Medical error and liability: How technology can be a safeguard

Medical error and liability: How technology can be a safeguard

Apr 01, 2008

As discussed previously, the emergence of a "reasonable physician" standard of care affects both human and veterinary practitioners, defining our approach to error management. Under this standard, adverse events previously defensible by deference to custom might now result in decisions of negligence if it is determined that such events were easily preventable.

The tremendous financial growth of the veterinary profession, as well as the human-animal bond, have concomitantly increased legal attention to this field.

The number of veterinary graduates entering post-graduate specialty programs and private practice has been accelerating for a decade. There are many 15-to 30-doctor general and specialty-care practices nationwide, some producing annual gross revenue between $8 million and $15 million. The growth of pet health insurance encourages clients to seek these newly advanced — but expensive — specialty services.

Traditional small-animal veterinary practices that attracted little legal attention now complement corporate providers such as VCA Animal Hospitals and Banfield, the Pet Hospital, each of which employs more than 1,000 veterinarians and thousands of receptionists and technicians. These corporate chains evince the growth of the profession but also provide deep-pocket targets for would-be litigants.

Legal value of human-animal bond

Much attention has been given to the legal value of the human-animal bond in recent years. Court rulings in Kentucky and Pennsylvania allowed non-economic damages for pet loss when the conduct of defendants was determined to be outrageous. An Illlinois statute allows for open-ended non-economic damages for pet loss when the defendant's conduct meets the law's definition of aggravated cruelty or animal torture. It also allows clients to recover the cost of their legal fees. This non-economic damage movement in veterinary medicine (as well as the separate but related guardianship movement) is noteworthy for the deluge of legal attention it foists on the veterinary profession.

Additionally, the fact that there are three editions of an Animal Law casebook has helped prompt more than 60 law schools to offer or plan to offer animal-law courses, reading groups, and/or seminars. Irrespective of its merits, animal legal-rights activity is enhancing liability risks for veterinarians.

The human-animal bond moves more clients to seek a perceived higher quality of care assumed to come from board-certified specialists. Secondary-care centers composed of emergency clinicians and a cross-section of specialists now offer 24/7/365 veterinary care for companion animals. They have intensive-care departments that offer CT and MRI scanning, ultrasound and fluoroscopic imaging. They offer kidney transplants for animals in renal failure and advanced chemo and radiation therapy for pets with cancer. Each of these advances brings with it the same potential for human error that befalls the human health-care profession, and all of the previously mentioned factors combine to define a landscape in veterinary medicine that is vastly different from what it was even 15 years ago.

Technology in error reduction

Just 100 years ago, the average human life expectancy was 40 years. By 1990 it had increased to 74 years. Longer life spans, quality of life and health improvements can be attributed in large part to advancements in computer technology.

Information technology (IT) can play an important role in medical-error reduction, too. Some industries, particularly aerospace and nuclear power, already use it to good effect. For example, airplane cockpits have numerous warning systems that provide pilots regular feedback on cabin environment, engines, surrounding airspace, weather patterns and ground conditions. Pilots remain in constant contact with air-traffic control towers, which in turn continuously relay information.

Most jets are now equipped with an Enhanced Ground Proximity Warning System (EGPWS), which provides a 60-second advance warning of approaching hazardous terrain. Planes have sophisticated flight-data recorders that track multiple conditions simultaneously during flight. In the event of an accident, this data can be retrieved to help assess any errors.

The impetus for these advances is the need for safe air travel, which has been ensured in large part by their implementation. More than 10 million airplane takeoffs and landings now occur each year with an average of fewer than four crashes annually.

Similarly, the Three Mile Island incident near Harrisburg, Pa., in the late 1970s prompted the nuclear-power industry to implement technology to reduce errors. Systems for nuclear-plant error detection and prevention are improving dramatically.