies such as structured postdischarge phone calls to patients and ensuring early follow-up appointmentsalso lack supporting evidence. There is considerable interest in harnessing the power of checklists to standardize the discharge process, and electronic health records offer great potential for improving information transfer between inpatient and outpatient physicians and developing standardized discharge instructions for patients.

Evaluating the magnitude of care transition problems and the effect of interventions is hampered by the lack of a standard outcome measurement. Hospital readmission rates are often used, but most adverse events after discharge cause patient harm without requiring readmission. A three-item patient survey measure has been developed to measure patient satisfaction with the transition process; hospitals are being encouraged to add these items to standard patient satisfaction questionnaires.

Common Types of Early Discharge Cases

Infant early discharge cases are the most common type of early discharge case. Because of the long list of problems that can occur early in life and the serious consequences that can be linked to those problems, infants should remain in a hospital for the first 48 hours after birth. This is according to a list of recommendations published by the American Academy of Pediatrics (AAP).

The 48 hour mark is a minimum guideline for healthy infants, but longer stays are recommended for infants experiencing complications. In addition to the 48 hour rule, the AAP list of recommendations includes 16 points, primarily related to health indicators that should guide the discharge of a healthy infant from a hospital. The list includes:

  • normal and stable vital signs for at least the past 12 hours
  • at least two successful feedings
  • urination and the spontaneous passage of at least one stool
  • hearing screening, and
  • assessment of family, environmental, and social risk factors.

Of course, early discharge does not merely affect infants. Adults can be the harmed by early discharge too. For example, a patient might be discharged before adequate testing for post-surgery infection is completed. Or, a heart surgery patient might be discharged before adequate testing of a pacemaker is completed.

Emergency Readmissions

In most early discharge cases, patients are readmitted to a hospital under emergency conditions. It is important to note that the hospital need not act negligently during the emergency readmission for the patient to have a valid medical malpractice case. In many early discharge situations, significant damage will have occurred before the patient is readmitted. The patient may be able to sue for any preventable harm, i.e. damages that would not have occurred if the patient had not been discharged from the hospital in the first place.

Also, doctors are more prone to make mistakes in emergency situations, so medical malpractice law tends to grant a certain amount of leeway for emergency room errors. But if the emergency situation only came about because of the inappropriate early discharge, the hospital will not be given leeway if a mistake is made during the ensuing emergency treatment.

Proving Medical Malpractice

The different factual possibilities for cases involving wrongful early discharge are infinite. But when patients sue for medical malpractice, courts analyze almost all cases using the same formula. Most medical malpractice plaintiffs must prove:

  • medical negligence on the part of a health care provider, and
  • harm caused by that negligence.

The question of whether a doctor committed medical negligence in these cases boils down to whether the patient was discharged too early. But the real question is, “How early is too early?” That question is answered by 1) determining the appropriate medical standard of care under the circumstances — what would a similarly-skilled doctor have done under the same treatment scenario, and 2) pointing out exactly how the doctor fell short of meeting that standard.

In early discharge cases, the medical standard of care might require a doctor to:

  • perform specific tests to ensure the patient is healthy
  • monitor a patient’s vital signs for a specific amount of time to ensure stability
  • schedule a follow-up visit, or
  • diagnose and treat an underlying condition.

In the vast majority of cases, proving the standard of care requires medical expert witness testimony. The same expert will usually be used to prove deviation from the standard of care. For example, if the standard of care required the doctor to wait until an infant was showing no sign of jaundice before discharging the infant, and the doctor failed to keep the infant for observation even while the symptoms were still obvious, the expert would document this treatment — showing what the doctor did in the context of what he or she should have done.

Proving Harm Caused by Medical Negligence

In order to win a medical malpractice lawsuit, the patient must prove that the doctor’s negligence caused foreseeable harm. This harm can take many forms, including:

  • pain and suffering
  • cost of medical bills
  • loss of earning capacity, and
  • loss of the ability to enjoy life’s pleasures.

The critical issue is whether the negligence actually caused harm. It is insufficient to show that a patient suffered harm after a mistake was made.

For example, imagine a doctor discharged a cancer patient after a round of chemotherapy. The patient died shortly after being discharged. Even though the death occurred shortly after the patient was released from the hospital, it may have been perfectly reasonable for the release to take place, and the patient’s family would not necessarily have a medical malpractice case against the doctor. The family would have to show that the discharge was inappropriate, AND that it contributed to the patient’s death. If the death would have occurred even if the patient had still been in the hospital, the doctor would not be liable for medical malpractice. Learn more about Proving Damages in Medical Malpractice Cases.