November 2017 Edition. Volume XVII

A most important and ubiquitous legal practice is that of defining “standards of medical or health care care.”  At one time such standards were referred to as the “standard of care in the community” but, with the globalization of information and credentialing, standards are now considered to be national (and probably will be global in the future) and not just simply related to the community.  There are however special circumstances, as when a community is physically isolated from the rest of a country, that national standards might not apply.

“Standards” can be primary or secondary.  An example of a primary standard is that of informed consent which requires complete disclosure of risk.  A secondary standard, which assumes that the primary standard has been met, may relate to the treatment itself.

An interesting situation exists when a common practice is  inherently unreasonable.  In this circumstance common practice would not be considered a “standard of care”?  This would be particularly so if the practice were to be based on misinformation or ignorance.

Do examples of unreasonable practice exist today?  Yes, indeed they do.  One of the most remarkable cases in point has been the use of neurotoxic substances in steroid suspensions being used in “epidural steroid” injections to treat low back pain.  Violation of primary standards, in such cases, is widespread.  Given that there are other, safer, alternatives than neurotoxic substances for use in this procedure the use of a neurotoxic agent can not be considered legitimate since it represents only a aberration of good practice.

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