How to implement a "standard of care" regulatory model for pharmacists.

National pharmacy associations have increasingly explored regulation according to a "standard of care." In such a model, pharmacists can provide a wide range of clinical services aligned with their education and training. Based on Idaho's experience implementing this model, there are five critical steps states must take to enact a standard of care: 1) Adopt a broad definition of "practice of pharmacy;" 2) Allow elasticity for practice innovation over time; 3) Decide which limited instances still necessitate prescriptive regulation; 4) Eliminate all unnecessary regulations; and 5) Strengthen accountability for deviations from the standard of care. States wishing to adopt a standard of care approach can follow this five-step process to enhance patient care and mitigate the lag that is otherwise constant between laws and practice.

Establishing the shadowline: the border between legally acceptable and unacceptable standards of surgical practice.

INTRODUCTION: Our study investigated how the standard of surgical care is assessed within the English and Welsh litigation process. The 'shadowline' represents the dividing line between acceptable and unacceptable standards of care. Our hypothesis was that different assessors risk adopting materially different interpretations regarding the acceptable standard of care. Any variation in the interpretation of where the shadowline falls will create uncertainty and unfairness to surgeons and patients alike. METHODS: We summarised the legal literature and suggested the factors affecting the assessment of surgical standards. We illustrated our findings on distribution curves. RESULTS: There was a risk that the shape of the curve and the location of the shadowline may vary according to the assessor. Importantly, a gap may have developed between the legal and clinical shadowlines in respect of the consenting process. DISCUSSION AND CONCLUSION: We suggested how a gap between the surgical and legal shadow lines could be narrowed. Clinical governance, balanced literature and realistic expert assessments were all part of the solution.

Two sides of the same coin: educational and professional pathway for surgical residents.

AIM: To provide a review of medical malpractice cases ruled by the Italian Supreme Court with the aims at identifying lawsuits targeting involved with surgical residents. MATERIAL AND METHODS: Legal cases ruled by the Italian Supreme Court, from September 2020 to October 2020, pertaining to medical claims involving surgical residents were examined, using the main online databases. RESULTS: Of a total of eleven (n=11; 100%) cases identified, four (n= 4; 36,4%) cases addressed the standard of care pertaining to the surgical residents' medical activity. The legal reasoning of the Italian Supreme Court does not focus on the manual skill in the resident's medical performance, but rather on the choice to accept to treat the patient, regardless of the participation of the tutor. CONCLUSIONS: The performance of the surgical residents is made more difficult due to their peculiar nature, characterized by the complex interactions between the directives given by the tutor and the need to guarantee patients' needs. KEY WORDS: Surgical Residents, Tutor, Educational Pathway, Medical Malpractice, Standard of Care.

Does an occupational physician have a duty to carry out general clinical assessments?

An occupational physician is employed to be responsible for the overall assessment of workers' health risks and all work-related pathological situations which creates an unusual doctor-patient relationship. The duties of the occupational physician are also very limited as is their professional responsibility. However, the boundaries of the occupational physician's duties and responsibilities are not always clear. The purpose of this article is to answer the following question: Does the occupational doctor have a duty to carry out general clinical evaluations (not work-related) of the patient?

Crisis Standards of Care.

Nursing considerations during states of emergency.

Reciprocity and Liability Protections during the Covid-19 Pandemic.

During the Covid-19 pandemic, as resources dwindled, clinicians, health care institutions, and policymakers have expressed concern about potential legal liability for following crisis standards of care (CSC) plans. Although there is no robust empirical research to demonstrate that liability protections actually influence physician behavior, we argue that limited liability protections for health care professionals who follow established CSC plans may instead be justified by reliance on the principle of reciprocity. Expecting physicians to do something they know will harm their patients causes moral distress and suffering that may leave lasting scars. Limited liability shields are both appropriate and proportionate to the risk physicians are being asked to take in such circumstances. Under certain narrow circumstances, it remains unclear that the standard of care is sufficiently flexible to protect physicians from liability. Given this uncertainty, the likelihood that physicians would be sued for such an act, and their desire for such immunity, this limited protection is morally legitimate.

Analysis and recommendations regarding surgeons' liabilities during an acute health crisis.

The SARS-CoV-2 pandemic has highlighted discrepancies between surgeons' professional duties and legal protections when acting outside their specialities during the pandemic. These discrepancies between legal and professional standards leave surgeons and the NHS vulnerable to litigation. In the following article, we explore the liabilities that have arisen for surgeons during this period in the United Kingdom and Canada. We recommend, upon review of the literature, that a two-pronged approach be taken to address these discrepancies; (a) a change in policy at the national level to accurately reflect the constraints and demands placed upon the profession in this acute health crisis and (b) the provision of clearer, more stringent legal protection. In the interim, we suggest that individual surgeons utilise a decision-making framework where they consider their personal and professional obligations in regard to resource stewardship, innovation in practice, patient-specific contexts, and patient advocacy while acting outside of their speciality.

The Key Elements of Medical Negligence-Duty.

American tort law (a.k.a. negligence) is designed to be flexible and elastic to adapt to changes in time and public policy. It provides a structure of elements and factors to be applied to each case's specific facts on a case-by-case basis. The purpose of this structure is to achieve as much uniformity as possible in the application of tort law. One side effect is that this structure makes predicting the outcome difficult because of so many variables. In addition, there is no national tort law. Instead, each state has developed its own law in the area of torts, which has resulted in differing exceptions and requirements based on where the medical care was given. The purpose of this article is to explain the first element of a negligence case-"duty to use care"-and its accompanying factors/variables. The first element that must be established in a medical negligence case is a duty to use care. In short, this means the physician must use a certain level of care in providing medical services. The physician typically owes her or his patient the duty to exercise care. However, there are special situations in which a physician may not owe a duty of care and thus cannot be held liable for medical negligence. This article is designed to provide an overview of the most common situations and summarizes the processes to determine whether a duty is owed.

Legal liability facing COVID-19 in dentistry: Between malpractice and preventive recommendations.

The dental profession is considered at high potential risk of exposure and transmission of SARS-Cov-2. Thus, dentists should implement special safety measures in order to prevent any possible contamination during dental sessions and should be aware of the legal implications of their act in order to avoid malpractice leading them to be a causative agent of transmission of this virus. This paper aimed to provide a global review on COVID-19 preventive recommendations at dental clinics and discussed the legal values of such procedures, the dentist criminal and civil liability arising from transmitting this virus to a patient, the obligation of care under COVID-19 and the possible solution to this dilemma. The review concluded that dentists should follow all modern scientific procedures which are in their interest and in the interest of patients to maintain their safety and advised dentists to document all steps taken during the period of COVID-19 outbreak, because any undocumented action is considered not to have taken place, and they shall be bound by the burden of proof.

Labour ward negligence.

No amount of symposia and clinical meetings and formal management will make a clinical difference unless obstetric units regularly and ruthlessly self-assess to curb medical negligence. Court case, which represent a small portion of substandard outcomes, not infrequently reveal a serious lack of obstetric judgment as well as paucity of knowledge which are compatible with unsupervised responsibility of labour ward duties. One UK court case ACF 32(2): 09/2019 presents a factual picture of obstetric practice which is difficult to reconcile with modern UK practice. This article limits itself to a number of facts as presented to court by the claimant, and the comments are directed purely at the resulting implications. These facts as stated are seriously worrying in themselves as they reflect practice well below the minimum care to be expected in a modern country and are far from what is recommended by the Royal College of Obstetricians and Gynaecologists and indeed every day standards. The article recommends the shifting of focus from individual to collective or unit responsibility to achieve better care. In any case where gross mismanagement is found, there should be a wider check on practices within the whole obstetric unit.

The doctor in a minority.

Suppose that a doctor carrying out a treatment or advising on a treatment or acting as an expert in litigation or writing or lecturing about a treatment is in a minority so far as contemporary medical opinion is concerned. It may be a matter of choice for the doctor between treatment A (the majority practice) or treatment B (the minority practice), and the minority treatment may be of an innovative character. Unfortunately, things went badly wrong, the patient suffered harm and the doctor finds him/herself a defendant in a case for clinical negligence. What is the legal duty of the doctor? Is it sufficient that he/she acted in good faith? Or that he/she was a competent doctor? Or that he/she was a doctor following the practice of a substantial number of doctors, albeit a minority? Or that he/she was in effect acting 'on his/her own'? The legal test is: Was the doctor following the practice of a responsible body of medical clinical opinion, albeit a minority opinion? Medicine has made huge advances over the years - one of the great achievements. But many advances have come about because of the initiative of one individual or a small group of individuals, often in the face of strong disbelief or opposition. The medical profession is a conservative profession, understandably so in view of the obvious inherent risks. Original ideas may not be well received. Therefore, the minority innovative doctor must proceed carefully because he/she runs the risk of a medical mishap, criticism and litigation.

Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care.

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) "Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations," which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both distributive and recognitive justice. The disability rights movement's demand "Nothing about us, without us" requires substantive inclusion of disabled people in decision-making related to their interests, including in crisis planning before, during, and after a pandemic like Covid-19.

Safe and competent nursing care: An argument for a minimum standard?

There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient's actual situation is unclear. Thus, both patients and nurses would benefit from the development of a minimum standard of nursing care. Clarity on this matter is also of ethical and legal concern. In this article, we explore the case for developing a minimum standard to ensure safe and competent nursing care services. Any such standard must encompass knowledge of basic principles of clinical nursing and preservation of moral values, as well as managerial issues, such as manpower planning, skill-mix, and time to care. In order for such standards to aid in providing safe and competent nursing care, they should be in compliance with accepted evidence-based nursing knowledge, based on patients' needs and legal rights to healthcare and on nurses' codes of ethics. That is, a minimum standard must uphold a satisfactory level of quality in terms of both professionalism and ethics. Rather than being fixed, the minimum standard should be adjusted according to patients' needs in different settings and may thus be different in different contexts and countries.

COVID-19 and medical litigation: More than just the obvious.

COVID-19 has massively changed the health landscape around the world. Wide-ranging changes to healthcare delivery have occurred, especially in hospitals and EDs. Health services have made local decisions about care pathways, in some cases deviating from what would, until recently, have been considered widely accepted care. These changes bring with them new medicolegal risk for clinicians. In Australia, civil liability Acts provide protection for professionals when the criterion of having undertaken 'competent' practice that would be 'widely accepted' 'in the circumstances' is met. There is doubt how courts, and the medical experts who advise them, will evaluate clinical care provided during the pandemic when health services have developed local care pathways and there is no nationally accepted standard.

Legal Liability Associated With rtPA Administration and Surrogate Decision Makers.

Stroke is one of the most common conditions neurologists treat in emergency situations. This article examines the issues of surrogate decision makers and the physician's potential legal liability in the context of the administration or nonadministration of recombinant tissue plasminogen activator (rtPA) in a common emergency department scenario.

Restatement (Third) of Torts Section 47(b) Bypasses Traditional Barriers and Offers Aspiring Parents a Clear Path to Recover Stand-Alone NIED when Their Cryopreserved Reproductive Material is Lost or Destroyed.

"[T]he tissue or embryo is not the primary victim at all. The victims are the parents who have been deprived of the potential to conceive a child together."1.