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Anyone can sue anyone for anything at any time.  Based on your description, it sounds like the standard of care was not met.


It sounds like you know what went wrong and why--or at least you think you know.


I'd do several things in rapid succession: 1) Notify your SP, 2) notify your malpractice insurance carrier, and 3) Apologize to the patient.


Apologizing is a very important thing to get in there early: If you lawyer up and say nothing, you're acting like a scumbag who deserves to be sued.  If you disclose the mistake in an appropriate manner as soon as your internal investigation is completed, you're acting in a forthright manner.  The #1 reason providers get sued is not because they made a mistake, but because they acted or communicated in a non-empathetic manner after an adverse outcome, regardless of whether or not the adverse outcome was preventable.


But I'm just a dude on the internet.  Your SP needs to know now.

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Thank you for your reply.
The pt came back while I was out of office and my colleague and my SP handled the pt.
She was referred to plastic surgeon for saline shot treatment and if it does not resolve by this,
fat transplant might be performed. SP advised me to avoid to use kenalog as there are other alternatives for this type of condition.
I did not and may not have a chance to apologize the pt, however if it is right thing to do I do not mind doing it. 

But is it a good idea to notify malpractice insurance? What if the pt condition resolved in short term and there will be no case.? If I notify the insurance it may hurt my practice record unnecessary? What would be the benefit of notifying insurance for the incidence?

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You are a bit quick to think that you are responsible for this outcome.

First, it seems that the indication you ordered this medication was correct.

The issue is that the medication was given by the wrong route, SQ not IM.

If there is a clear order to give the med IM, if the MA is allowed to give IM injections, then the bulk of the issue lies with the skill set of the MA, not the ordering provider.

In the end though, harm needs to be proven along with not meeting a standard.

While I dont usually give kenalog, there is an indication for what you gave it for.

Then the process broke down.

Are you employed in a place that has a risk management or QA person?

If so, they should be involved in this from the beginning.

In the end, what occurs if there is legal action is that everyone is swept up and deposed.

Then the shakeout happens until the most likely to be at fault are left.

The only thing I can believe would keep you in this would be if you witnessed the MA providing the injection and did not correct them.

One thing that is helpful is that the patient returned to your clinic for help. Sounds like your colleagues handled this and made an appropriate referral. Hopefully they also apologized at the time. This can go a long way to defuse any potential action.

There is a way to handle these situations right from the beginning that reduces risk for legal action.

It also depends upon your state and the legal climate how risky this is for legal action.

I would also take a look at your malpractice policy and see what it stipulates for informing about a bad outcome.

Good luck.

G Brothers PA-C

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In every MA training program, MAs are taught to give sub q, IM and TB injections. They are also made to practice these objections on at least 50 people prior to receiving their verification. At least that's how it works in the two states I have worked as an MA in. So, the MA should have know how to give an IM injection, and is at fault for this, especially if she was instructed to perform one.



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