Public Health Law Map - Beta 5 - Medical and Public Health Law Site

a) Acute Medical Care
Physicians have an obligation to ensure that children are not deprived of medical
care for financial reasons. Ethically, children are entitled to special consideration
because of their dependent status. Legally, it is risky to turn away a child in need of
care because of the volatility of childhood diseases. A simple case of diarrhea can
prove fatal quickly in an infant. The delay that is attendant upon being refused care
without a proper referral to a physician willing to care for the child may prove fatal.
A physician must never allow a child to be turned away from a hospital or
emergency room because the parents do not have money or insurance. If there is an
ongoing physician–patient relationship, the physician must be the child’s advocate
and demand care. Payment issues between the parents and the hospital should not
be allowed to interfere with medical care. A physician who is not willing to insist
on proper hospital care may violate federal laws governing the provision of
emergency medical care.
b) Long Statutes of Limitation
The period of time that a physician may be sued for malpractice by or for a child is
much longer than it is for an adult. Most states have a statute of limitations that
starts when the injury occurs or when it is discovered by the patient. It is common
practice to toll the statute of limitations on children until the child reaches the age of
majority. For instance, an adult patient might have 2 years to bring suit. A 3-year-
old child may have until age 18 plus 2 more years to bring a malpractice suit, a total
of 17 years. This prevents the child’s rights from being compromised if the parents
fail to pursue the action.
The functional statute of limitations may also be quite long if the statutory period
does not begin to run until the injury is discovered. Assume that the uterus of a 5-
year-old child is negligently damaged during bladder surgery. As the child grows,
her sexual development is normal, and no problem is suspected. The girl reaches
adulthood, marries, and uses contraceptives to postpone childbearing until she is
ready for children. At age 30, she attempts to conceive and is unable to do so. After
2 years of infertility, she has a surgical procedure that reveals that the damage from
the first surgery is the reason for her infertility. If the statute of limitations runs until
2 years after the injury is discovered, this patient may be age 34 when she sues the
surgeon for an operation done 29 years before.
Despite the long-term potential liability and the uncertainty it generates in
malpractice insurance rate setting, general pediatricians still pay relatively low
rates. Nonetheless, all physicians who care for children should be careful to
preserve medical records until at least a few years past the child’s maturity. As
with other medical records, the physician should attempt to provide the patient with
a copy before destroying the old record. While this is difficult with records of nowadult
pediatric patients, these records can be especially valuable. Unlike adults who
are informed of the nature of their illness at the time the care is rendered, pediatric
patients have no personal memory of their early medical history. This history can
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