Liability for prescribed devices

Liability for prescribed devices

Warren Mays

3/1/2007

Hello All,

 

I'll attempt to make this as brief as possible.

 

A local hospital just called us with an order to fit an off-the-shelf AFO,
recommended by the physical therapist, and subsequently signed off on by the
physician. The patient is a Medicare patient in a Medicare bed. The patient
is to be discharged this afternoon, after receiving the AFO, and sent to a
skilled nursing facility. We do not know if the patient has the correct shoe
for use with the AFO. Apparently, the patient has developed drop foot from
laying in bed for an extended period of time. We are unaware as to whether
or not the patient has an appropriate shoe for use with the AFO. We do know
that the hospital has deemed it dangerous for the patient to leave without
an orthosis.

 

Our concern is that, if we go to the hospital and do a thorough evaluation
of this patient, we may decide that the patient needs something more than an
off-the-shelf AFO. Perhaps they need a custom AFO. If we provide the
off-the-shelf AFO knowing that this is not the correct device, what kind of
liability are we opening ourselves up to? If we go into the patient room and
don't, or can't, do a thorough evaluation of the patient and fit them with
the device, only to have them fall in rehab at the SNIF, are we liable?

 

Finally, could we have the patient, or a family member, sign a statement
acknowledging user guidelines, and decrease our liability? It seems to me
that if a patient and/or family member is not a medical professional, they
could claim to not understand the instructions. After all, if the prescribed
device is not appropriate for the patient, why on earth would we provide it?

 

I know that we all go into hospitals and fit devices all the time, without
the luxury of being able to stand up or otherwise fully examine our
patients. I also know that a hospital cannot wait to discharge a patient
while waiting for a custom device to be made and delivered. Finally, the
hospital has indicated to us that if we cannot provide the orthosis, they
will find someone who can. I certainly don't want to loose a referral
source, if possible.

 

Am I making too much of this, or is this really a dangerous liability?

 

One of the reasons that this is such a sensitive issue for us right now is
that we just went through the same situation with another patient who ended
up in a SNIF. We have received a call from a different employee at the SNIF
EVERY DAY since, asking why the brace doesn't fit, and why would you
provide such an ill-fitting device. They don't understand that it is an
off-the-shelf device meant to fit within small, medium or large guidelines,
or that you must use a shoe with Velcro or string-tie closure and with a
3/8 heel with the orthosis at all times. (They were using a slipper with
the AFO, and noted that the orthosis was rubbing the patients' heel because
the heel wouldn't stay down within the AFO.) We've repeated this information
to someone at the SNIF four days in a row now. They think we're nuts for
being so defensive and also for providing a patient with such an ill-fitting
device.

 

Sorry for the rant.

 

Warren R Mays, CPO


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