Review Adverse Event occurrences in Canada

Litigation realities in Canada for physicians and nurses

Malpractice-what is it and who’s involved The process and the anatomy of a lawsuit

in Canada

Definition of an Adverse Event:

An adverse event is an unintended injury/complication that is caused by healthcare management rather than by the patients underlying disease condition.

May prolong discharge (hospital stay) May lead to disability May lead to death

Landmark study (2004) 3745 charts One teaching hospital/one large community

hospital/two small community hospitals

OBS Trauma FB left in OR Falls DVT/PE prevention Infection prevention Medication errors

360,572 RN’s working in Canada (CIHI 2011) and 88,200 RPN’s.

1000-1400 cases per year are litigated in Canada. Anywhere from 3-5 nurses per lawsuit.

Based on LNC, 1 out of 40 Canadian nurses will be named.

1 out of 12 US nurse will be named.

Realities about lawsuits -protects the healthcare consumer -it’s a business -takes a long time before a case ever makes it to the courtroom.

Plaintiff lawyer-represents the patient (plaintiff) with the alleged injury

Hospital lawyer-represent the defendant nurses (this is sometimes the insurance company)

Physician lawyer-represents the defendant doctors (most often, but not always the CMPA)

The definition of malpractice:“Improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position…..to denote negligent or unskilled performance of duties…..a cause of action for which damages are allowed” (JCAHO, 2003). The definition of negligence:“Failure to use such care as a reasonably prudent and careful person would use under similar circumstances.” (JCAHO, 2003).

1. An alleged injury or loss occurs.2. The Plaintiff sues the Defendant: seeking

financial damages from the doctor/nurse.3. Production of medical records.4. Examination of Discovery.5. Expert Evidence, Expert Opinions, Rebuttals6. Settlement or Trial.7. Judgement and/or Award of Damages.

1. The Duty.

2. The Breach in the Standard.

3. Was there an injury?

4. Causation.

1. Failure to communicate adequate information to the physician.

2. Inadequate patient assessment, nursing intervention or nursing care

3. Medication errors4. Inadequate infection control5. Unsafe and improper use of equipment

The premise of all litigation against a nurse is that the nurse failed in some manner to meet the Standards of Care established by their governing body.

The Plaintiff The Defense

(Mr. Callas –the patient)

The Defense Day Surgery Nurses JP and Sherry

Dr. Dick

ER Nurse Jane

Nurses are responsible and accountable for ensuring that their nursing practice and conduct meet the standards of their profession and legislative requirements.

Nurses are responsible to provide safe, ethical and competent care.

“The witness that never dies and never lies”.

1. Failure to communicate adequate information to the physician.

2. Inadequate patient assessment, nursing intervention or nursing care.

3. Medication Errors.4. Inadequate Infection control. 5. Unsafe and Improper use of equipment.

A change in condition equals a change in action equals a change in nursing documentation.

Document evidence of patient teaching and post administration monitoring.

Protect yourself from a lawsuit by being the nurse whose clinical knowledge, skill and professionalism protects yourself and your patients. And then document in such a way that shows that you acted as another reasonably competent nurse would have acted in that same situation.

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