Enduring The Endless Paperwork Shuffle: Why Tort Reform Is Essential

Molly Judge DPM FACFAS

Have you gone to a hospital for a case using local anesthesia lately? It has truly become bizarre. When I began private practice in 1997, you could walk into the hospital, fill out little more than a consent form and you could be in and out as fast as you would at any outpatient surgery center.

That said, I almost blew an artery from the chaos and disorganization that I witnessed in the hospital this week. I went to the hospital in the Northwest Ohio area for two cases of pulsed dye laser treatment of chronic verruccal lesions. I bring my own consent and home instructions for the sake of completeness.

The process started with two sheets of paper. The hospital, of course, has an entire chart of paperwork already prepared. I was instructed that I had to complete a history and physical (H&P) for the case (which included airway staging) before I could go back into the procedure room despite the fact that it was a local case. This meant filling out another three pages of documentation and an extra 15 minutes of interview and examination with the patient.

Since I needed to inject a local anesthetic, I had to ask the circulating nurse to draw up that medication. Five minutes later (and with three nurses passing this request along the way), the circulating nurse presents only to give me that “deer in the headlights stare” as I ask for the injectable and then goes off to get that medication. One more sheet of paper was required for the injectable and syringe, etc.

As I was injecting, another nurse presented with the hospital’s consent form (another two pages of documentation). She insisted that the patient sign this one since it had all of the hospital lingo on it. This consent form trumped what I had prepared and educated the patient with in my office. Yes, since I had to sign this as well, I was required to review the procedure and the risks and benefits of the procedure again with the patient. Another five minutes elapsed.

The patient became concerned about the extra paperwork. What did it include that it required everyone to sign off on it? Was it something serious that the patient did not understand? I had to spend another five minutes providng reassurance and patient education.

At this point, I had eight sheets of paper in addition to a chart of documents for admission and discharge of the patient. I marked the foot of the patient in the exact area of the lesion and put my initials literally on the skin before proceeding to the procedure room. The eight sheets of paper were in a stack on top of the chart orderly and complete.

A different nurse came up to the stack and shuffled the entire pile in order to confirm that the consent form was completed. The stack became a mess on the countertop with the chart at the end of the counter. Another nurse reported to the mess of paperwork, grumbled, shuffled through the entire stack of papers and once again left the papers in a mess on the counter. A different nurse (the circulating nurse) presented and said she needed to see the consent form since she heard there was no consent form on the chart in advance. Once again, the stack of papers was shuffled. At this point, we had waited another 15 minutes and have not accomplished a thing.

We went into the procedure room and the nurse running the laser had to confirm that the consent form was filled out and account for a series of papers. Then the circulating nurse had to reshuffle the pile of papers to perform the “time out” for the patient. The procedure, which took only four minutes to perform, was completed with the blessing of the nurse running the laser only after she shuffled all eight sheets of paper and added a sheet for the use of the laser unit.

In total, nine sheets of paper and a chart were stacked neatly before the patient went to the recovery room. To call this frustrating does not do the problem justice.

In Conclusion

Here is the problem. The majority of the forms prepared on this day were to protect against the patient having a litigious grievance as a result of walking onto hospital property and undergoing a very conservative procedure. Despite a detailed in-office examination and consultation, all of this paperwork is required to protect the hospital and myself from litigation. This underlines the fact that tort reform is a long way away.

Do I believe we will ever get tort reform? No. There is simply too much money in it for the legal people and the clients. Will the government ever pursue tort reform? This probably will not occur in a meaningful way in my lifetime (which is growing shorter due to stressful situations like this).

If the government tries to run a nationalized health care system, I suspect the paper problem will only get worse. Can you imagine the amount of legal “ease” that will be required in implementing such a system? It will take thousands of legal people to develop reams of paperwork describing what should be done for everyone in the United States (including the millions of illegal people now residing here).

Further, there will need to be thousands of legal people following the paperwork throughout the year to ensure that the paperwork covers the medical procedures and testing that are carried out within each state. Of course, a ream of paperwork will be required if you intend on pursuing any type of surgical intervention (but only for patients who qualify).

Quite frankly, I am convinced that government control of the U.S. health care system will make things exponentially worse. Hold on to your hats because it is going to be a very long and bumpy downhill ride. Let me know your thoughts. Just writing this blog has saved me hours of “couch” time in counseling.


I did my residency at a VAMC. So I know fist hand about government paper work.

Dear Aug 30, 2009 5:08pm

I wish you could give us your impression of whether or not the government can take over the entire national health care situation. It will prove enlightening to our readers. Thanks in advance for your response.

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