Working as a scribe - malpractice pitfalls?

[PASamsOTHERacct]

For various reasons, looking for medical work from home.  Only job I've found available is remote medical scribing.  

Wondering about medical malpractice risks.

On the one hand, many sources (including insurance companies) say non-physician providers CAN scribe, as long as they include a disclaimer such as "Mr/Ms ____, acting as scribe for Dr _______".

Of course, though, the doctor/provider can erase that line in three seconds if they wish, once they finalize their chart, leaving no record of this required disclaimer.

Furthermore, even though nurses are just following doctor's orders, it seems they could be subject to malpractice if they did not oppose an order they thought might be harmful and challenge the provider.  I can only wonder if this same caveat would apply to a PA acting as a scribe who scribes something they believe might be incorrect/harmful...does having professional licensure prevent one from "downgrading" their cognitive involvement beyond simply typing someone else's words, because they should "know better" from a practice standpoint?

 

Edited March 26, 2020 by PASamsOTHERacct
Change of text

[SirScottric]

I don't have an answer to your question but just wanted to point out: any EMR will save every addendum that is ever made on a note. So, if your "Mr./Mrs. _____" signature were to disappear, it would still be on record in the EMR.

[Mayamom]

Would the company you are scribing for offer any coverage?   I would think scribes would need some type of insurance but not sure.  And yes RN get sued all the time.

[rev ronin]

You're overthinking it. When I work as an EMT, I'm the most knowledgeable BLS provider in the county... But I don't get to overrule the medics or make up protocol on the spot, nor would I ever be at legal risk for NOT doing so if it were required.  Thankfully, all the medics in the county know who I am (I show up to their inservices when I can) and if I felt the need to say "I think you ought to check with the ER doc on that..." I can't imagine any of them would refuse.

[mgriffiths]

4 hours ago, PASamsOTHERacct said:

Of course, though, the doctor/provider can erase that line in three seconds if they wish, once they finalize their chart, leaving no record of this required disclaimer.

It wouldn't be in their final note, but it would still be logged in the EMR and if there was a malpractice case then that log would be seen and the provider would now be eligible for fraud charges as providers are required to include when dictation was used.

 

4 hours ago, PASamsOTHERacct said:

Furthermore, even though nurses are just following doctor's orders, it seems they could be subject to malpractice

I was not aware the nurses can be sued individually for malpractice.  I thought they were universally covered by the hospital, so to sue a nurse is to sue the hospital.  The same as the transport team, respiratory therapists, CNAs, LPNs, housekeeping, dietary, etc.  Has this really changed that nurses need individual malpractice now? (NOTE: I am NOT referring to NPs, only RNs.  Also, I am not referring to situations where a nurse was found to be guilty or assault or some other criminal offense that would make a civil suit eligible.)

[PASamsOTHERacct]

Thanks for the replies. My thoughts:

8 hours ago, SirScottric said:

I don't have an answer to your question but just wanted to point out: any EMR will save every addendum that is ever made on a note. So, if your "Mr./Mrs. _____" signature were to disappear, it would still be on record in the EMR.

3 hours ago, mgriffiths said:

It wouldn't be in their final note, but it would still be logged in the EMR and if there was a malpractice case then that log would be seen

I can't imagine this is always the case.  For one, if you are literally typing into the doctor's note (via screen sharing), not logged in on your own account, it's just as if the doctor typed and erased something. I wouldn't think EMRs save every iteration and version of a particular note...Every deleted letter, word, rearranging, spelling correction, etc...that would be dozens or even hundreds of pages for a single encounter.

4 hours ago, rev ronin said:

You're overthinking it. When I work as an EMT, I'm the most knowledgeable BLS provider in the county... But I don't get to overrule the medics or make up protocol on the spot, nor would I ever be at legal risk for NOT doing so if it were required.

I hear that (especially the overthinking part!) but I don't know that that's the case.  Let's say the medic is obviously inebriated, or is completely getting something so wrong that any BLS provider would notice...I would think not stepping in would be failure to act or even negligence of some variety.

6 hours ago, Mayamom said:

Would the company you are scribing for offer any coverage?   I would think scribes would need some type of insurance but not sure.  And yes RN get sued all the time.

Seriously doubt it, as it is likely an independent contractor position, and it would have to be PA-level coverage to be effective in the sort of situation we are talking about anyway, no? Scribes, to my knowledge, don't get anything beyond what any clerical worker would get...but not what clinical staff get.

3 hours ago, mgriffiths said:

I was not aware the nurses can be sued individually for malpractice.  I thought they were universally covered by the hospital, so to sue a nurse is to sue the hospital.  The same as the transport team, respiratory therapists, CNAs, LPNs, housekeeping, dietary, etc.  Has this really changed that nurses need individual malpractice now? (NOTE: I am NOT referring to NPs, only RNs.  Also, I am not referring to situations where a nurse was found to be guilty or assault or some other criminal offense that would make a civil suit eligible.)

I believe the nurse AND the institution are both sued in those cases. This seems to be supported by a quick search online. As well, I recall hearing that in many suits, especially private practice, practically everyone gets named, from RN to MA to receptionist to janitor.  I'd fear that in a scribe situation, especially if it's independent contractor, the entire malpractice burden is passed right along to the individuals involved, as there is no hospital.

 

Edited March 27, 2020 by PASamsOTHERacct
edits.

[SirScottric]

8 hours ago, PASamsOTHERacct said:

Thanks for the replies. My thoughts:

I can't imagine this is always the case.  For one, if you are literally typing into the doctor's note (via screen sharing), not logged in on your own account, it's just as if the doctor typed and erased something. I wouldn't think EMRs save every iteration and version of a particular note...Every deleted letter, word, rearranging, spelling correction, etc...that would be dozens or even hundreds of pages for a single encounter.

 

That is most definitely the case with EMR. If you click the save button at any time during a note you are writing, a copy is saved in the EMR. People looking back through EMRs can look at EVERY addendum ever made to EVERY note.

Edited March 27, 2020 by SirScottric

[mgriffiths]

9 hours ago, PASamsOTHERacct said:

I wouldn't think EMRs save every iteration and version of a particular note...Every deleted letter, word, rearranging, spelling correction, etc...that would be dozens or even hundreds of pages for a single encounter.

I don't work in IT and have very little knowledge about the inner workings of an EMR, but I think you are underestimating how much is saved.  I doubt every little typed and deleted letter would be saved, but an entire phrase I would certainly expect to be saved.

 

9 hours ago, PASamsOTHERacct said:

As well, I recall hearing that in many suits, especially private practice, practically everyone gets named, from RN to MA to receptionist to janitor.

There is a huge difference between being named and being sued.  Yes, malpractice lawyers are often scum and just name everyone, but in the early stages of the suit all of the extraneous individuals are removed.  Again, maybe I'm wrong, but apart from actual intentional harm to the patient that would include law enforcement and very few other exceptions, I am not aware of RNs (or other nursing staff) being eligible for individual malpractice lawsuits.