Legal Aspects of Medical Emergencies

By Vicky Vance, JD

A patient emergency may present before, during or after an in-office visit. Naturopathic physicians and office staff must be prepared to recognize crucial clinical clues and respond appropriately.

Hindsight is 20/20, and it's easy to simply reschedule a patient for another office appointment when they really need a referral. What can you do beforehand to identify the critical, yet often subtle, distinctions that warrant an emergency referral?

Tips to Detect an Impending Emergency

Listen—to what is said and how it is said. How does the patient (or family member) describe the concern? Be attentive to their choices of words and adjectives (“worst headache of my life”), body part involved (“the pain wraps around my entire upper chest,” “my stomach feels bloated”), and tone of voice (alarm, urgent, frightened, anxious).

Engage—by asking probing questions to elicit the important clinical details: time of onset, pattern (“what makes it better or worse?”) and history (“have you ever felt like this before?”).

Access—the patient’s medical record or EHR, to quickly put the visit into clinical context. Are the patient’s complaints new or different? Has there been a recent intervention, procedure or medication that may be causing or contributing to the patient’s problem? Is the acuity and severity of the occurrence out of the ordinary or worse than expected given the patient’s history? Is there family, social, work or medical history that warrants changing the differential diagnosis?

Ask for help—from an experienced colleague, supervisor, or another healthcare provider  to help sort out a confusing or complex clinical picture. Do not hesitate to make a referral to a specialist or emergency provider, if the clinical circumstances warrant. There is no “I” in Team. Fresh eyes and a different clinical experience can be crucial to making a correct diagnosis.

Think twice about your conclusion–and revise it if needed. Stubbornly clinging to a preconceived diagnosis and being reluctant to rethink the situation can have disastrous consequences. Often mistakes are made or a correct diagnosis is delayed because:

  • Providers hold fast to an established diagnosis or condition and do not recognize that a new complication is emerging.
  • A medicine is having an unexpected side effect.
  • The patient’s recovery is taking longer than normal.
  • A post-operative complication has developed.
  • The vital sign trend line is moving in the wrong direction for the diagnosis that you thought was right.

Take good notes—documentation is crucial! It must be accurate, specific and timely. Capture the details of what the patient is describing: the area of complaint, time of onset, duration, etc. And NEVER alter or destroy records after the fact. The penalty for “spoliation of evidence” can be staggering.

Risk Management Resources

NCMIC takes their role as your malpractice insurance company very seriously. They want you to be successful in your practice and, if at all possible, help you avoid a malpractice allegation or board complaint. Find more NCMIC risk management resources in the blog section of 

Vicky Vance enjoyed a 20-year career as a trial attorney defending doctors, hospitals and pharmaceutical companies in high value and complex litigation, when she was recruited to move in-house and develop the nationwide litigation program for The Cleveland Clinic Foundation. Vicky is Chair of the Healthcare Practice Group at Tucker Ellis LLP, where her practice now focuses on providing a full range of regulatory counsel and litigation services to healthcare providers, insurers, underwriters and pharmaceutical clients.

ND Insights is published for NCMIC policyholders. Articles may not be reprinted, in part or in whole, without the prior, express consent of NCMIC. Information provided in ND Insights is offered solely for general information and educational purposes. Names and events are created for illustrative purposes only. It is not offered as, nor does it constitute, legal advice or opinion. You should not act or rely upon this information without seeking the advice of an attorney.

How can you determine when a situation warrants an emergency referral?