The Problem with Problem Lists: How Medical Records Policy Can Backfire

Largest Medical Malpractice Verdict of the Year Hinges on "Problem List"

When a 28-year-old woman suffered a severe stroke after giving birth to her first born child, it was an unexpected outcome given that the woman's life-threatening and previously diagnosed brain abnormality was not properly entered into her medical record. The ensuing medical malpractice case of Larkin v. Johnston (tried by Lubin & Meyer's Benjamin Novotny) returned a verdict of $35.4 million. The landmark case illuminates the topic of "problem lists." In the October issue of Healthcare Risk Management, the article Problem Lists Can Threaten Safety, Pose Liability Risks digs into problem lists as illustrated by the Larkin case — one of the largest medical malpractice verdicts of the year.*

According to the article,
"Many hospitals use problem lists as a way to catalog all health issues affecting a patient, or at least those that are particularly noteworthy for other physicians. A recent study and malpractice case, however, highlight the risk posed by having a policy on problem lists and not following it."
One recent study published in the October 2015 issue of International Journal of Medical Informatics found the levels of completeness of problem lists varied from 60% to 99% across 10 facilities in the study group, with an average of 78%. (See more on the study here.)

According to Attorney Novotny the health system’s problem list backfired...
"The existence of the problem list encouraged clinicians to depend on it for important alerts about a patient’s conditions, he says, which in turn made them lax about digging through the entire patient record in search of important information. When key findings were left off the problem list, the policy ended up causing the very thing it was meant to prevent."
Said Novotny, “They actually had a policy that was right on point for trying to prevent this kind of disaster, and they didn’t follow it. That will always come back and hurt you in court if you have a policy and procedure and don’t follow it.”

* The National Law Journal Verdict Search database from July 1, 2014 through June 30, 2015 ranks the Larkin v. Johnston verdict as the 20th largest verdict in the nation, and #1 in Massachusetts.

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