Case 2

Claimant was a 28-year-old female alleging negligent performance of answering service and office staff, resulting in delayed treatment.

Case Summary

(Day 1) 28-year-old female patient presented to Emergency Department with fractured ankle. Dr. 1 attempted a closed reduction of the fracture and was unsuccessful. Patient was admitted for surgery on the following day.

(Day 2) Patient had ORIF, with plates and screws, and a cast applied by Dr. 2. The patient was discharged to home the next day with instructions to follow up with Dr. 1 in one week.

(Day 6) Patient called Dr. 1’s office and spoke to answering service. She requested to speak with Dr. 1 secondary to a “pop” she felt, complaints of pain and that the cast was loose. She also needed a prescription for pain medication at a pharmacy close to her home. According to the claimant’s testimony, the answering service was rude and inappropriate with her and stated that the on-call doctor would call her. The on-call doctor never called the patient. The answering service records did not reflect patient’s need to speak with the on-call doctor, just that the patient wanted to pick up drug samples at the doctor’s office.

(Day 11) Patient called Dr. 1’s office four times requesting to speak with the doctor with complaint of pain and need for pain medication, as well as a new foul-smelling odor emanating from the cast. The office made an appointment for the patient to see the doctor in four days and told the patient that the doctor would not fill any prescriptions after hours and that the doctor would not be contacted. The office had no record of the phone call.

(Day 12) Patient called Dr. 1 again with complaint of severe pain and foul odor. The doctor’s office had no record of this call. The patient had phone bills proving all phone calls made to the doctor’s office.

(Day 15) The patient went to Dr. 1’s office for scheduled appointment where it was found that she had a significant infection of the ORIF site. The patient informed Dr. 1 of the phone calls she made to the answering service and office. The patient was immediately admitted for surgical debridement and skin flap.

Outcome

The patient was discharged to home two weeks later with a PICC line and visiting nurse services. The wound healed with significant scaring, permanent numbness and weakness.

Risk Issues

There was inadequate policy and protocol for both the answering service and the office staff with regard to triaging patient phone calls to determine which ones require immediate attention; there was also no policy or protocol requiring documentation of calls.

There was incomplete and inconsistent documentation of phone conversations between the patient and the answering service, as well as the office staff.

Conclusion

A clear policy and protocol for both the answering service and the office staff should be developed for conducting telephone assessments and triage, and to document and communicate patient questions and concerns.  Both staff and the answering service compliance should be routinely monitored. 

Summary

Documentation is a critical part of patient care as it serves to memorialize the doctor’s thought process, the patient’s state of health, and is the foundation for defense of a medical malpractice claim. In some cases, concise documentation will prevent a claim from being filed. Lack of and incomplete records can aid the plaintiff’s attorney in demonstrating negligent care, even when standards of care are met.

The Princeton Insurance Physician Office Practice Toolkit was developed for and provided to office-based physicians. It includes a convenient off-hours patient telephone call record pad, which is designed to improve documentation of out-of-office patient phone calls. The toolkit also contains a sample telephone call log for in-office use. 

To request additional patient telephone call record pads, please call our Risk Resource Line at 1-866-Rx4-Risk.