State Civil Liability Protections for Physicians who Provide Care During Covid-19 Pandemic map.

How States are Protecting Health Care Providers from Legal Liability in the COVID-19 Pandemic

By Valerie Gutmann Koch

Since the onset of the COVID-19 pandemic, clinicians and policymakers alike have raised the alarm about potential legal liability for following crisis standards of care.

Liability protections may be necessary when, due to the circumstances of the emergency, a state faces scarce resources (such as ventilators or ICU beds) and the state activates its crisis standards of care (CSC). A CSC authorizes the legal prioritization of patients for scarce resources based on changing circumstances and increased demands. CSCs provide a mechanism for reallocating staff, facilities, and supplies to meet needs during a public health emergency.

Notably, and by necessity, the standard of care that clinicians may be able to provide during the COVID-19 pandemic may depart significantly from standard non-emergency medical practice. In a non-crisis setting, the prevailing medical standard of care focuses on the needs of each individual patient and is centered on the principle of informed consent. In a public health emergency, however, such concentrated care may be impossible or inadvisable due to: (1) resource limitations and (2) the goal of saving as many lives as possible.

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woman with iv in her hand in hospital. Labor and delivery preparation. Intravenious therapy infusion. shallow depth of field. selective focus

Maternity Care Choices in the U.K. During the COVID-19 Pandemic

By John Tingle

One of many legal, ethical, and patient safety issues raised by the COVID-19 pandemic across the National Health Service (NHS) is that expectant mothers are considering freebirthing more after home births are cancelled.

The charity AIMS (Association for Improvements in the Maternity Services) states that while there is no specific definition of freebirthing, “…broadly speaking, a woman freebirths when she intentionally gives birth to her baby without a midwife or doctor present. Some women prefer to use the term ‘unassisted childbirth’ or UC to describe this.”

In The Guardian Hannah Summers recently wrote about this issue, which can carry major health risks. For example, if complications occur during a freebirth, professional clinical help will not be at hand to help.

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LOMBARDIA, ITALY - FEBRUARY 26, 2020: Empty hospital field tent for the first AID, a mobile medical unit of red cross for patient with Corona Virus. Camp room for people infected with an epidemic.

Pandemic Guidelines, Not Changed Malpractice Rules, Are the Right Response to COVID-19

By Valerie Gutmann Koch, Govind Persad, and Wendy Netter Epstein

On March 17, the Washington Post published an op-ed by Dr. Jeremy Faust, titled Make This Simple Change to Free Up Hospital Beds Now. In it, he argues that cities and states should “temporarily relax the legal standard of medical malpractice,” in order to encourage hospitals to admit, and physicians to treat, the patients who need help during the COVID-19 pandemic.

In a tweet promoting the piece, Dr. Faust expresses concern that in the absence of such a legal change, “docs will keep doing ‘usual’ low yield admissions.”

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an ambulance parked at the entrance of an emergency department

Patient Safety and Health Quality in the NHS (National Health Service) in England: A Zip Code Lottery?

By John Tingle

The independent regulator of health and social care in England, the Care Quality Commission (CQC) regularly produces detailed inspection reports on the health and care organisations that it regulates. These reports show that quality of care and patient safety are not consistent across England’s health and care facilities. Wide variations in quality and safety between core services in the same NHS hospital or in the same locality as well as regionally are sometimes revealed. It is clear from reading the reports that patient safety and health quality cannot be a measured as a constant across England.

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The Ostrich Syndrome and Patient Safety

By John Tingle

Sadly, the NHS (National Health Service) in England is littered with examples of cases where individuals and organisations have seemingly buried their heads in the sand when patient safety errors have occurred. Attitudes that can be seen in past reports range from,’ it’s not my responsibility’, to procrastination, or passing the buck, assuming that another organisation is dealing with the matter or just simply delaying a response or even ignoring the situation completely.

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Photograph of a report on a table, the report is labeled, "NHS"

The NHS In England: Patient Safety News Roundup

By John Tingle

There is always a lot happening with patient safety in the NHS (National Health Service) in England. Sadly, all too often patient safety crises events occur. The NHS is also no sloth when it comes to the production of patient safety policies, reports, and publications. These generally provide excellent information and are very well researched and produced. Unfortunately, some of these can be seen to falter at the NHS local hospital implementation stage and some reports get parked or forgotten. This is evident from the failure of the NHS to develop an ingrained patient safety culture over the years. Some patient safety progress has been made, but not enough when the history of NHS policy making in the area is analysed.

Lessons going unlearnt from previous patient safety event crises is also an acute problem. Patient safety events seem to repeat themselves with the same attendant issues

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An index finger rests on one yellow star while four other stars are shaded to the right, indicating a one star review.

Improving the Mindset on NHS Complaint Handling

By John Tingle

History has not served the NHS (National Health Service) complaints system well

History has not served the NHS complaints system well. There have been many reports about NHS complaints going back well over two and a half decades, saying the same or similar things about the system. Many have argued and continue to argue that the NHS complaints system needs to be much more responsive, simpler in operation and less defensive. It is fair comment to argue today that the NHS complaints system is still plagued with endemic and systemic problems. The NHS has never been able to gets its health care complaints system right.

Two contemporary reports, one published in 2018 and the other in 2020, give support to the view that the NHS needs to do much more to improve how patient complaints are handled. Read More

Soft-focus photograph of wheelchairs lined up in a hospital hallway

Toward a Safer NHS in 2020

By John Tingle

As the New Year begins its important to reflect on the previous year’s National Health Service (NHS) patient safety milestones in England. We should ask also whether the NHS patient safety agenda will make major advances in 2020.

The year 2019 was another bumper year for NHS patient safety policy developments and crises. Some major patient safety publications were produced, and stories of NHS patient safety crisis continued to regularly hit the headlines. The NHS is no sloth when it comes to patient safety policy report writing and the number patient safety adverse incidents happening. Read More

Three hard hats for construction work lined up on a concrete wall

Enhancing Patient Safety Education and Training through Legal Study

By John Tingle

In the new NHS Patient Safety Strategy for England there is a discussion of patient safety education and training. While safety is now better understood there are significant numbers of people who still have a limited understanding of safety science.

A National Patient Safety Syllabus

A commitment is made to have a universal patient safety syllabus and training program for the whole of the NHS. Health Education England (HEE) will have a pivotal role: Read More