Page 18 - APP Collaboration - Assessing the Risk (Part Two)

SVMIC Advanced Practice Provider Collaboration: Assessing the Risk

The following case illustrates an inappropriate delegation:

C A S E S T U DY

A patient presented with a right trimalleolar ankle fracture,

typically a serious injury with a high risk of complication.
The repair and recovery from such a fracture is difficult

even if all goes well, and the method for treating this type
of fracture is varied. The longtime cast technician was out

unexpectedly, and the Clinic CEO asked the Physician
Assistant (PA) to take over casting rather than hire an

experienced technician. The patient thereafter suffered an
equinus contracture. A lawsuit was filed alleging the cast

was applied improperly which caused the contracture.
The PA admitted in deposition to only “limited training

and general familiarity with casting and splinting”. During
litigation, it was revealed that a physician had emailed

the CEO stating his concerns about having a PA perform
this casting function stating, “Casting is crucial to patient

recovery. If a cast is not adequate, the fracture could shift,
which could cause the patient to need surgery or lead

to other complications.” Yet, the CEO did not provide
adequate training or remove the PA from casting.

Ultimately the patient required amputation and the patient

sued. At trial, the jury found for the Plaintiff.

Effective Systems

In medicine today, physicians and other healthcare practitioners
worry about missing something or discovering that follow-up on

a diagnostic test or specialty consult fell through the cracks. Not

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