Question
Discuss your answer in points. Discuss the following.
1. Describe and discuss falsifying Medical records
2. Tampering with Medical records
3. Falsifying Business records
4. Nurse Changing Records
FALSIFICATION OF RECORDS Tampering with Medical Records hen handling medical records, professionals must ree- Dr. McCroskey faced a lawsuit for the alleged tampering ng with records sends the wrong signal to with documents. The state board of medical examiners, in a min and can shatter ones credibility, and that altered records disciplinary hearing in State Board of Medical Examiners v ion McCroskey, 4 issued a letter of admonition to Dr. McCroskey based on a series of incidents arising out of the care of a patient's stab wound. Although the patient's condition was initially thought to be stable, he bled to death several hours after his admission to the hospital. Dr. McCroskey was the attending surgeon on the date of the incident and, therefore responsible for the accurate completion of the patient's med- Falsifying Medical Records e in Dimora v. Cleveland Clinic Founda- that the patient had fallen and broken five n examination, the physician noted in notes that the patient was smiling and laugh- ical record. Dr. McCroskey declined to accept the admonition, and a formal disciplinary hearing was hel the P ly. exhibiting no pain upon deep palpation of was in pain and crying. The discrepancy between the written progress notes and the testimony of the witnesses who observed the was sufficient to raise a question of fact. The court Dr. McCroskey erased and wrote over a preoperative note blood loss. Specifically, the original record entry was com- pleted by a surgical resident on the date of the patient's death Other testimony indicated that she made by another physician concerning th and stated that the patient's blood loss just prior to surgery d the possible falsification of documents by Dr. McCroskey changed the record to "now greater than 3000 cc." Sometime after the autopsy then the physician in an effort to hide the possible negligence blood loss was "now greater than 2000 cc:" After listening of hospital personnel. The testimony of the read that the patient's esses, to conflicting expert testimony, the administrative law judge if believed, would have been sufficient to show that the (ALJ) concluded that the physician had not violated gener- falsified the record or intentionally reported the incident inaccurately in order to avoid liability for the negligent care of the patient. The intentional alteration or destruction of medical records to avoid liability for medical negligence is sufficient to show actual malice, and punitive ally accepted standards of medical practice by adding the note to the patient's medical record days or weeks the patient's death and then backdating the note to the date of the death. On review of the ALJ's decision, the board accepted damages may be awarded regardless of whether the act of the ALJ's evidentiary finding that many physicians date a altering, falsifying, or destroying records directly causes medical record entry to reflect the date of the medical event, rather than the date on which the entry was made. The board disagreed, however, with the ALJ's conclusion that this fact brought McCroskey's conduct within generally accepted tandards of medical practice. Instead, the board determined that backdating a medical record entry falls below accepted standards of documentation. Having thus found two acts that 21 In another case, the court in the Matter of Jascalevich22 held: e are persuaded that a physician's duty to a patient cannot but encompass his affirmative obligation to maintain the integrity, accuracy truth and reliability of the patient's medical rd. His obligation in this regard is no less compelling than his duties respecting diagnosis and treatment of the patient since the medical community must, of necessity, be able to rely on those records in the continuing and future care of fell below generally accepted standards of medical p tice, the board concluded that Dr. McCroskey committed unprofessional conduct and issued a letter of admonition. On appeal, the court of appeals held that the board erroneously rejected the ALJ's findings On further appeal by the board, the Colorado Supreme Court held that the findings of the board were supported by substantial evidence. Because of the expertise of the board it was in a position to determine the seriousness of the phy- sician's conduct by placing the events in their proper factual con Obviously, the rendering of that care is preju- diced by anything in those records, which is false, misleading or inaccurate. We hold, therefore, that a deliberate falsification by a physician of his ient's medical record, particularly when the reason therefore is to protect his own interests at All three of the inquiry panel's witnesses testi- fied that the generally accepted standard of practice requires that a medical record entry be dated with the date it is made. Even one of McCroskey's wit- s acknowledged that misdating the medical the expense of his patient's, must be regarded gross malpractice endangering the health or life
Explanation / Answer
1.) Falsifying Medical records: Medical records are personal documents and there are several laws to protect them from third-party access that are unauthorized. Also, medical records are those legal documents that may not be falsified or altered in any way. A medical chart is a form of summarized record of the treatment that was given to a patient and it must be preserved as a means to get refresh the memory and explain the medication and care rendered. For victims of medical malpractice, there is always a concern that negligent healthcare professionals will attempt to cover up incriminating evidence by falsifying the medical record. Falsification of a medical record with any kind of destruction or alteration is considered as tampering with the evidences in a medical malpractice case.
2.)Tempering with medical records: Tampering with evidence in a medical malpractice case is a crime. This is a cause of action permitting compensation in most jurisdictions. A medical practitioner could lose their license to practice medicine if a court of law determines a tendency to tampering with medical records.
3.)Falsifying Business records: A person is found guilty of falsifying the business records if with intent to defraud he makes a false entry in the business records of an enterprise or alters, obliterates, deletes, removes, erases, or destroys a true entry in the business records of an company or omits to make a true entry in the business records of an enterprise or prevents the making of a true entry or causes the omission in the business records of an company.
4.) Nurse changing records: When falsification is carried out by nurses, it carries a message to patients that they are not trustworthy and can lead to bad consequences. A nurse might do an ‘early documentation by signing early on the chart indicating that she has given the medication before she had actually did. Falsification in nursing is a punishable offence that can threaten the career.