PA/NP attestation note

[cyanide12345678]

New to the attending world. When you guys attest PA notes for low acuity things that you didn't personally see, what do you guys write in your attestation?

What I'm writing right now says "I was personally available for consultation in the ED. I have reviewed everything on the chart that is available and agree with the documentation provided by the MLP including discussion about the assessment, treatment plan and discussion. Based on medical record the care appears appropriate".

I'm thinking of adding something In the beginning that explicitly states that I did not see this patient

Thoughts?

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[GonnaBeADoc2222]

Doesn't matter if you saw or not, if they asked you to see or not, etc, for liability. You will be nailed for "failure to supervise."

 

[Groove]

New to the attending world. When you guys attest PA notes for low acuity things that you didn't personally see, what do you guys write in your attestation?

What I'm writing right now says "I was personally available for consultation in the ED. I have reviewed everything on the chart that is available and agree with the documentation provided by the MLP including discussion about the assessment, treatment plan and discussion. Based on medical record the care appears appropriate".

I'm thinking of adding something In the beginning that explicitly states that I did not see this patient

Thoughts?

I posted this in another thread awhile back:



If I was sent a note to sign, I simply sign it (per CMG policy) without an attestation.

If the management was questionable, I add the following attestation:

"I was available for consult in real time but was not asked to participate in the care of this patient nor was I asked to assist in management. The APC functioned independently in this pt's care. I am unable to determine appropriateness of management without obtaining a personal history and exam."

Although there is evidence on here from others that none of these attestations really insulate you...I like to think I could mount a reasonable defense in the event that I never knew about the patient, nor knew about the care provided. I base that on the following excerpt from the link above:

In addition, many physicians have misconceptions about insulating themselves from liability. It is commonly assumed that if physicians distance themselves from the care provided by advanced practice providers, they will limit their liability exposure. However, this is only partially true. As a supervising physician, it is likely you’ll be named in a claim and lawsuit if negligence is alleged regarding an advanced practice provider you are supervising. This is particularly true when you are physically located in the same treatment area (e.g. emergency department) and at the same time as the advanced practice provider.

If the supervising physician was never informed about the patient, this would be very useful in their defense, as one cannot be expected to provide care for those they do not know exist. However, if the advanced practice provider discusses the case with the physician or the physician knew or should have known about the patient, their inaction will likely be challenged as unreasonable.

Reasonableness of actions is the underpinning of all tort liability claims. Operational policies that clearly define how advanced practice providers will function in your emergency department and the physician’s supervisory responsibilities are very risk protective. In other words, if an advanced practice provider saw a patient and the physician did not see the patient and did not discuss the case with the provider, the physician will have a strong defense if that level of supervision comports with the department policy defining the required level of supervision.

 

[carbonizedeyesockets]

Attestation statements do not provide protection. Write a note if you saw them. If you didn’t, just do whatever you’re supposed to do (sign, send to medical director, whatever).

 

[cyanide12345678]

Attestation statements do not provide protection. Write a note if you saw them. If you didn’t, just do whatever you’re supposed to do (sign, send to medical director, whatever).

I was originally just signing, got a lot of documentation notes back to put in an attestation note I'm addition to signing. So the above attestation is what I'm writing.

 

[GonnaBeADoc2222]

Not worth the mental energy, emotional strife reading the garbage these midlevels put out. You're liable either way.

If you are truly required to sign, look the other way, hold your nose, and sign. No point in even reading the note.

If you are lucky your group might be able to collectively refuse to sign the notes and force the medical director to sign all of them. Probably doesn't decrease liability as you're still present on shift and "supervising," but feels better to not have your name associated with sh**.

 

[RustedFox]

Presently in a lawsuit regarding a patient that I never saw. PA saw, discussed it with a different attending. Chart came to me to sign. Signed.
Patient died.

It doesn't matter what you do or don't type in your attestation. At all.

 

[Groove]

Presently in a lawsuit regarding a patient that I never saw. PA saw, discussed it with a different attending. Chart came to me to sign. Signed.
Patient died.

It doesn't matter what you do or don't type in your attestation. At all.

Damn. Would love to know more details but understand if you can't share them considering the active case. Surely the other attending was also named? It seems to me you could still mount a good defense since you weren't the one that they discussed the case with and never knew about the pt.

I hate signing these things. I had one yesterday sent to me about a human bite wound over the MCP of someone's dominant hand dx as "hand cellulitis" and sent home on keflex of all things. No documentation of extensor tendon exam and wasn't even specific about the lacerations from the bite. There was so much swelling that the radiologist even commented on it on XR. I tried calling the pt to come back for MD eval and of course....the number doesn't work, so I had to have our nursing manager send them a letter in the mail and sent in alternate new Rx with a note to the pharmacist asking them to return to the ER if they filled the Rx.

 

[RustedFox]

Damn. Would love to know more details but understand if you can't share them considering the active case. Surely the other attending was also named? It seems to me you could still mount a good defense since you weren't the one that they discussed the case with and never knew about the pt.

I hate signing these things. I had one yesterday sent to me about a human bite wound over the MCP of someone's dominant hand dx as "hand cellulitis" and sent home on keflex of all things. No documentation of extensor tendon exam and wasn't even specific about the lacerations from the bite. There was so much swelling that the radiologist even commented on it on XR. I tried calling the pt to come back for MD eval and of course....the number doesn't work, so I had to have our nursing manager send them a letter in the mail and sent in alternate new Rx with a note to the pharmacist asking them to return to the ER if they filled the Rx.

Yeah, I can't share any details as the case is ongoing. The other attending was also named.

We're in the "deposition" part of it now.

Here's the WORST part: We all received letters from the state medical board that we were all being investigated for "failure to whatever"
Once I reported this letter to my attorney, he said: "Another one ?!" and proceeded to explain how this was a move to alter the timeline to their advantage.

Yep. Plaintiff's attorneys will get the state medical board to *investigate* you for a patient that you never saw. Now, I have to list that on every piece of paperwork from here until Doomsday. Sure, it will be dismissed easily... but you still have to list it.

In the afterlife, I get to punish med-mal attorneys for their sins.
That is, of course; after I spend several years in purgatory for all of my sins... because I'm pretty sure that neither Heaven nor Hell will take me when I'm fresh dead.

 

[Old_Mil]

Rustedfox, go google "Florida Man Meme"...

 

[RustedFox]

Rustedfox, go google "Florida Man Meme"...

Pfft.

Please.

You think I haven't done this 100+ times already?!

Florida Man is my neighbor.

Also: Great to see you posting again, amigo. Don't fall-off again. Please.

 

[cyanide12345678]

Not worth the mental energy, emotional strife reading the garbage these midlevels put out. You're liable either way.

If you are truly required to sign, look the other way, hold your nose, and sign. No point in even reading the note.

If you are lucky your group might be able to collectively refuse to sign the notes and force the medical director to sign all of them. Probably doesn't decrease liability as you're still present on shift and "supervising," but feels better to not have your name associated with sh**.

Somewhat disagree. I read through a note from my first shift, disagreed with PA as far as disposition went. Called patient, told her to come back to the ER, and put in an attestation saying what I did.