Medicolegal Mishaps: The Airline Industry and Medicine

Robert Blumm, PA returns with insights on how airlines can relate to medicolegal risk. Also, he’ll share his recommendations for PA/NP medical malpractice insurance.

Last Updated: 4 December 2019

Medicolegal Mishaps: Medicine and the Airline Industry

By Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus. PA Advisor for CM&F.

How PA/NP Medical Malpractice Insurance

Relates to the Airline Industry

It’s been almost a decade since medical practitioners have seen the advantage of looking to the airline industry as an inspiring and useful template for addressing safety concerns.

We recognized the fruit of this comparison as we deal with ever-increasing statistics revealing medical errors, both by providers as well as by healthcare systems.

We learned the importance of drills and safety checks and written and online manuals and, most importantly, flight checks in surgery. One of these checks that reduced the chances of wrong site surgery in operating room (OR) was an “X” and an initial by the surgeon in the holding room.

The flight check moves through a patient’s admission to an OR, including nursing questions and interventions to ascertain identity, knowledge, allergies, and other important variables prior to a patient becoming anesthetized.

As I contemplated these discoveries and their medical implications, I thought of the marvel of the Black Box.

The flight data recorder and cockpit voice recorder, commonly called a ‘Black Box,’ stores information concerning the aircraft’s travel and fuel consumption. They provide valuable input into the causative factors in air accidents. The Black Box is compulsory on commercial and corporate aircraft.

They are not really black but orange, like the Golden Gate Bridge. They are a color that is known as ‘international orange.’ Speed, altitude, vertical acceleration, and fuel flow are just a few of the 700 parameters in these solid-state recorders.

The Black Box in Medicine

In 1979, we developed the ‘Black Box’ as referred to in pharmacy to warn the prescriber, the pharmacist, and the patient of possible life-threatening adverse reactions.

A black box warning is the strictest warning put in the label of prescription drugs or drug products by the Food and Drug Administration (FDA) when there is reasonable evidence of a serious hazard with a drug. It is basically a warning inside of a stark black box, hence the name.

Some of our most commonly prescribed drugs are in classes that have this designation. Antibiotics like fluroquinolones carry a black box warning, as do multiple drugs prescribed for mental health issues, anticoagulants such as blood thinners like Pradaxa, diabetic medications, CNS stimulants, sedatives, pain medications, antiplatelet medications, and injectable antibiotics.

Noting the many classes of drugs that are affected should alert the PA or NP to perform due diligence before prescribing and look for the warning as well as other information concerning allergy, side effects and adverse reactions.

I worked with a surgeon who hardly ever used his prescription pad. When he did, it was to write a small group of twelve medications that were known to him from fifty years ago when he was in training. He picked up on some of the newer antibiotics, but had no continuing education in pharmacology.

I believe it is the responsibility for all PAs and NPs to take a refresher on pharmacology at least every three years.

There are a few immediate actions that can make a significant difference. First, clinicians should be familiar with a small set of their specialty’s most commonly prescribed drugs. Additionally, be aware of black box warnings and know the information available on the package insert.

Medical Malpractice Risk

What is the urgency here?

I have served as an expert witness on many malpractice actions taken against my fellow PAs and it is difficult, if not impossible, to defend an adverse outcome when the defendant’s attorney has a large black box slide projected before the jury.

Ignorance of potential drug complications demonstrates apathy and lack of concern for your patient. What can you do to protect yourself from a judgement that has the ability of destroying your career?

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Your Clinical Safety Check

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Your safety check is called awareness. Be aware of the potential problems, side effects, and contraindications of every drug you prescribe.

Remember that the malpractice attorney will be looking at this list first. They will also be looking for the dreaded black box.

Of course, there are times in the practice of medicine where there may be confusion or an unusually fast pace. These are the times that increase your potential for making a medication error.

A surgeon once told me that he was “operating on a patient, not a clock.”

The distractions of EMRs and other personnel entering your operating or exam room are always present, and with them the possibility for error.

With the potential for your making a medication error, do not make the error of not having the proper liability insurance. Many practices are bought by larger systems and, often without our knowledge, the insurance protection may change.

We are often not as astute as we should be. We may be far too trusting and discover only after a legal action that we are inadequately insured. To prevent this, I strongly encourage you purchase an individual professional liability insurance policy. It is your only life boat if your plane or case crashes.

Don’t be caught unaware: contact a CM&F insurance broker for PAs and NPs today. CM&F policies are different from others in that they are backed by an A.M. Best Rating of A++ (Superior). It’s been my policy for over twenty-five years and the only one that I encourage PAs or NPs to purchase.

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