Understanding Standard of Care for Patients

The standard of care is a benchmark used in medicine to determine whether the professional obligations to patients have been met by a healthcare provider. Failure to deliver the standard of care may be deemed medical negligence.

Standard of care is a legal term—not a medical one—defined by law and regulated by state administrative agencies. The laws governing the standard of care can vary by state. If the standard of care is not met, a patient can file for medical malpractice and seek damages in court. A surgeon who leaves an instrument inside a patient after surgery is an example of a breach of the standard of care.

This article helps you understand what the standard of care means in medicine, how it is legally defined, and what happens when the standard of care is breached. It also describes the legal actions you can take if you have grounds for a lawsuit.

Legal Definition of Standard of Care in Medicine

The standard of care, in plain English, refers to treatments and practices that are appropriate for a specific disease that are both accepted by medical authorities and widely used by healthcare professionals. The standard of care is also sometimes referred to as "best practice."

The legal definition is far more complex. Although the definition can vary by state law, most states base their definition, at least in part, on a national standard first described in Connecticut Code §52-184 which defines the standard of care as:

Although there is an increasing push to adopt a uniform national standard, some states allow for variations in how the standard of care is defined.

For instance, some states have adopted a locality rule wherein the standard of care is based on what other professionals in the same area and community would do in a similar circumstance. Other states designate a locality rule for general practice and a national standard of care for specialists.

Factors Affecting Standard of Care

It is important to note the standard of care does not mean optimal care. The standard of care runs a spectrum from a barely acceptable level of medical care right up to the optimal level of medical care.

Therefore, for any action to be regarded as a breach of the standard of care, it may need to fall well outside of the legal definition of what is acceptable and be subject to legal interpretation.

This is where the locality rule is potentially problematic. Rather than measuring physicians against all physicians in the country, the locality rule allows physicians to be measured against other physicians in the local area.

People who favor the locality rule contend that medical resources vary by community and that physicians in areas with fewer resources should not be bound by the same standards (or risk or malpractice) as those practicing in high-resource communities.

Those opposing the locality rule argue that advancements in medical technology allow for a national standard. They also contend that the locality rule undermines patient rights by making it difficult to prove negligence if a physician is just "doing what everyone else does."

Proving malpractice can often prove difficult. To determine if the standard of care has been breached, the court must take into account multiple factors, including:

• Federal laws and regulations
• State laws and regulations
• Court opinions and precedences
• Published clinical guidelines from a recognized authority, such as the American Health Association (AHA)
• Guidelines from state medical licensing boards
• Policies and guidelines from professional organizations, like the American Society of Clinical Oncologists (ASCO)
• Published, peer-reviewed medical journal or research articles
• Accreditation status, such as from the Accreditation Council for Graduate Medical Education (ACGME)
• Facility policies and procedures
  

When Treatment Doesn't Meet the Standard of Care

If the standard of care is breached, either by accident, neglect, or recklessness, there are actions you can take to make the practitioner liable for their actions. With that said, medical negligence doesn't always mean you have a case for medical malpractice.

To file a malpractice suit, you must show that the negligence caused you direct harm for which you should be compensated.

Examples include:

• Failing to diagnose or misdiagnosing a disease that turns out to be serious
• Failing to order or perform the appropriate medical tests
• Prescribing treatments or medications incorrectly or inappropriately
• Failing to obtain informed consent before a procedure, particularly surgery
• Surgical mistakes, including anesthesia errors or unnecessary surgery

If there are grounds for a suit, you may also pursue a case against others, including the hospital or healthcare facility that employs the practitioner.

If you decide to pursue the case, you would need to hire a malpractice attorney given that some states have enacted laws that make malpractice claims more challenging and complicated to pursue.

The attorney can also tell you if your claim is within the statute of limitations of your state (meaning the time between which the negligence occurred and the lawsuit was filed). The statute of limitations in some states like Kentucky and Louisiana is only one year, while most others are between two and three years.

Even if your claim does meet the definition of a compensatable act, you can still file a complaint with the following authorities who can enact disciplinary actions or even suspend or revoke licenses:

• Your state medical board
• Your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)  for complaints about the standard of care a Medicare provider
• The Joint Commission which certifies hospital safety

Summary

The standard of care is a legal term that defines which medical treatments and practices are prudent and appropriate in caring for patients. The laws governing the standard of care can vary by state. If the standard of care has been breached, a medical malpractice lawsuit can be filed to seek compensation for damages caused by the negligence. A medical malpractice attorney is needed.