As a result, defense experts focused on the failure of KL to obtain debridement as the main reason for his injury. Dr. Hospitalist, the PCP and the ED providers at Hospital B, all documented KL’s refusal to allow debridement by a podiatrist other than his own. KL denied this allegation, but the chart was consistent in this regard.
Conclusion
In the era of patient-centered care, patient wishes and preferences are important to integrate into the overall care plan. But when a patient’s wishes and preferences delay or otherwise subvert optimal care, it is vital that the hospitalist document the circumstances in their entirety. Documentation should confirm that the patient has capacity for decision making and that care recommendation benefits, risks for not following said recommendations, and care recommendation alternatives have been fully reviewed.
It is also helpful to have such discussions witnessed by other providers (that is, the nurse) so that the documentation is corroborated. The PCP and Hospital B were dismissed from the case. Hospital A settled with the plaintiff by waiving all hospital charges from his original hospitalization.
Dr. Michota is director of academic affairs in the hospital medicine department at the Cleveland Clinic and medical editor of Hospitalist News. He has been involved in peer review both within and outside the legal system.