Emergencies in Medical Practice and Delegation of a Physician’s Duty Flashcards
an unforeseen combination of circumstances which calls for an immediate action to save the life or limb and to avoid permanent damage.
Emergency
“In an ____ there is no emergency.”
epidemic
4 EMERGENCIES THAT MAY CONFRONT A
PHYSICIAN
- Emergency before the commencement of the management procedure
- Unforeseen conditions discovered
- Accident which requires emergency treatment.
- Complications during emergency treatment.
The service of a physician is solicited when the patient’s condition is already serious and immediate treatment is necessary.
Emergency before the commencement of the management procedure
Patient’s condition is already serious and immediate treatment is necessary.
Emergency before the commencement of the management procedure
For example, when treating a patient there is already a certain working diagnosis and upon opening up (surgery) the patient, there is another
condition which calls for emergency.
Unforeseen conditions discovered during the
application of a treatment procedure might require an emergency treatment.
An example is when the plaintiff’s esophagus was perforated during a gastroscopy, necessitating the thoracotomy to repair the damage.
Accident occuring during treatment requiring emergency treatment
For example, you perform an abdominal operation but after a few days there is internal hemorrhage
due to fragility of tissues. The situation calls for emergency treatment.
Complications which require immediate attention may arise after a medical procedure has been applied.
is usually an exception to the observance of the standard ethical conducts
Condition of emergency
All government and private hospitals are required to
provide facilities. is under what obligation?
EXTEND MEDICAL ASSISTANCE IN
EMERGENCY CASES
the process of deciding which patients should be treated first based on how sick or seriously injured they are.
Triage
2 Liablilites under the obligation of hospitals and physicians to extend medical assistance
- Failure to stabilize patient before transfer to another hospital
- immediately concluding that a patient’s condition is not an emergency
If happend to have abandoned a person in danger or on exhibited abandonement of one’s own victim can be penalized under what?
Arresto mayor
Punishment duration of arresto mayor
minimum 1 month and 1 day, maximum of 6 months imprisonment).
abandonment of an injured person in a
public place ___ make you liable.
Does not
For example, you are driving and ACCIDENTALLY hit a child. Your only obligation is to assist, and you are NOT obliged to pay for medical expenses. However you did not do any of that and decided to enact a hit and run. This is punishable under what law?
Failure to assist another whom he has accidentally injured
The law gives the physician the right to act under the theory of implied consent.
STANDARD OF CARE IN EMERGENCIES and EMERGENCY OPERATIONS WITHOUT CONSENT
This cannot be strictly applied to physicians when prime consideration is prompt action to apply lifesaving procedure.
Standard of care in emergencies
a patient has difficulty breathing. You perform an emergency tracheotomy using a pen. Usually, there is failure to observe aseptic techniques, however, if it is an emergency, it is understandable. This falls under what standard?
Standard of care in emergencies
Vehement refusal by the patient who is of age and of sound mind shall prevail even if danger to his life is imminent.
EMERGENCY OPERATIONS WITHOUT CONSENT
An exception, though: If the patient is a minor, as the state to give consent
EMERGENCY OPERATIONS WITHOUT CONSENT
4 CONDITIONS TO BE SATISFIED IN EMERGENCY OPERATIONS WITHOUT CONSENT
- Unconscious
- Necessity
- Can save a life
- Consultation with other doctors is recommended
3 REFUSAL TO GIVE CONSENT DURING
EMERGENCIES
- Refusal of patient
- Refusal of guardian
- Refusal followed by emergency
one in which physician must desist but must try to persuade patient
Refusal of patient
If parents or persons “in loco parentis” (in the place of the parents) refuse to give consent (in a lifesaving operation in case the patient is a MINOR),
physician must file court action to compel giving of consent or divest custody.
Refusal of guardian
A patient does not give consent, but his condition deteriorates, and he becomes unconscious. No decided cases but physician will have defense of
emergency.
Refusal followed by emergency
If during an operation, an accident occurs, or a condition is discovered which requires attention, but such condition is not covered by the consent, the surgeon is justified in extending the operation and be absolved of
liability
EXTENSION OF OPERATIONS IN CASE OF
EMERGENCY
For example, you are performing a simple
appendectomy but discover a rupture in the
intestines or any condition that is considered an
emergency, you are allowed to extend the surgery.
EXTENSION OF OPERATIONS IN CASE OF EMERGENCY
A surgeon may lawfully perform an extended operation as good surgery demands in cases of emergency without the consent of the patient
Existence of emergency
Surgeons cannot extend surgery if the condition ______
does not require immediate action
3 who can attend to an emergency
- Any medically trained person
- Med students and nurses
- Physicians
Physician treats unconscious patient under the ______ of the patient in the physician-patient contractual relationship
theory of implied consent
How to determine the amount that one should pay?
Principle of “quantum meruit”
the value of services is dependent upon the amount of medical services rendered.
Principle of “quantum meruit”
Certain parts of the management may be delegated to
other persons
Delegation of a physician’s duties
A person who was trained to do laparoscopy, when not available, may delegate the duty to a colleague who is also trained in laparoscopy surgery. Is under what?
Delegation of physician’s duties
delegating a performance of an
operation without the knowledge and consent of the patient.
Ghost surgery
For example, if you are a pediatric gastroenterologist and you want to take a vacation you must refer your patients to a physician who is
also a gastroenterologist
Requisite for a valid delegation
4 DUTIES THAT CANNOT BE DELEGATED BY THE
PHYSICIAN
- Duty is part of the contract
- Strict personal service to the patient
- No one is more competent than the physician
- Patient object to be delegated
if ghost surgery is successful is there malpractice?
No
Person performing delegated duty is___ if proper care and diligence is exercised
not liable
Physician may be held liable if he was ___ when the negligent act occurred or otherwise in a capacity to control the act of the person to whom the delegated duty is assigned.
present
During a surgery, the main physician delegated the actual performance of the surgery to an assistant or resident. The physician, who is present in the room, saw the negligent act done by the assistant, but did not do anything. The main physician may be held liable. This is under what?
Liabilities for injuries in negligent performance of the delegated duties