Primary care has been defined by the American Academy of Family Physicians as the service provided by professional medical practitioners competent to give all-inclusive first contact and sustained care for patients with any unidentified health issue. State agencies have also defined primary care as that care occurring when a person makes contact with a health care provider who takes responsibility for the continued health care provision regardless of the absence or presence of disease. The health care provided must be continuous and comprehensive. The tussle on who deserves the exclusive designation as the primary care provider is still raging. There are three types of primary care providers (PCP) that include nurse practitioners, physicians, and physician assistants (Buppert, 2004).
A nurse practitioner is a registered nurse with over one year of additional training, which equips him/her to provide most of the services doctors provide. In addition, “the nurse practitioner works either independently or as part of a health care team” (Buppert, 2004). A physician assistant is a trained medical practitioner who does not practice independently, but has to directly report to a supervising physician who holds the license to operate as such. His license allows him to conduct any medical or surgical duties assigned to him by the supervising physician. Both the physician assistant and the nurse practitioner are often times called physician extenders or mid-level practitioners, and are required by law to refer complex cases to the physician (Buppert, 2004).
Defendants and Areas of Negligence
In the foregoing case, the long time primary care provider(s) (PCP) will be the defendant. The family to the deceased woman will serve as the plaintiff in this case. As the plaintiff, they reserve the right to sue if they suspect that there was negligence on the part of the defendant. The burden of proof will however, fall on the plaintiff who must prove that indeed the defendant erred in his practice. The plaintiff will also have to prove that the defendant owed the plaintiff a duty of care, which he (the defendant) failed to exercise. As demonstrated in Columbia Medical Center of Las Colinas v Bush 122 S.W, the nurse practitioners and other physician extenders are not exempt from being charged with negligence simply because they followed orders. They stand sued for negligence. Both the physician extenders and the physician will be liable for negligence and would thus stand jointly accused.
The primary health provider owed the patient duty of care. The care provider should have conducted a thorough medical examination on the patient. Supposing the PCP was a nurse practitioner or a physician assistant, he should have certified the case as complicated and referred it to the collaborating physician or the supervising physician respectively for directions. This move would help them avoid negligence charge while doing their work, effectively shielding them from any future lawsuit. The PCP was supposed to have ordered a new ECG, which would have revealed that the patient was suffering from a cardiac dysrhythmia, a condition where the heartbeat is either too slow or too fast. This condition results from abnormal electrical activity in the heart. Had the PCP ordered an ECG, the results would have shown the disease and the PCP would thus have taken measures to treat the patient and save her life. The patient must have developed the cardiac disease over time, and relying on the previous doctor’s diagnosis of gastro esophageal reflux disease (GERD) was ill advised.
Though cardiac dysrhythmia is often times asymptomatic, the PCP should not use this as a point of defense because the patient had clearly stated that she had pain and fluttering in her chest. These two conditions are part of the symptoms of cardiac dysrhythmia. From the visit by the patient, the PCP should have noted the symptoms and ordered an ECG to confirm the presence or absence of cardiac dysrhythmia (Mosack, 2011).
The PCP thereby relied on the past medical history and committed three different types of medical errors, namely, diagnostic by using inappropriate investigations, error in administering wrong treatment, and failure to provide adequate follow-up. The defendant is negligent of the three forms of medical errors. The investigation results pointed to GERD as the probable condition thereby giving a wrong prescription. The wrong treatment administered by the primary care provider relied on the wrong investigation report, and thus failed to unearth the underlying problem of cardiac dysrhythmia. Further, the PCP failed to offer adequate follow-up, which might have revealed that the wrong prescription given was not working, and in turn, he would have had a chance to change the prescription to a right one (Mosack, 2011).
Further, the PCP is negligent in his duty because his profession demands that he not only provides the patient with the first contact care, but also a continued care. He should therefore, be in a position to conduct routine medical checks to ensure that the customer is in excellent health. It is during this routine checks that most undiagnosed medical conditions would surface. He would then take the necessary steps to cure the patient. The best weapon to fight any disease is early diagnosis, and this would come in handy when the diagnosing physician conducts routine checks on the patient (Nagelkerk, 2006).
Defendant’s Action That is Very Common on Day-To-Day Bases with Providers
In this case, the defendant assumed that his patient was suffering from the condition diagnosed earlier, leading to false diagnosis, and thus death. This is common practice in day-to-day operations of primary care providers. The PCP thought that the patient was suffering from gastrointestinal reflux disease, a condition that she previously was suffering from. This informed his decision to prescribe an anti-flux drug, which apparently did not tackle the real disease (cardiac dysrhythmia). Reliance on past medical history is common practice in most of the primary healthcare practices, and it is considered common practice and acceptable in some circumstances. However, if a medical practitioner relies on past medical history and it results in a complication, he will be liable for negligence. It is expected of long time providers to open and maintain a medical file for each of their patients. These files should contain records of the medical conditions diagnosed and the line of therapy adopted in each case. Such files come in handy especially if the patient is taken ill and she cannot explain to the attending physician what is ailing her at that moment. The file is also beneficial, as it will brief a new physician on the medical history of the patient who has been handed down to him by a retiring or transferred physician. The file should be updated with every visit of the patient to the physician.
According to my analysis, I believe the primary care provider was found guilty of negligence. He committed medical malpractice by providing treatment that fell below the acceptable standards expected of practitioners in the medical field. This conclusion is informed by the fact that the primary care provider gave the customer a wrong drug, which did not help to cure her of the disease. In essence, the drug prescribed was to tackle GERD and not cardiac dysrhythmia. It is widely acceptable that medication error is the most common and preventable cause of patient injury. Therefore, all medical practitioners should exercise due diligence and ensure that they conduct their trade in the professionally acceptable manner. They should conduct thorough and in-depth medical examination to establish the root cause of the disease a patient has presented. Further, over-reliance should not be placed on past medical history, as this tends to change. Had he exercised due diligence, the primary health care provider would have been innocent of the negligent charge (Nagelkerk, 2006).
From the verdict of this case, I would do certain things differently. For starters, I would adhere to all recommended rules of practice and adhere to the set code of conduct. I would investigate all my patients’ cases on an independent basis. Limited reliance would be placed on the past medical history files. Moreover, I would ensure that thorough medical examination is conducted for all cases that come through my clinic. As a physician, I would ensure that I employ qualified physicians to ensure that I am not held liable due to their incompetence. Further, I would insist that all cases handled by my physician extenders be reviewed and audited by myself to iron out any grey areas that would likely land me in a medical malpractice suit. On the patients’ side, I would recommend to them that they avoid self-medicating; instead, they should seek my advice on all matters touching on their health. I would also impress on them to avoid taking over-the-counter drugs, as these often only serve to treat the symptoms to a disease, thereby concealing the root cause and hampering early diagnosis (Mirr & Zwygart-Stauffacher, 2010). I would further advise my patients to make regular visits to my clinic for routine checkups. This would help me to diagnose fatal diseases early and help tackle them on time. To avert cases that might arise from other physicians, I would advise my patients to avoid consulting many physicians, as this would bring about diverse diagnoses.
As a precautionary measure, I would take a medical liability insurance cover in order to shield myself against any charge that might arise due to negligence on the part of my physician extenders. In this case, the insurance cover will come in handy in compensating cases arising from medical error, which may at times be inevitable. I would also insist that all my physical extenders attend regular trainings to keep abreast with the emerging issues in the field of healthcare provision. I would also attend regular seminars to hone my skills in primary care provision and consultancy. As a nurse practitioner, I would ensure that I maintain regular consultations with my collaborating physician in grey areas. These measures will afford protection to my medical practice from any malpractice suit that could have arisen in their absence (Mir, & Zwygart-Stauffacher, 2010).
Buppert, C. (2004). Nurse practitioner’s business practice and legal guide. Sudbury: Jones and Bartlett.
Mirr, J. M. P., & Zwygart-Stauffacher, M. (2010).Advanced practice nursing: Core concepts for professional role development. New York: Springer.
Mosack, V. (2011). Psychiatric nursing certification review guide for the generalist and advanced practice: Psychiatric and mental health nurse. Sudbury: Jones and Bartlett Publishers.
Nagelkerk, J. M. (2006). Starting your practice: A survival guide for nurse practitioners. St. Louis: Mosby Elsevie.