Staff Medical Errors

October 2, 2006

I received an e-mail from a patient who had come into my office for an injection. The medical assistant (MA) gave her an intradermal injection. The MA then came back and told the patient that she had actually gotten a pneumonia vaccination rather than what she needed. The MA proceeded to give the patient what she needed and told her the pneumonia vaccine was really expensive but not harmful, and then added that this matter was to be kept between her and the patient.There is absolutely no documentation of this, and the MA told no one. What do you recommend I do? My first inclination was to fire her on the spot.

Question: I received an e-mail from a patient who had come into my office for an injection. The medical assistant (MA) gave her an intradermal injection. The MA then came back and told the patient that she had actually gotten a pneumonia vaccination rather than what she needed. The MA proceeded to give the patient what she needed and told her the pneumonia vaccine was really expensive but not harmful, and then added that this matter was to be kept between her and the patient.

There is absolutely no documentation of this, and the MA told no one. What do you recommend I do? My first inclination was to fire her on the spot.

Answer: Oh, dear.

This certainly is a fire-able offense, especially since you found out through the patient. It's hard to tell whether this happens frequently.

I would call the risk-management contact at your malpractice carrier. This person can usually offer frank advice and give you details on how to document your decision. You might also ask for advice about how to communicate your course of action so the patient will know that you've done something about this and aren't taking it lightly.

If -- for whatever reason -- your risk-management contact can't offer advice, I'd have a documented conversation with your MA. Find out what happened. If it was a simple one-time mistake, OK, but I'd still develop a written compliance plan for your staff that states that any and all errors must be reported to you.

I'd also look into the processes you're using to place injection orders and locate the correct medications. Would the mistake have been made if the medication had been labeled more clearly? Or did your employee misunderstand your order? Document any improvements you make.

Responding to the possible procedural errors may be more important than responding to an individual's error. You want to make sure errors don't happen, regardless of whether this staff member is worth keeping.