Veterans Hospitals and Medical Malpractice Actions


As a result of recent directives, Veterans Administration hospitals now are surveyed and accredited by the Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations). The Joint Commission accredits all 152 VA medical facilities in the United States and has been doing so for at least 6 years.

This means that these hospitals can be held accountable to the hospital accreditation standards in the same fashion as civilian health care facilities. Standards regarding such things as corporate responsibilities for the delivery of care, physician credentialing procedures, and policy implementation, can be applied to the VA hospitals in medical malpractice actions. The hospitals are surveyed in the same manner as their civilian counterparts and summaries of their accreditation status are available online in the Joint Commission website.

For attorneys, this means that much of the typical analysis they conduct regarding malpractice actions and accreditation can be utilized in cases that occur in VA medical facilities. Experts in hospital administration can assist in the analysis and the same standards as used in civilian hospitals will apply here as well. The VA facilities use the same accreditation manual and follow the same processes.

The VA has also issued a directive in 2007 that they will comply with the intent of the federal Emergency Medical Treatment and Active Labor Act (EMTALA). This means, again, that the same standards that apply to civilian hospital emergency departments are followed by the VA hospitals. Patients must be evaluated and stabilized in the emergency department prior to being discharged. Violations of this regulation can be considered in evaluating the VA hospitals cases.

The VA medical facilities are able to be held to the same standards as all other hospitals regarding accreditation and EMTALA. This is important information for attorneys in their consideration of medical malpractice actions in these hospitals.

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This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Nursing Home Negligence

If you have a loved-one in a nursing home, you want to know that they are being taken care of just as you would take care of them at home, if you had the means to do it. But in reality, we know this is not the case.

We see continuing cut-backs in the medical industry in efforts to off-set the increase in the rising costs of supplies and services and decreasing payments by insurance companies. This is reflected in less staffing, lacking supplies and cutting corners any way the medical provider is able to – regardless of the impact these actions will have on the patients. This can lead to many serious problems for patients in the nursing home.

Some of the most common problems that we see in nursing homes are patients developing pressure ulcers due to not being turned often enough or if they are incontinent, not having their brief changed often enough. If pressure ulcers are not recognized in the early stages, they can become a serious problem for the patient. If the area is not treated appropriately, the ulcer can become infected and this infection can lead to a more serious infection. There are numerous complications that can occur from a pressure ulcer that is not treated appropriately. Various standardized tools can be used by the nursing home to determine the patient’s risk for developing pressure ulcers and should be completed on all patients when they are admitted to their facility.

Another common problem in the nursing home is patient falls with injury. There are many interventions that can be used in an attempt to prevent a fall, but these interventions are not always implemented by the nursing home staff. Using the bed rails is one way of deterring the patient from rising without assistance. There are also bed alarms that are used to alert the staff when the patient changes from a lying to sitting position. Other interventions that are available are chair alarms, low beds and floor mats. These should be used on any patient that is a risk for falls. A facility should determine the patient’s risk for falls by using a fall risk assessment tool. There are many varieties of these tools available. The most common injuries resulting from nursing home falls are head injuries and hip and/or bone fractures.

Be sure you ask questions of the nursing home on these issues. It is your right to know. Our loved-one’s safety is our top priority. The nursing home should be open and honest with you regarding their protocols on preventing pressure ulcer and fall prevention measures.

The expert who prepared this article has over 18 years of professional experience including home health care, nursing home care and hospital acute care.  She earned her Bachelors of Nursing degree at Duquesne University in Pittsburgh, Pennsylvania.  She also completed training for legal nurse consulting at The Medical Legal Consulting Institute.

This expert has extensive experience with medical record review, regulatory guidelines including Joint Commission standards, policy and procedure analysis and development, nursing home compliance, and hospital compliance.  She is currently self-employed as a Legal Nurse Consultant providing her expertise to clients to assist them with achieving the answers they require and giving patients the answers they deserve.
To have this expert review your case, prepare a report/affidavit and be listed as one of your experts, please contact American Medical Experts at 888-678- EXPERTS.


This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Role of Joint Commission on Accreditation of Healthcare Organizations Standards in Med Mal Cases

Lawyers often ask me to explain how I use the JCAHO standards in evaluating medical malpractice cases and whether this evaluation will assist them in their pursuit of justice for their clients. I usually start my explanation with a brief history of the Joint Commission and its role in hospital operations and reimbursement.

The JCAHO was formed in 1951 by several professional organizations: the American Hospital Association, the American College of Physicians, the American College of Surgeons, and the American Medical Association. Its mission is “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value”.

To accomplish this mission, the JCAHO has developed standards for accrediting hospitals and other types of healthcare organizations that focus on the delivery of the highest possible quality patient care as well as ensuring a safe environment for patients and staff. While a hospital’s participation in the JCAHO accreditation is technically voluntary, the federal government requires hospitals to meet their standards in order to receive reimbursement from the Medicare and Medicaid programs. Obviously, this requirement essentially mandates that all hospitals meet the JCAHO standards or one of the few other organizations that are included in this payment mandate. While the process is voluntary, it is important to understand that the standards are mandatory and that receiving a full accreditation from the JCAHO is still the gold standard for a hospital’s quality of care.

The JCAHO is continuously updating their standards and issues a new standards manual each year. While the actual changes made each year may be minimal, they often occur as a result of information sent to the JCAHO by hospitals regarding medical errors under the so-called Sentinel Event standard. For our purposes, it is important to use the correct annual edition of the standards in evaluating a medical malpractice case.

The accreditation process focuses on following randomly selected actual patients care from admission to discharge. The strength of this process is that it does look at actual care processes rather than the former process which only looked at whether the hospital complied with the standards on paper. Its weakness is obviously that most patient care is performed correctly and most patients receive high quality care, while being accredited does not mean that every standard was complied with and some important processes may not be evaluated in the every three year survey process. Hence, a fully accredited hospital may have some issues and problems that the accreditation process does not uncover.

With this background in mind, I recommend using the standards to evaluate the hospital’s corporate responsibilities in delivering care to their patients. The standards include such things as the board’s responsibility to lead the hospital, the administrator’s job requirements, how physician credentialing should be accomplished and the overall delineation of the way patient care should be delivered. The standards require the hospital to have a number of policies and procedures in place and further require that they be actually followed uniformly for all patients regardless of their ability to pay or the type of insurance they have. While it is important to note that these policies must exist, the JCAHO does not typically prescribe how the hospital should accomplish the required activities. Each hospital has a great deal of latitude in how they do things and this often provides us with key insights in how seriously the hospital takes this process. For example, the hospital should look at all key policies annually and update them as needed based on their own experience as well as industry information regarding changing processes. Hospitals often do not do this on a regular basis and it is not unusual for me to see policies that have not really been changed for many years.

In today’s complex health care delivery environment it is crucial for a hospital to understand that its corporate responsibilities must be taken seriously and I often counsel hospitals on how to improve their risk management processes. Conversely, in my work with patient’s counsel I look for evidence that any deviation in implementing these corporate responsibilities caused the hospital to bear some responsibility for a medical malpractice event. In my opinion, this evaluation should take place in every case in order to determine if the hospital has essentially participated in the process that caused the case to occur.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.