Alterations of Medical Records

Doctors, hospitals, medical offices, medical clinics and other medical care providers are obligated to keep medical records on all patients. Most doctors, hospitals, medical offices, medical clinics and other health care providers make every effort to preserve the integrity of their patient's medical records. The alteration of a patient's medical records is illegal and unethical.

The vast majority of doctors, nurses and other medical workers will not resort to altering records, even when faced with a claim of medical malpractice or medical negligence. Most doctors and hospitals have medical malpractice insurance. Doctors and Hospitals understand that there is a risk of medical mistakes. However, occasionally doctors, hospitals, nurses or their medical staffs will alter patient's medical records in the hopes of avoiding successful medical malpractice litigation and/or damage to their professional reputation.

Have Your Medical Records Been Altered?

When a patient suspects that medical records have been changed in a medical malpractice case, there are methods to determine if these suspicions are valid. One simple method is to go and look at the original patient chart. Sometimes, the alterations are blatant; like the use of a different pen or ink color. Expert document examiners may also be helpful in evaluating the integrity of a patient's medical chart.

Medical records can easily be cross checked, as very often multiple copies have been made and sent to other medical professionals, healthcare institutions, or even to the patient. Additionally, computer files and storage drives may preserve evidence of medical record alterations. Technology can also be used to prove if changes have been made to medical charts. For instance, Mylar transfer can determine if a written medical record has been altered, even if the change is in the same handwriting and the same pen.

Kentucky Medical Malpractice Attorney, Brett H. Oppenheimer has been involved in medical malpractice cases where concerns of changes to a patient's medical records have been investigated. Brett and his legal team have been able to show that the doctor had, in fact, changed a patient's medical records.

Medical Professional Oversight

Another type of inappropriate action taken by certain doctors, nurses or medical staff has to do with removing medical records from a patient's chart. A doctor or nurse can also fail to copy the complete patient chart upon a patient's request. A doctor or nurse can decide not to provide copies of phone call slips. Even though these are often kept in patient charts and often contain very important information, the call slips are sometimes removed or simply not copied when the patient or the attorney requests a complete copy of the patient's medical records.

In Kentucky, each patient has a right to one FREE copy of his or her medical records. This is provided for by Kentucky law in the Kentucky Revised Statutes.

If you believe that a doctor, nurse or other medical care or health care provider has altered your medical records in a case of medical negligence or medical malpractice, you are welcome and encouraged to contact Brett H. Oppenheimer, PLLC. Brett is a Kentucky medical malpractice lawyer who will provide a free consultation to help evaluate your legal claims of Medical Malpractice or Medical Negligence.