Skip to main content
SpringerLink
Log in
Book cover

Principles and Practice of Geriatric Surgery pp 1–25Cite as

Legal Issues in Older Adults

  • Living reference work entry
  • First Online:

  • 235 Accesses

Abstract

The practice of surgery involving older patients is extensively regulated in the United States in a variety of ways. Besides direct government command and control (“Thou shalt” and “Thou shalt not”) regulation and indirect regulation through Medicare and Medicaid reimbursement rules, a number of private entities contribute to the oversight of surgery practice through their standard-setting and disciplinary activities. A further source of regulation is the American judicial system, under which the courts may be used by individual patients who bring private civil malpractice lawsuits to seek financial compensation from particular surgeons and other health care professionals and institutions for harms that the defendants have wrongfully caused. Particularly egregious behavior, such as patient abuse, may even subject a health care professional to the possibility of criminal law prosecution. This chapter examines three specific areas of legal regulation affecting the practice of surgery for older patients. These foci are medical malpractice litigation, informed decision-making requirements and exceptions, and confidentiality protections. Additionally, general risk management considerations for the surgeon treating geriatric patients are outlined.

This chapter draws on previous work of the author, particularly Kapp MB (2011) Legal aspects of geriatric surgery. In: Katlic MR (ed). Cardiothoracic surgery in the elderly. Springer, New York, pp 79–87 and Kapp MB (2015) Legal issues in critical care. In: Hall J et al. (eds). Principles of critical care, 4th edn. McGraw-Hill, New York, pp 125–130.

This is a preview of subscription content, log in via an institution.

Abbreviations

ACS:

American College of Surgeons

AHRQ:

Agency for Healthcare Research and Quality

APS:

Adult Protective Services

ASC:

Ambulatory Surgical Center

CPG:

Clinical Practice Guideline

CPR:

Cardiopulmonary resuscitation

CPT:

Cognitive Performance Test

DNAR:

Do Not Attempt Resuscitation

DNR:

Do Not Resuscitate

DPOA:

Durable power of attorney

EHR:

Electronic Health Record

HCQIA:

Health Care Quality Improvement Act

HIPAA:

Health Insurance Portability and Accountability Act

IEC:

Institutional Ethics Committee

IRB:

Institutional Review Board

MMSE:

Mini-Mental State Exam

NPDB:

National Practitioner Data Bank

PCORI:

Patient-Centered Outcomes Research Institute

PDR:

Physician’s Desk Reference

PHI:

Personal Health Information

POCD:

Postoperative Cognitive Dysfunction

POLST:

Physician Orders for Life-Sustaining Treatment

PPI:

Pharmaceutical Package Insert

PSA:

Prostate-specific antigen

SURPASS:

Surgical Patient Safety System

UP:

Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery

WHO:

World Health Organization

References

  1. Pellino IM, Pellino G (2015) Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons’ medical practice and on health service. Updat Surg 67:331–337

    Article  Google Scholar 

  2. Praderelli JC, Campbell DA Jr, Dimick JB (2015) Hospital credentialing and privileging of surgeons: a potential safety blind spot. JAMA 313:1313–1314

    Article  Google Scholar 

  3. Hsieh MH, Meng MV (2014) Prostate cancer screening and risk of litigation: caught between Scylla and Charybdis. J Urol 191:1648–1649

    Article  PubMed  Google Scholar 

  4. Hernandez BW (2011) The crossroad: an analysis of the intersection between medical malpractice, health care costs, and prostate cancer. Elder Law J 18:361–390

    Google Scholar 

  5. American College of Surgeons (2013) Choosing wisely: five things physicians and their patients should question. http://www.choosingwisely.org/societies/american-college-of-surgeons/

  6. Ferreres AR (2014) Ethical issues of expert witness testimony. World J Surg 38:1644–1649

    Article  PubMed  Google Scholar 

  7. Coaco M, Sandberg J, Badlani G (2014) Influencing factors leading to malpractice litigation in radical prostatectomy. J Urol 191:1770–1776

    Article  Google Scholar 

  8. Gordhan CG, Anandalwar SP, Son J et al (2015) Malpractice in colorectal surgery: a review of 122 medicolegal cases. J Surg Res 199:351–356

    Article  PubMed  Google Scholar 

  9. American College of Surgeons (2016) Statements on principles. https://www.facs.org/about-acs/statements/stonprin

  10. Pugliese OT, Solari JL, Ferreres AR (2014) The extent of surgical patients’ understanding. World J Surg 38:1605–1609

    Article  PubMed  Google Scholar 

  11. Thompson BM, Sparks RA, Seavey J et al (2015) Informed consent training improves surgery resident performance in simulated encounters with standardized patients. Am J Surg 210:578–584

    Article  PubMed  Google Scholar 

  12. Peters E, Hibbard J, Slovic P et al (2007) Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Aff 26:741–748

    Article  Google Scholar 

  13. Agency for Healthcare Research and Quality (n.d.) Quick tips – when planning for surgery. AHRQ Pub. No. 01-0040d

    Google Scholar 

  14. Agency for Healthcare Research and Quality (2014) What to ask before surgery. http://archive.ahrq.gov/news/columns/navigating-the-health-care-system/011608.html

  15. American College of Surgeons (n.d.) Informed consent. https://www.facs.org/education/patient-education/patient-resources/informed-consent

  16. Taylor LJ, Schwarze ML (2016) Best practices: targeting surgeon communication at the end of life. Ann Surg 263:7–8

    Article  PubMed  Google Scholar 

  17. Givel J-C, Meier B (2014) How much information do patients want or need? World J Surg 38:1610–1613

    Article  PubMed  Google Scholar 

  18. Ganai S (2014) Disclosure of surgeon experience. World J Surg 38:1622–1625

    Article  PubMed  Google Scholar 

  19. DiPaola CP, Dea N, Noonan VK et al (2014) Surgeon-industry conflict of interest: survey of north Americans’ opinions regarding surgeons consulting with industry. Spine J 14:584–591

    Article  PubMed  Google Scholar 

  20. Yi PH, Cross MB, Cross MB, Johnson SR et al (2015) Are financial conflicts of interest for the surgeon a source of concern for the patient? J Arthroplast 30(Suppl 1):21–33

    Article  Google Scholar 

  21. Mello MM, Livingston EH (2016) Managing the risks of concurrent surgeries. JAMA 315:1563–1564

    Article  CAS  PubMed  Google Scholar 

  22. Giampieri M (2012) Communication and informed consent in elderly people. Minerva Anestesiol 78:236–242

    CAS  PubMed  Google Scholar 

  23. Cainzos MA, González-Vinagre S (2014) Informed consent in surgery. World J Surg 38:1587–1593

    Article  PubMed  Google Scholar 

  24. Bal BS, Brenner LH (2015) Medicolegal sidebar: informed consent in the information age. Clin Orthop Relat Res 473:2757–2761

    Article  PubMed  PubMed Central  Google Scholar 

  25. Clark S, Mangram A, Ernest D et al (2011) The informed consent: a study of the efficacy of informed consents and the associated role of language barriers. J Surg Educ 68:143–147

    Article  PubMed  Google Scholar 

  26. Patel DN, Wakeam E, Genoff M et al (2016) Preoperative consent for patients with limited English proficiency. J Surg Res 200:514–522

    Article  PubMed  Google Scholar 

  27. Cooper Z, Koritsanszky LA, Cauley CE et al (2016) Recommendations for best communication practices to facilitate goal-concordant care for seriously ill older patients with emergency surgical conditions. Ann Surg 263:1–6

    Article  PubMed  Google Scholar 

  28. Cooper Z, Courtwright A, Karlage A et al (2014) Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness. Ann Surg 260:949–957

    Article  PubMed  Google Scholar 

  29. White DB, Ernecoff N, Buddadhumaruk P et al (2016) Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision makers of critically ill patients. JAMA 315:2086–2094

    Article  CAS  PubMed  Google Scholar 

  30. Feblowitz J, Richards J (2015) What are the patient’s wishes? JAMA Intern Med 175:490–491

    Article  PubMed  Google Scholar 

  31. Ho A, Pinney SJ, Bozic K (2015) Ethical concerns in caring for elderly patients with cognitive limitations: a capacity-adjusted shared decision-making approach. J Bone Joint Surg Am 97:e16(1-6)

    Article  Google Scholar 

  32. Terranova C, Cardin F, DiPietra L et al (2013) Ethical and medico-legal implications of capacity of patients in geriatric surgery. Med Sci Law 53:166–171

    Article  PubMed  Google Scholar 

  33. Setacci C, Sirignano A, Ricci G et al (2015) A new ethical and medico-legal issue: vascular surgery and the postoperative cognitive dysfunction. J Cardiovasc Surg 56:607–615

    CAS  Google Scholar 

  34. Suri M, McKneally DK (2014) Tragic knowledge: truth telling and the maintenance of hope in surgery. World J Surg 38:1626–1630

    Article  PubMed  Google Scholar 

  35. Noah BA, Feigenson NR (2016) Avoiding overtreatment at the end of life: physician-patient communication and truly informed consent. Pace Law Rev 36:737–800

    Google Scholar 

  36. Hall DE, Hanusa BH, Fine MJ et al (2015) Do surgeons and patients discuss what they document on consent forms? J Surg Rsrch 197:67–77

    Google Scholar 

  37. Oresanya LB, Lyons WL, Finlayson E (2014) Preoperative assessment of the older patient: a narrative review. JAMA 311:2110–2120

    Article  CAS  PubMed  Google Scholar 

  38. Peschman J, Brasel KJ (2015) End-of-life care of the geriatric surgical patient. Surg Clin N Am 95:191–202

    Article  PubMed  Google Scholar 

  39. Kale MS, Ornstein KA, Smith CB et al (2016) End-of-life discussions with older adults. J Am Geriatr Soc 64. doi:10.1111/jgs.14285. PMID 27549494 64:1962–1967

    Google Scholar 

  40. Redmann AJ, Brasel KJ, Alexander CG et al (2012) Use of advance directives for high-risk operations: a national survey of surgeons. Ann Surg 255:418–423

    Article  PubMed  Google Scholar 

  41. Mohanty S, Rosenthal RA, Russell MM et al (2016) Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg 222:930–947

    Google Scholar 

  42. Aziz H, Branco BC, Braun J et al (2015) The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations. J Vasc Surg 61:1538–1542

    Article  PubMed  Google Scholar 

  43. Scarborough JE, Pappas TN, Bennett KM et al (2012) Failure-to-pursue rescue: explaining excess mortality in elderly emergency general surgical patients with preexisting “do-not-resuscitate” orders. Ann Surg 256:453–461

    Article  PubMed  Google Scholar 

  44. American College of Surgeons (2014) Statement on advance directives by patients: “do not resuscitate” in the operating room. Bull Am Coll Surg 99:42–43

    Google Scholar 

  45. Goede M, Wheeler M (2015) Advance directives, living wills, and futility in perioperative care. Surg Clin N Am 95:443–451

    Article  PubMed  Google Scholar 

  46. Cauley CE, Block SD, Koritsanszky LA et al (2016) Surgeons’ perspectives on avoiding nonbeneficial treatments in seriously ill older patients with surgical emergencies: a qualitative study. J Palliative Med 19:529–537

    Article  Google Scholar 

  47. Willmott L, White B, Gallois C et al (2016) Reasons doctors provide futile treatment at the end of life: a qualitative study. J Med Ethics 42:496–503

    Article  PubMed  Google Scholar 

  48. Grant SB, Modi PK, Singer EA (2014) Futility and the care of surgical patients: ethical dilemmas. World J Surg 38:1631–1637

    Article  PubMed  PubMed Central  Google Scholar 

  49. Abaunza H, Romero K (2014) Elements for adequate informed consent in the surgical context. World J Surg 38:1594–1604

    Article  PubMed  Google Scholar 

  50. Imhof M (2013) Malpractice in surgery: safety culture and quality management in the hospital. DeGruyter, Berlin/Boston

    Google Scholar 

  51. Makary MA, Daniel M (2016) Medical error – the third leading cause of death in the US. BMJ 353:i2139. doi:10.1136/bmj.i2139

    Article  PubMed  Google Scholar 

  52. Treadwell JR, Lucas S, Tsou AY (2014) Surgical checklists: a systematic review of impacts and implementation. BMJ Qual Safety 23:299–318

    Article  Google Scholar 

  53. Newkirk JD (2013) Preventing surgical mishaps: using surgical checklists. Clin Plastic Surg 40:475–487

    Article  Google Scholar 

  54. Lipira LE, Gallagher TH (2014) Disclosure of adverse events and errors in surgical care: challenges and strategies for improvement. World J Surg 38:1614–1621

    Article  PubMed  Google Scholar 

  55. Roberts F, Gettings P, Torbeck L et al (2015) Reflection on adverse event disclosure in the postsurgical hospital context. J Surg Educ 72:767–770

    Article  PubMed  Google Scholar 

  56. Sherer BA, Coogan CL (2015) The current state of medical malpractice in urology. Urology 86:2–9

    Article  PubMed  Google Scholar 

  57. Painter LM, Kidwell KM, Kidwell RP et al (2015) Do written disclosures of serious events increase risk of malpractice claims? One health care system’s experience. J Patient Safety. PMID 25831069

    Google Scholar 

  58. Howard J, Levy F, Mareiniss DP et al (2010) New legal protections for reporting patient errors under the patient safety and quality improvement act: a review of the medical literature and analysis. J Patient Safety 6:147–152

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Florida State University Center for Innovative Collaboration in Medicine and Law, Tallahassee, FL, USA

    Marshall B. Kapp

Authors
  1. Marshall B. Kapp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marshall B. Kapp .

Editor information

Editors and Affiliations

  1. Surgical Service, Yale University School of Medicine VA Connecticut Health Care System, West Haven, Connecticut, USA

    Ronnie A. Rosenthal

  2. SUNY Downstate School of Public Health, National Capital Region Johns Hopkins Medicine, Bethesda, Maryland, USA

    Michael E. Zenilman

  3. Center for Geriatric Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

    Mark R. Katlic

Section Editor information

  1. School of Medicine, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA

    Marcia McGory Russell

  2. Ariadne Labs, Boston, MA, USA

    Zara Cooper

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this entry

Cite this entry

Kapp, M.B. (2017). Legal Issues in Older Adults. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20317-1_20-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-20317-1_20-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20317-1

  • Online ISBN: 978-3-319-20317-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation