jillio

Whose responsibility is it to inform the parents if it is not the physicans performing the surgery? LTHF Advocate said her clinic, not all clinics. Whose resposnibility is it to do the follow up. And, if the urgeon operates without first ascertaining that vaccine has been given, then who is responsible? Protocal begins and ends with the physician.

Deafness

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LTHFAdvocate

Of course we do, but we do it based on chart reviews. That doesn't require that we be in current contact with the patient.

What makes you think that we have any control whatsoever about what our patients remember? I have come across families (through the appeals program, not at our clinic) where they can't even tell me what brand of implant their child has or when they had their last mapping, much less something that was told to them the week before surgery.

And I don't have the answer to that question, but I would ask you that when they aren't aware, what makes you conclude it's automatically the clinic's fault?

shel90

I see the same with the families of our students. They dont know the brand names ...

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~Shel~

jillio

Once again, who else provides the medical information to these patients? But I never said that all of the fault lies with the clinic. But the services would appear to be so fragmented that the left hand is oftern unaware of what the right hand is doing. The ball is getting dropped somewhere.

LTHFAdvocate

Sorry Jillio, but I don't agree with you. Protocols change over time. There was a time (not really that long ago) where meningitis vaccinations didn't even exist, then there were but they weren't required, then there was one vaccine, now I think there are two. Protocols change over time, and individual physicians, as a whole, are reluctant to change their clinic protocols without recommendations from higher authorities, like the FDA, the AAO-HNS, or the manufacturers. What happens if it turns out 20 years from now that this new meningitis vaccination causes cancer or infertility? Then everyone would be screaming at the doctors for having a blanket requirements that everyone get these shots when the risk of meningitis was so low? Extreme example, I know, but you get my point.

Physicians cannot assume a lifetime of responsibility for a patient. They are responsible for the services they provide and ongoing care as long as the patient remains part of that practice. If the device is raising the risk of meningitis, then it is the device manufacturers' responsibility to notify patients of the changing nationwide recommendations. They have the money, and they have more up to date contact information for the patients. That is how patients implanted 10 years ago when meningitis vaccinations either didn't exist or weren't done should be contacted about getting their shot records examined and updated.

LTHFAdvocate

Be careful with your quotes, Jillio, I didn't say that but you have it attributed to me

jillio

Are you talking about the quote that was cited in your above resposne? No those are not your words, they are mine. They were not attributed to you at all.

LTHFAdvocate

Yet they show up in the grey box marked "Originally Posted by LTHFAdvocate"

R2D2

I didn't say that the surgeon wasn't responsible for improving their systems. It's clear that parental forgetfulness must be taken as a given, even when information is provided and there is a need for the clinics to improve their systems to take account of this. It's quite normal in the medical world and elsewhere for systems to continuously undergo improvement after information is provided via the feedback loop.

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Left ear implanted 9th June 2006 Activated 29th June 2006
Right ear implanted 31st August 2007 Activated 18th September Both Nucleus Freedom

Cochlear implant myths

jillio

Yes, protocols do change over time, and when it is discovered that there is a procedure that caqn reduce the risk, then it becomes standard protocol. So why is it not protocol to simply chaeck a patient's medical record to see if there is documentation of the completed vaccine. Physicans check for medication allergies and complicating health issues prior to surgery. Why not the vaccine? It isn't that difficult, and it requires minimal effort. The medical record is available. All that has to be done is to look in the chart for documentation. No documentation, no surgery until documentatio0n is there. Can't get much simpler than that.

And, no physicians, unless practicing in the field of family medicine, generally are not responsible for the life time of any given patient. However, a surgeon is responsible for that patient pre-surgically, during surgery, and post-surgically. Pre-surgical responsibility would imply that the surgeon determine whether the vaccine had been completed prior to putting the patient under the knife. If a dentist fails to insure that an orthopedic implant patient has been premedicated with antibiotics prior to dental procedures, and that patient contracts bacterial endocarditis as a result, the dentist is held responsible, because it is his area of expertise to insure that the patient is not put under undue risk. Likewise,the implant surgeon who fails to insure that a patient has been vaccinated, and that patient later contracts bacterial memingitis as a result, the surgeon is resposnible under the same premise of expertise.

jillio

Exactly what # post are you referring to. In order for your words to show up as a quote, I had to click on your original post. It automatically copies it when you click on "reply with quote". Are yousaying something was copied that was not in your post?

LTHFAdvocate

#214 -- your answers are intermixed with my quotes, and it looks like I said most of it (at least the way I am reading it)

R2D2

A bit of a worry! One wonders if they know the make of the car they drive too?

__________________


Left ear implanted 9th June 2006 Activated 29th June 2006
Right ear implanted 31st August 2007 Activated 18th September Both Nucleus Freedom

Cochlear implant myths

LTHFAdvocate

If only it were that simple. It isn't. It can take years before protocols change, and university hospitals (where over 1/2 of implants take place) are even more hierarchical and inflexible on this than small clinics.

Again, a total oversimplification. Even when the standard of care is raised due to expertise, a plaintiff would still has to prove proximate cause and actual cause for a negligence case.

jillio

Guess I should have changed the font color. I thought the space was sufficient, particulary since it was a reply to an earlier post, and clarification is readily available should one choose to took.

For all purposes, the paragraph in the center talking about protocols and surgeon responsibility are my words.

jillio

And that would not be difficult to do if a surgeon knew of a risk, and did not insure that the patient was protected against it. Particularly so in close proximity.

LTHFAdvocate

But if the surgeon informed the patient of the risk and the patient (or her parents) blew off the vaccine, that is NOT the surgeon's fault. Personal responsibility needs to fit in here somewhere, patients cannot hold other's responsible for their poor outcomes when it is due to their individual action or inaction.

Know anyone who has successfully sued a restaurant for food poisoning? It doesn't happen exactly for the same proximate cause proof problems.

jillio

Hence, requiring documentation. If there is documentation in the chart, then obviously the aprent did blow off the surgeon's reccommendations. And if there is no documentaiton, obviously the parent failed to follow reccommendations. Therefore, no surgery.

jillio

Fallicious argument. Restaurants are not held to the ethical standards or criteria of expertise and scope of practice that a medical professional is.

LTHFAdvocate

Standard of care and causation have nothing to do with each other except for the fact that they are both required to prove negligence. Or so they taught me in law school.

jillio

And if a physican fails to insure that a patient is vaccinated, thus increasing that patien's risk for bacterial meningitis, then that physician has not adhered to standards of care. And you are telling me that a judge and jury would not hold a physican to a higher ethical standard and a greater degree of responsibility than they would a line cook?

Tousi

Hey, you two; let's go have some coffee or something, huh?

jillio

[QUO1TE=Tousi;855674]Hey, you two; let's go have some coffee or something, huh? [/quote]

Sure!