is challenging, but the effort can bring
justice for your injured client.
Kara DiCecco is a legal nurse consultant with the Law Offices of Doroshow,
Pasquale, Krawitz & Bhaya in Wilmington, Delaware, and an assistant
professor at Wilmington University.
Mindy Cohen is a legal nurse consultant and the owner of Mindy Cohen &
Associates in Villanova, Pennsylvania.
Barbara J. Levin is a clinical scholar in
orthopedic trauma and an independent
legal nurse consultant in Hingham,
Massachusetts. All the authors are
associated with the American Association of Legal Nurse Consultants.
Notes
1. Julia Napper & Terry Napper, CTRM
Raises the Bar for Patient Safety and Staff
Productivity, 28 Radiology Management 36,
37 (Nov./Dec. 2006).
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2. See generally Joint Commn., 2010 National
Patient Safety Goals (2009 prepublication
version), www.jointcommission.org/
PatientSafety/NationalPatientSafety
Goals.
3. Michael Leonard et al., The Human Factor:
The Critical Importance of Effective
Teamwork and Communication in Providing
Safe Care, 13 Quality & Safety Health Care,
i85–i86 (Supp. 2004) (citing Joint Commn.
on Accreditation of Healthcare Orgs.,
Sentinel Event Statistics (2004)).
4. Id. at i86. To understand how miscommunication can lead to patient harm, see Mark
R. Chassin & Elise C. Becher, The Wrong
Patient, 136 Annals Internal Med. 826
(2002).
5. Am. Med. Assn. Code of Medical Ethics,
Op. E-9.045(1) (Dec. 2000), www.
ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-
ethics.shtml.
6. See Kevin B. O’Reilly, Only One Medical
School Uses Classic Version of Hippocratic
Oath, Amednews.com (Feb. 20, 2006),
www.ama-assn.org/amednews/site/free/
prsb0220.htm; see also Melissa Hantman,
From Antiquity to Eternity: Revised
Hippocratic Oath Resonates with Graduates, Cornell U. News Serv. (June 22, 2005),
www.news.cornell.edu/stories/june05/
hippocratic_oath.mh.html.
7. Am. Nurses Assn., Code of Ethics for Nurses
with Interpretive Statements (Nursebooks
2001).
8. For example, an American Medical
Association ethics opinion that addresses
doctors’ communication with nurses
reminds doctors that nurses may have
good cause to refuse to comply with a
doctor’s order if it is “contrary to standards
of good medical and nursing practice.” Am.
Med. Assn. Code of Medical Ethics, Op.
3.02 (updated June 1994), www.ama-assn.
org/ama/pub/physician-resources/
medical-ethics/code-medical-ethics/
opinion302.shtml.
9. The commission is the leading private
accrediting agency for health care
facilities. See George J. Annas, The Rights
of Patients: The Basic ACLU Guide to
Patient Rights 34–49 (2d ed., S.U. Ill. Press
1992); see also Joint Commn., Achieve the
Gold Seal of Approval: Benefits of Joint
Commission Accreditation (July 22, 2009),
www.jointcommission.org/HTBAC/
benefits_accreditation.htm.
10. See Joint Commn., “Do Not Use” List: Facts
about the Official “Do Not Use” List (June 9,
2009), www.jointcommission.org/Patient
Safety/DoNotUseList/ facts_dnu.htm (The
list of “Do Not Use” abbreviations is found
under “Patient Safety.”).
11. Inst. for Healthcare Improvement & Kaiser
Permanente Colo., SBAR Technique for
Communication: A Situational Briefing
Model,
www.ihi.org/IHI/Topics/Patient
Safety/SafetyGeneral/Tools/SBAR
TechniqueforCommunicationASituational
BriefingModel.htm.
12. SBAR was adapted from an early U.S. Naval
situational debriefing model. The
technique was used to provide submarine
commanders rapid access to critical
information. As a former safety officer in
the Navy, Doug Bonacum introduced the
communication technique to a group of
executives during a perinatal patient safety
training session at Kaiser Permanente. See
Jill Rose, Management: The Big Hand-Off,
Inside Healthcare (Jan. 2007), www.
inside-healthcare.com/content/view/1658/
index.php?option=com_content&task=
view&id=1270.
13. 916 F.2d 608, 614 (11th Cir. 1990).
14. Id. at 615; see also Sullivan v. Edwards
Hospital, which brought to light the
controversial issue of the doctor’s
qualifications to speak to the nursing
standard of care. At the trial level, the core
issue of negligence concerned the failure
of the nurse and doctor to accurately
communicate about the patient. 806
N.E.2d 645, 653–56 (Ill. 2004).
15. The AMA Code of Medical Ethics defines
“disruptive behavior” as “personal
conduct, whether verbal or physical, that
negatively affects or that potentially may
negatively affect patient care.” Am. Med.
Assn. Code of Medical Ethics, Op. 9.045(1)
(Dec. 2000), www.ama-assn.org/ama/pub/
physician-resources/medical-ethics/
code-medical-ethics/ opinion9045.shtml.
16. See e.g. Joint Commn., Behaviors That
Undermine a Culture of Safety, 40 Sentinel
Event Alert Issue (July 9, 2008), www.
jointcommission.org/SentinelEvents/
SentinelEventAlert/ sea_40.htm.
17. See e.g. Alan H. Rosenstein & Michelle
O’Daniel, Impact and Implications of
Disruptive Behavior in the Perioperative
Area, 203 J. Am. College Surgeons 96
(2006); see also Kathleen M. Sutcliffe et al.,
Communication Failures: An Insidious
Contributor to Medical Mishaps, 79
Academic Med. 186 (2004).
18. See Timothy Keogh & William Martin,
Managing Unmanageable Physicians, 18
Phys. Exec. (2004).
19. See Jason Byrd & Michael D. Webb, A
Question of Patient Safety: Disruptive
Physicians and Colleagues, 72 Am. Socy.
Anesthesiologists Newsltr. 27, 27–28
(2008), www.asahq.org/Newsletters/
NL%20Portal/PDF/Nov08.pdf.
