Question

Explain the four elements necessary to prove negligence. (The four D's: duty, dereliction, direct cause, damages.)

How might accurate, complete medical records help in defending efforts from a plaintiff's attorney to establish the four D's?

Comment on how positive ethical practice behavior improves quality of care and helps to protect against malpractice litigation.

Answer 1

1) Negligence claims must prove four things in court: duty, breach, causation, and damages/harm. Generally speaking, when someone acts in a careless way and causes an injury to another person, under the legal principle of "negligence" the careless person will be legally liable for any resulting harm.
Duty: You must first prove that the person against whom your claim is made owed a duty to you. The duty can arise from ownership or operation of the instrument of the injury, the relationship between the people involved, or by law. The existence of a duty is fundamental to a successful claim.

Breach of Duty: You must then prove that the responsible party breached its duty. A breach can come as a result of an action or, sometimes, inaction by the responsible party. The ability to explain, with clarity, how a duty was breached is necessary in any negligence claim.

Causation: You must then prove that the responsible party, by breaching its duty, caused you harm or damage. In addition, your injury or damage must have been reasonably foreseeable at the time. This is typically determined on a case by case basis, based upon all of the available evidence.

Damages: You must then show the nature and extent of your damages,ie, your injuries or property damage. In negligence cases, damages often include things like hospital or medical expenses, lost wages and pain and suffering.Oftentimes, even when liability is clear, disputes arise between the parties as to the nature and extent of damages in the case.Depending upon the information available, an experienced personal injury attorney can generally determine what your case may be worth, and why. Attempting to negotiate on your own against the negligent party (or their representatives) can be a bad idea. Unfortunately, over the years, the process has become increasingly complex and confusing. As a result, it’s usually best to contact an attorney before attempting to handle an injury claim on your own.

3) According to the non-maleficence principle of medical ethics, ensuring patients safety and preventing any injury or damage to them is a major priority for healthcare providers. Thus, it has been the most emphasized component of the quality of health care services all around the world. The Institute of Medicine (IOM) released a report in 1999 entitled "Man is fallible: create a safe health system" in relation to the incidence of medical errors in United States, and consequently, initiated widespread international change in the field of patient safety. Correspondingly, the Iranian health care system implemented special plans purposed to deliver standard health care services and prevent any mistakes and an organized approach to risk management, systematic deficiency, and patient safety improvement. One of these programs is clinical governance which was introduced by the Ministry of Health and Medical Education (MOHME) and initiated since November 2009. Although great emphasis has been placed on the importance of clinical governance by the MOHME, there are some challenges in achieving the desired outcomes. This could be the result of healthcare providers inadequate understanding about the importance of clinical governance and lack of organizational safety culture.Studies showed that a non-negligible percentage of patients are exposed to health care-related injuries. Based on World Health Organization (WHO) report, the possibility of harming patients in the process of providing health care services is 1 out of 300, whereas the possibility of aviation accidents is 1 out of 100,000. Since 2004, with the beginning of the patient safety project, so far 140 countries have attempted to improve their patients safety plans in their own health system. The most common cause of injury is medication errors and falling. Although falling includes 21% of total incidents, only 4% of them are serious. Meanwhile the neonatal falling statistics in the USA is 1.6-4.4 in 10,000 live births, an estimated 600-1600 falling incidents in a year. These cases are often the result of shortcomings in systems and processes, organizational complexity and ambiguity, and poor communication.Despite various patient safety guidelines and standards, less attention is paid to the ethical and legal aspects of this issue. From a moral perspective, the main goal of patient safety in the health system can be studied from two aspects. It can be studied as a practical value, in the sense that the main focus is its positive outcomes and benefits. It can also be studied as a moral value by focusing on the protection and promotion of humanity and human dignity. It should be emphasized that both aspects are important in the health system. From a professional point of view, moral values in patient safety are not separated from basic medical obligations, but are so central that they may be the source of other moral values emphasized in medicine. This means that patient safety is closely related to the concept of human dignity and all patient safety measures taken must insure the protection of human’s dignity. In other words, the responsibility of the health care staff and professional commitment, in general, are closely related to human dignity.This case was raised in the monthly ethics round in the Children's Medical Center of Tehran University of Medical Sciences, Iran, and ethical dimensions of patient safety were discussed by experts in various fields. The opinions expressed in this article are a summary of the views of experts in various fields including neonatology, medical law, ethics, and nursing.It is worth mentioning that the ethics round has been held every month for more than 5 years in the Children's Medical Center. A complicated case is discussed in each session with the presence of different relevant experts.