Standard of care is a legal term that essentially revolves around the concept of the reasonable person standard – i.e. whether someone acted with care as another ordinary, law-abiding individual would have in the same circumstances. When it comes to medical care, the definition refers to the type and level of care that a prudent health care professional with the same training and experience would provide under similar circumstances.
For a physician expert witness, the idea and intent behind the concept of medical standard of care ultimately relates to patient outcomes – and how the best outcome for a particular patient, confronted with a particular set of clinical circumstances, can be realized, as much as possible, by the patient’s providers and the system in which those providers practice.
We’re often asked what we, as correctional medicine experts witnesses, use as the basis for our concept of standard of care when opining on it. Ultimately, our knowledge and understanding of the standard of care is gleaned from three areas:
1/ Education, training, and board certification: For physicians, this typically involves four years of medical school education and an additional three to five years (or more) of internship, residency, and fellowship training. Relevant post-graduate education, such as a master’s degree in Public Health, adds another layer of specialized knowledge in the promotion and protection of the health of communities. Achieving board certification provides additional representation of an expert witness’s advanced knowledge, training, and skills in their specialty area of medicine.
2/ Standards established by national organizations: The Agency for Healthcare Research and Quality, National Quality Forum, Institute of Medicine, and several other such organizations publish evidence and standards to improve the safety, quality, and accessibility of healthcare. These standards are developed by panels of experts from multiple disciplines. For health services provided to incarcerated individuals, the National Commission on Correctional Health Care has established minimum standards for the quality of healthcare; according to the NCCHC, accreditation based on these standards can reduce the risk of adverse events.
3/ Clinical practice guidelines by specialty organizations: Entities such as the American Thoracic Society, the American College of Occupational and Environmental Medicine, and the US Preventive Services Task Force regularly publish evidence-based best practices that define the role of specific diagnostic and treatment modalities for the diagnosis and management of patients. These guidelines are not mandated protocols, but are best practices based on evidence from a rigorous systematic review and synthesis of the published medical literature.
All patients are entitled to care that meets the prevailing standard of care. Healthcare providers and the systems in which they practice are obligated to meet that expectation. Individuals who are incarcerated are no exception.