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Chapter 3 - Legal Considerations in Quality Control Programs

The central legal consideration in establishing a quality control program in the prevention of medical malpractice litigation. Malpractice litigation is based on the breach of the duty to render medical care in a nonnegligent fashion. Whether the care in question was negligent is determined by reference to what other providers would have done under similar circumstances. This is called the community standard rule. This rule requires quality control programs to incorporate the appropriate community standards for practice into their monitoring protocols. The selection of appropriate standards is crucial to developing a quality control program that will reduce the risk of litigation.

The selection of standards is simple for hospitals because the JCAH has developed comprehensive standards and guidelines for most aspects of hospital practice. The selection of standards is more difficult for individual providers, such as nurses and physicians. While the various medical specialty organizations do promulgate standards of practice, none of these organizations seeks to enforce these standards on the level of individual providers. This leads to the promulgated standards being treated as goals, rather than minimal requirements. The use of such standards in a quality control program can result in many of the providers being defined as rendering substandard care. Unless these providers can be persuaded to change their mode of practice, this will create more legal problems than it solves.

There is a basic conflict in quality control; standards must be high enough to prevent injuries, but not so high as to reflect badly on the regulated providers. Balancing these conflicting interests requires a knowledge of the legal duties that health care providers owe patients.


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