LNCtips.com: Locality Issues for LNCs

Locality refers to a rule regarding the standard of care for medical malpractice cases.  It's a rule that's almost non-existent today, but it still has implications for legal nurse consultants.

At one time, standards of care were based on locality, another word for community.  There were no such things as guidelines from professional organizations or standardized training of healthcare providers.  Therefore, states determined rules about testifying experts using community standards or care, rather than national ones.  This meant it was necessary to find a testifying expert within the same or a similar neighboring community.  This was sometimes a very difficult task because experts didn't want to testify against colleagues they knew personally.  With the advent of national professional guidelines and regulation of professions, most states recognize that community standards of care are no longer relevant. 

However, Tennessee, still has a statute which requires that the expert must work in Tennessee or one of its border states of Kentucky, Virginia, North Carolina, Georgia, Alabama, Mississippi, Arkansas, or Missouri, unless there is no other qualified expert available.  This is as close to a community standard as there is now, although even the Tennessee courts recognize that national and community standards of care are representative of each other.  Expert LNCs need to know that they can't testify in Tennessee unless they live in that state or a bordering one, unless an attorney files a waiver and the court approves it. 

Does the decline of locality mean that the community is no longer a consideration in medical malpractice cases?  Some legal nurse consultants confuse access to care with professional competence.  It's true that healthcare workers in all communities, whether urban or rural, are now held to national standards.  However, neither the locality rule nor national standards require that rural hospitals have the same facilities and services that urban centers have.  For instance, rural hospitals might have a mobile MRI on site only one or two days a week, whereas many urban hospitals have access to an MRI 24 hours a day, 7 days a week.  In this situation, if a patient at the rural hospital requires an urgent MRI, it's not a deviation in the standard of care if the MRI is unavailable on that particular day.  It IS a deviation if the physician and hospital don't transfer the patient in a timely fashion to a facility with an MRI.

Legal nurse consultants need to take these types of factors into consideration when reviewing cases.  Locality, while no longer a big force in medical malpractice litigation, is still important and often misunderstood.

...Katy Jones