Virginia: Medical Malpractice – a Lawyer’s Pilot (July 7, 2015)

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On July 2, 2015, Defendant, Riverside Hospital, Inc. provided as ordered its 2012 “imaging results reporting communication pilot” materials in response to Plaintiff’s discovery – despite one responsive memoranda being marked self-servingly “Confidential documents for Quality of Care Purposes under VA Code Ann. §8.01-581.17”. The underlying wrongful death case is Rauchfuss v. Schultz, et al., No. CL1302754V-04(DP) in Circuit Court for the City of Newport News, Virginia.

Riverside’s radiology pilot program was developed in conjunction with Defendant, Peninsula Radiological Associates, Ltd. commenced at Riverside Walter Reed Hospital on July 2, 2012; at Riverside Shore Memorial Hospital on August 20, 2012; at RDC Out-Patient on September 4, 2012; and at Riverside Tappahannock Imaging Services on October 8, 2012. Notably, except for RDC OP, Riverside’s radiology pilot program was limited to Emergency Department and in-patients, i.e., excluded out-patients; plus it was confined to its Middle Peninsula facilities.

Riverside declared its program’s purpose: “This pilot is designed to identify imaging results that require follow up and review whether appropriate actions have been taken.” It also emphasized its “direct notification” process: “The direct notification of the ordering physician/provider will facilitate closed loop communication of important findings potentially requiring further action.”

On October 24, 2012, Riverside provided a Hospitalist Team Update for its Imaging Results Reporting Project. Significantly, this Update’s “Background and History” admitted multiple substantial shortcomings with Riverside’s then-existing radiology reporting policy/procedure/protocol in Riverside’s health system:

1. Delay in or failure to act upon test results is one of the top exposures for medical malpractice. In many cases, test results never reach the intended physician and follow up care is not timely.

2. July 2011: RMG [Riverside Medical Group] tracking policy approved by the Board…but this wasn’t enough.

3. Multiple cases with similar themes:

A. Lung nodules

B. Inpatients

C. Inconsistencies in hand offs

D. Technology/interfaces

E. Location/RWRH

F. Patients were never notified

G. PCP’s never notified

4. Decision made to utilize the following case to facilitate RHS [Riverside Health System] wide processes involving radiology diagnostics.

Riverside’s Update also recounted “What happens now (pre-pilot)”.

Additionally, Riverside’s Update marquees “Short Term Corrective Action/Pilot”. Therein re the Radiology Department, corrective action mandates: “If the EMR contains no evidence of follow up care, make phone call to primary care physician or ordering physician to ensure proper hand off.” (emphasis added).

Further, Riverside’s Update tabulates favorable “Imaging Results Pilot”. That included expansion and transitioning of the pilot program.

Finally, Riverside’s Update concludes with “Imaging Results Reporting – Next Steps”. That features inter alia: (A) “Follow-up handled centrally”; (B) “Phone call to ordering physician from radiology”; and (C) “Auto-push to PCP”.

Two practice pointers flow from this Riverside example. First, Plaintiff counsel need to be savvy to the prevalence of such trenchant pilots at hospitals and possibly other healthcare facilities.

Second, Plaintiff counsel should propound special Interrogatory/Request for “pilots and like programs or projects”. Riverside did not identify any of its pilot information and materials in response to discovery about its policies, procedures, protocols, guidelines, etc. – indeed, in Mr. Waterman’s 33-year practice, no healthcare provider has identified such pilots, programs and/or projects in response to discovery requests seeking policies, procedures, protocols, guidelines, etc.