MDNews - Long Island

SPECIAL CLINICAL SECTION: GERIATRICS Rosaleen T. McCrory, JD Yuko A. Nakahara, JD IN NURSING HOMES, inclusive of sub- acute and long-term care facilities, the attending physician is typically respon- sible for overall medical care, treatment and management of his/her assigned patients. Among other things, this respon- sibility includes ordering consults based upon the patient's specific condition or needs, as well as following for various tests and/or treatments as recommended by a consulting physician. What is the responsibility of the consulting physi- cia n with respect to the patient, and what is the potential exposure of the consulting physician? What is the potential impact of the consultation in civil actions against the facility? The role of a consulting physician is to render an opinion and/or to make recom- mendations sought by the attending physician. Often, the physician performs a directed examination and makes rec- ommendations based on his assessment. W het her a consu lt must fol low t he patient a f ter the initia l consultation is fact specific. However, if the consult- ing physicia n documents that he or she will follow the patient, fa ilure to appropriately attend the patient may expose the physician to liability. In the event the consultant determines that fur ther follow-up is not indicated, a note should be authored to that effect. In many nursing facilities, the attend- ing physician is responsible for issuing orders and may or may not follow the rec- ommendations of consulting physicians. When the attending physician does not follow the consulting physician's recom- mendations and subsequent litigation is initiated, the consulting physician may be included in the litigation. Generally, the duty of a consulting physician is lim- ited to his or her treatment of the patient, and the consultant is not responsible for the treatment provided by the attend- ing physician or other physicians. If a consulting physician has continued to follow the patient, responsibility for the failure to comply with the recommended treatment may nevertheless be at issue. Clear and thoughtful documentation as to the recommended plan of treatment will assist in defending the consult- ing physicia n. In a facilit y in which the consultant may issue orders, the consultant should consider entering the recommended plan into the orders. C lea r a nd a c c u r at e do c u ment a- tion by the consulting physician will assist in the defense of the physician and, often, the facility. Careful review of the patient 's cha r t will assist the consultant in accurately documenting the patient's condition, history, symp- toms and treatment plan. Inconsistent documentation bet ween ca reg ivers makes a defense of the physician and facility more difficult. Care should be taken to avoid documenting opinions beyond t he con su lt a nt 's specia lt y. Ca re should a lso be ta ken to ensure that the consultant's report is inserted into the patient's chart, particularly if t he consu lta nt uses his or her ow n computer or consu lta nt forms. The consultant should consider maintaining copies of consultation reports. In many cases, a patient in a nursing facility is transferred to the consultant's off ice for eva luation. This is of ten the case when the patient is admitted for acute rehabilitation following surger y and requires follow-up by the surgeon. Cha n ges i n t he pat ient 's cond it ion should be ca refully documented, a nd the recommended pla n of treatment should be clearly set forth for the facil- ity. If the outside physician is contacted by the faci lit y, documentation a s to t he deta i ls of t he contact shou ld be noted. A ga in, the outside physicia n's dut y is limited to the ca re a nd treat- ment rendered to the patient; however, careful documentation will help defend the physician in the event of litigation. Ultimately, the goa l in a sub-acute a nd long-term ca re setting is for the interdisciplinary team to collaborate to ensure that patients receive appropriate care and treatments, including appro- priate consultations. Documentation should adequately ref lect that neces- sary consults were requested, obtained and documented. The consulting phy- sicia n should clea rly a nd accurately document his/her findings, impression a nd recommendations. Appropriate follow-up should be instituted when indicated. Accurate a nd thoughtf u l documentation increases the likelihood of a successful defense of the consult- ing physician. Rosal ee n T. McCro r y , J D, S e nio r P a r t n e r a t M C B , a n d Y u k o A . N a k a h a r a , J D , P a r t n e r a t M C B , focu s their practice on all aspects of medical malpractice and nursing home defense. For more information , visit mcblaw.com . n THE ROLE BY ROSALEEN T. MCCRORY, JD AND YUKO A. NAK AHARA, JD of Consulting Physicians in a Nursing Home Setting 2 0

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