A 55-year-old man regularly attends the ED complaining of recurrent abdominal pain, which he relates to episodes of heavy alcohol ingestion. He consistently demands opiate analgesia, discharging himself once treated. One evening, he discharges himself after being refused opiates by a junior doctor, and buys morphine from a dealer. He is found collapsed and hypotensive in the street, and dies from respiratory arrest in the ED. A subsequent autopsy reveals mesenteric infarction. His wife states angrily that the hospital has been negligent and she will sue.
Regarding negligence, which ONE of the following statements is TRUE?
Answer: A: For negligence to be proven, a number of points must be established:
Duty of care is a legal obligation to conform to a particular standard of conduct for the protection of unreasonable risks. Reasonable care is the standard of care that might be expected of the average practitioner of the class to which the healthcare practitioner belongs. It includes a duty to possess and exercise proper skill, to maintain competence and current knowledge in their field.
In allegations of breach of duty of care, the subsequent event must involve both foreseeability and probability of harm. This is not clear in this situation from the information given. Damage to a plaintiff is considered in terms of physical harm or psychological injury, rather than emotional distress. While this patient had a life-threatening illness, and a breach of care has not been excluded, the precipitating cause of death was not a direct consequence of such a breach.
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A 32-year-old woman with advancing multiple sclerosis (MS) is brought to the ED following a significant paracetamol overdose 12 hours before. She had not informed anyone at the time but had admitted it to her GP on developing vomiting and abdominal pain. She states clearly that she had attempted to kill herself, as she did not wish to end up like her father, now bed-bound and in a care facility due to MS. Transaminases are > 2,000 IU. She declines treatment with N-acetyl cysteine infusion. The GP, who accompanies her, insists she should be detained and treated.
Regarding consent issues, which ONE of the following statements is TRUE?
Answer: B: Consent may be implied (e.g. arriving at hospital seeking assistance), verbal or written. The level of consent must be commensurate with the seriousness of a proposed procedure, or the consequence of declining treatment. For example, consent for a surgical procedure must be obtained in writing, with evidence that the procedure, possible side effects, complications and purpose have all been explained, and the patient has had a chance to ask questions. This is then signed by both patient and doctor.
In order for consent to be valid, five elements must be established. It must be:
Assessment of competence is based on a number of factors:
The patient’s judgement as to what is in her own best interest may differ from that of the treating team but constitute a valid viewpoint. When in doubt, enlist another staff member or senior, and document the decision-making process clearly. Where there is disagreement, discuss with the hospital legal advisors at an early stage.
In which ONE of the following situations is there NOT a mandatory requirement to report the issue to a relevant authority?
Answer: A: While hospital staff have a duty to provide each patient with the best clinical care and support, there is no legal obligation to report a victim of domestic abuse without the patient’s consent, unless concern exists that a vulnerable adult or child may also be at risk in the domestic environment. Where concern exists that the public may be endangered, this outweighs the duty of non-disclosure protecting patients’ confidentiality.
A medical practitioner who believes that a patient is unsafe to possess a firearm by reason of illness, disability or deficiency, is legally obliged to inform the officer in charge of their jurisdiction’s firearms section at the earliest point after this belief is formed.23 The Communicable Disease Network Australia & New Zealand coordinates the surveillance of more than 50 communicable diseases, including AIDS, diphtheria, leptospirosis, measles, mumps and most sexually transmissible diseases.
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Regarding forensic examination in alleged sexual assault, which ONE of the following statements is TRUE?
Answer: D: Victims of sexual assault have the right to access an appropriately trained forensic practitioner. Clinical care takes precedent over forensic considerations. Forensic examination is carried out at the request of the police service for collection of evidence, rather than for any therapeutic benefit, and therefore requires specific consent to be obtained. Specimen handling should follow the legal concept of ‘chain of evidence’. The forensic examination is to collect evidence regarding three areas:
Proof of sexual contact is established by detecting semen or spermatozoa on or within the victim or their clothing. It is not necessary to prove sexual contact to prove sexual assault. Evidence of force might be detection of physical injuries.
Regarding preparing medicolegal reports, which ONE of the following statements is TRUE?
Answer: D: Provision of healthcare information requires signed consent from the patient, unless required by the coroner. In providing a report, it is important to confine statements to actual fact rather than speculation, and to confine reporting to one’s own area of expertise. Where opinion has been requested, this should be clearly differentiated from reporting of facts. Reports should be written in the understanding that the author may be called upon in future to speak to their report in court.
Components should include:
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