Expert: JM Starkman, MD - 9/26/2010

Question
Which of the following anesthesia reports would be used to document an unusual event or complication that occurred during surgery?

postoperative or intraoperative

Answer
Either one, or many times a hospital or physician's organization will have a separate documentation area for adverse events.   Hospitals call them "risk management" or "quality review" managers/offices. That meets the requirement to document, but makes it nearly impossible to uncover any details for lawsuit purposes--which is, of course, why they are set up in this fashion in the first place.  A physician's duty to his patient, however, remains above this---adverse events that could not be foreseen and are preventable in the future should be reported to the patient in writing and often via certified mail to prove that the responsibility to avoid future problems  rests with and has been transferred to the patient to communicate the matter to his future doctor/"provider".