The number of trucking accidents has increased by 20 percent over the last two decades. This is despite newer trucking regulations and safety features.
Connecticut truck accidents are unfortunately common. Whether you are traveling along I95, I84 or a local highway, truck accidents can occur at any time. These tractor-trailer accidents are often catastrophic and can result in serious injury.
Large commercial trucks are difficult to maneuver due to their size and weight. In fact, a fully-loaded tractor-trailer can weigh as much as 80,000 pounds. A small passenger car weighs just 3,000 pounds. Due to these size and weight discrepancies, passenger vehicle occupants suffer the majority of the injuries during a crash.
Here at Walsh Woodard LLC we know the damage a truck collision can cause and we want to help. While you cannot avoid all truck accidents, there are ways to reduce the chances of getting into a serious Connecticut truck accident. If you follow these steps, you may be able to reduce the risk of getting into a life-altering truck crash.
Steps to Avoid a Truck Accident in Connecticut
Of course, when driving on the road, it is always important to remain alert and vigilant. Keeping these safe driving practices in mind will help you to avoid what can be a life-altering event:
- Maintain a safe distance. Large commercial trucks need more time to respond to dangerous situations. A truck can use up to 90 percent more space to stop than other vehicles. That’s why passenger vehicles need to give trucks extra stopping distance when traveling in front of them. If a truck is behind you, be sure that there is enough distance between you so the driver can respond safely. If you are following a truck and you are too close, you may not be able to respond if the truck driver suddenly brakes. Give the truck some more room to help avoid a crash.
- Maintain visibility. Trucks have large blind spots. Car drivers need to be aware of these blind spots and avoid them whenever possible. Truck drivers cannot avoid what they cannot see. Never drive directly behind a truck or in the adjacent lanes by the cab doors. If you cannot see the truck driver’s face, you are likely driving in a blind spot. Either slow down or speed up so that you are not alongside the truck for any extended distance.
- Anticipate turns. Large tractor-trailers need more space when navigating turns. At intersections, truck drivers often need to swing their trucks through multiple lanes to turn. Do not pass a truck while it is turning. Anticipate when a truck is going to turn and give it some extra room to turn safely.
Contact Our Hartford Truck Accident Lawyers
If you suffered an injury in a truck accident on I95 or anywhere in Connecticut, contact our Hartford truck accident lawyer immediately. At Walsh Woodard LLC, our lawyers have successfully represented individuals injured by reckless truck drivers. We know that the injured need help quickly. That’s why we work aggressively for them. Call us today at 860 -785-2011 or fill out our confidential contact form for more information. We offer free initial consultations so you can seek justice after a catastrophic trucking accident. Call us today!
MOTION TO COMPEL PRODUCTION OF AUDIT TRAIL
Pursuant to Connecticut Practice Book § 13-14, the plaintiffs, [PLAINTIFFS], hereby respectfully move the Court for an order directing the defendant to provide a complete and adequate response to the document requests contained in the Re-Notice of Deposition dated September 5, 2019 (Exhibit A). Briefly summarized, the document requests seek, inter alia, the production of the federally mandated audit trail for the October 2, 2014 prenatal ultrasound, in its entirety. In response thereto, the only documents produced by the defendant are two largely undefined and unintelligible documents which appear to be “access logs”, and do not in any way meet or satisfy the requirements of federal law, the Connecticut Practice Book, or the document requests made by the plaintiffs in this matter.
The defendant is required by federal law to maintain an audit trail which tracks and records critical information about each entry in a medical record in an electronic hospital chart. The audit trail records, inter alia, the identity of any health care provider who accesses, reviews, or edits the document in any way, and records the nature of any change made to the document. In this way, entries in an electronic chart may be tracked and accessed, even if the electronic record has been altered at a later date.
In the present case, such information is critical to corroborate or disprove the claims of the defendant that are central to its defense. The plaintiffs therefore respectfully urge the Court to order the defendant [DEFENDANT] to produce the audit trail for the October 2, 2014 pre-natal ultrasound.
I. FACTUAL BACKGROUND
In the subject action, the plaintiffs claim, inter alia, that the defendant’s maternal fetal medicine physician, [DOCTOR], failed to properly interpret and act upon the October 2, 2014 prenatal ultrasound, which revealed diagnostic evidence that the [PLAINTIFFS], were suffering from cytomegalovirus (CMV). Specifically, the ultrasound showed echogenic bowel, which is an indicator of CMV at the 21-week gestation period.
There is no question that the ultrasound report authored by [DOCTOR] clearly documents in capital letters a finding of “HYPERECHOIC SMALL BOWEL” for Fetus A. Notwithstanding the clearly documented finding of “HYPERECHOIC SMALL BOWEL”, the defendant failed to perform any of the necessary testing which would have clearly shown that both babies were infected with CMV. At his deposition, [DOCTOR] testified that he had no specific recollection of this case, or reading this ultrasound film or preparing the report.
Notwithstanding [DOCTOR] sworn deposition testimony, on July 25, 2019, over a year after his May 21, 2018 deposition, the defendant filed an interrogatory response suggesting that [DOCTOR] was retracting and changing his sworn deposition testimony, as well as contradicting the clear documentation in his report. The interrogatory response reads:
After review of the entries by the ultrasound technologist (sonographer), [DOCTOR] found no hyperechoic bowel in either twin. [DOCTOR] deleted an informational box captioned “hyperechoic bowel” pulled down into the report by the technologist, but he did not see the second identical informational box in the other fetus’ report findings and, therefore, failed to delete this second informational box.”
[DOCTOR] appears to suggest that his non-existent memory was somehow resurrected by a review of the entries of the ultrasound technologist. It is by no means clear as to what entries he is referring, although whatever allegedly jogged his memory was just as available to him before his deposition as after. Needless to say, such a complete reversal of a signed medical report and sworn deposition testimony leads the plaintiff to seriously question [DOCTOR]’s veracity and whether he was forthcoming and honest in ether his sworn deposition testimony or written discovery. [DOCTOR]’s credibility is very much in issue.
Fortunately, Congress enacted legislation to directly address this type of situation, by tracking the evolution of electronic medical documents. In the present case, the audit trail will show whether the sonographer entered “HYPERECHOIC SMALL BOWEL” for both babies, and it will further show whether [DOCTOR] deleted the entry for one baby, as he now claims, and the source of the referential information in Baby B’s report. In short, the audit trail will either corroborate or disprove the latest rendition of events now being offered by [DOCTOR]. As such, the audit trail is a critically important piece of evidence, which should be produced by the defendant.
Accordingly, the plaintiffs respectfully urge the Court to order that the defendant produce the audit trail for the October 2, 2014 ultrasound.
II. LAW AND ARGUMENT
A. Standard of Review
Practice Book § 13–14(a) provides in pertinent part that a trial court “may on motion [to compel production], make such order as the ends of justice require.” “Consequently, the granting or denial of a discovery request rests in the sound discretion of the court …” (Internal quotation marks omitted.) Berglass v. Berglass, 71 Conn.App. 771, 786, 804 A.2d 889 (2002).
B. The Importance of the Metadata in Electronic Medical Records
In response to the plaintiffs’ requests, the defendant has provided two documents – attached hereto as Exhibits E and F. Though the defendants offered no clear explanation for either document, both appear to be “access logs” – Exhibit E for the PACS transponder system and Exhibit F for the “Observer” software which runs on a laptop connected to the ultrasound machine and is used to generate the ultrasound report. Neither complies with the Practice Book requirements of fair production; and neither complies with the HIPAA requirements for the preservation of audit trails in electronic medical records.
“Depending on the circumstances and the needs of the case, a particular piece of metadata may be critical . . . .” The Sedona Principles, 19 Sedona Conf. J. 1, 170 (2018) (discussing Principle 12, pp. 169–186)(The Sedona Principles have been held to be the leading authority on electronic document retrieval and production.). Further, the principles state that:
[A]side from potentially bearing upon the merits of the case, metadata also may play a functional role in the usability of [electronically stored information]. For example, system metadata may allow for the quick and efficient sorting of files by virtue of the dates or other information captured in the metadata. Application metadata may be critical to allow the functioning of routines within the file, such as the coding that makes documents display in a certain way to the user. . . . In addition to application and system metadata, some [electronically stored information] in its native format will contain user created data that may not be apparent on the face of the document when printed . . . .
Id. at 170–171 (2018).
An electronic medical record (EMR) audit trail is considered system metadata because it contains “a record of every change or addition to an electronic medical record” and “includes the identification of the terminal used to access the record and the date, time, and author of the change or addition to the electronic medical record.” Jeffrey L. Masor, “Electronic Medical Records and E-Discovery: With New Technology Come New Challenges,” 5:2 Hastings Sci. and Tech. L. J. 245, 254 (2013) (citations omitted). Audit trails can demonstrate whether records have been changed, notes have been added, or items have been deleted from the electronic medical record. However, audit trails provide much more than simply proof of alterations. These audit trails identify who accessed the patient’s records, when they were accessed, who authored each entry, when and from what terminal.
ASTM E2147-01 also lays out a national standard specification for audit trails for use in health information systems. According to the ASTM standard, the audit trail must capture the date and time of the access event and exit event; patient identification information unique to each patient; user identification unique to each health care provider; access device from which the user is accessing the system; type of action completed, including addition, deletion, change, query, print, copy, or other; identification of the patient data that is accessed, such as demographics, pharmacy data, test results, imaging, or transcribed notes; source of access application; and reason for access indicated by the user.
The access logs produced by the defendants provide none of this required information. Rather, Exhibit E indicates only a series of “log-ins” between 5:08 and 5:10 p.m. on October 2, 2014, and fails to reflect any access or editing by Ms. Steinhart (the sonographer who conducted the ultrasound). Exhibit F provides a brief and seemingly incomplete “list” of accesses – none of which include access by [DOCTOR], or any other physician. Interestingly, every other date of service referenced on Exhibit F appears to have a physician log-in; and [DOCTOR]’s name appears on the concurrently produced Exhibit E. There is no indication of what, if anything, was completed, edited, changed, accessed or reviewed concomitant with these “log-ins” on either Exhibit, nor – as to Exhibit F – any time code indicating when the software was accessed at all. In short, both exhibits raise many more questions than they provide adequate answers. And neither appears to indicate any of the relevant information HIPAA demands be preserved.
Audit trails show who has accessed a computer system, when it was accessed, and what operations were performed, including input and deletion. Access logs, on the other hand, document and maintain a record of access to confidential health care information, and little else.
The two documents produced by the defendant are crude, unintelligible and inadequate. They do not fulfill the requirements of full and fair discovery, and they do not represent the audit trail the defendant is required to maintain under HIPAA.
C. HIPAA and the HITECH Act Require Preservation of the Audit Trail
The Health Insurance Portability and Accountability Act (HIPAA) gives patients a right of access to their entire medical record. 45 C.F.R. § 164.524(a)(1) states:
- Right of access. Except as otherwise provided… an individual has a right of access to inspect and obtain a copy of protected health information about the individual in a designated record set, for as long as the protected health information is maintained in the designated record set…
Since 2003, the HIPAA Security Rule has required that hospitals like the defendant undertake regular monitoring of system activity, including audit logs and access reports by IT personnel or compliance officers, on a quarterly basis (if not more frequently) as well as the implementation of software and procedural mechanisms to record and examine system activity. 45 C.F.R. §§160, 162, 164 (2014); 45 C.F.R..§ 164.308(a)(l )(ii)(C); 45 C.F.R. § 164.312(b). More specifically, Section 164.132(1)(b) provides that audit controls are required. Under HIPAA, hospitals must ” implement hardware, software and procedural mechanisms that record and examine activity and information systems that contain or use electronic protected health information.” 45 C.F.R. § 164.132(1)(b).
In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted to promote meaningful use of healthcare technology. 42 USC §300jj (2014), §17901(2014). The HITECH Act specifies that EMR Systems must satisfy certain requirements such as recording access to patient records, showing who viewed or changed information, when this was done, and from what location. Specifically, 45 C.F.R. § 170.210 sets forth the standards for health information technology to protect electronic health information created, maintained and exchanged. Subsection (b) provides:
Record actions related to electronic health information. The date, time, patient identification, and user identification must be recorded when electronic health information is created, modified, accessed, or deleted; and an indication of which action(s) occurred and by whom must also be recorded. (emphasis added).
Together, the HIPAA Security Rule and the HITECH Act provide a legal framework that requires organizations using EMRs to track and maintain a log of all access and changes to electronic records. Withholding the data violates a patient’ s right of access to her complete medical file. The federal regulations make clear that the standards were established to protect the health information – information regarding the care of the patient for whom the record was created.
HIPAA set the national standard for maintaining patients’ medical information, including electronic data. One of its purposes was to ensure that medical records could not be altered without detection, to “protect the security and privacy of individually identifiable health information.” 42 U.S.C.A. §1320d-2(d)(2); See also, R.K v. St. Mary’s Med Ctr., Inc., 735 S.E.2d 715, 720 (W.Va. 2012), cert. denied, 133 S.Ct. 1738 (2013). HIPAA applies to any health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter. 45 C.F.R. § 160.102(a)(3).
D. Metadata, Including Audit Trails, Is Fairly Subject to Discovery
- Connecticut Practice Book § 13-9 Requires EHR Production
The plaintiffs’ requests fully comply with the Practice Book requirements. Practice Book § 13-1 specifically allows for the production of electronic health records (EHR) metadata through its definitions, which allow for the production of an electronic writing and/or data and the production of such in its “native form” pursuant to Practice Book § 13-9 (e). Furthermore, metadata is part of the functioning of an EHR during the ordinary course of business and is necessary to ascertain exactly what information was present to the defendants during the care and treatment of the plaintiffs. Practice Book § 13-9 (e) states that when information has been electronically stored the plaintiff is not constrained to delivery of records in non-native format (PDF and print files), but rather may specify the form, including in native format, that is preferred. Conn. Practice Book § 13-9 (e) (discussing that failure of the plaintiff to specify form of production of electronic documents allows production of such in ordinarily maintained form). This section of the Practice Book would be meaningless if the plaintiffs were unable to request alternate forms of the electronically stored information. Furthermore, Practice Book § 13-1 (a) states that electronically stored information “means information that is stored in an electronic medium and is retrievable in perceivable form” and includes “data or data compilations, stored in any medium from which information can be obtained either directly or, if necessary, after translation by the responding party into a reasonably usable form.” See Practice Book § 13-1(c) (2).
- Courts Have Repeatedly Held Audit Trails Must Be Produced
Courts nationwide have repeatedly ordered that audit trails must be produced where information contained therein is relevant to the claim or defense of either party. Gilbert v. Highland Hospital, 52 Misc. 3d. 555, 558-59 (Sup. Ct., Monroe County, NY 2016) (“while the Vargas court concerned itself with the former consideration of relevance, it is the latter consideration, the who, what and when of chart access, which was at issue here.”). See also Moan v. Mass. General Hosp., No. 15-CV-1122-H, 2016 WL 1294944 (Super. Ct. Mass. Mar. 31, 2016) (defendant hospital was ordered to produce all audit trails or other documents sufficient to identify each person who accessed the patient’s EMR; the periods of time they had accessed it; what they had accessed; and, all changes or additions made to the EMR by each person at each time in both paper and electronic form).
In Baker v. Geisinger Community Medical Center, 2017 WL 1293251 (Pa.Com.Pl., April 7, 2017), the plaintiff produced discovery depositions reflecting disparities between the testimonial recollections of her healthcare providers and the entries contained in her hospital chart. The court granted the plaintiff’s motion to compel the audit trail up to the day preceding oral argument on the motion, finding that the “audit trail will reveal which healthcare providers received or reviewed what medical information, when they possessed that knowledge, where and when they made their respective entries, and whether those entries were ever edited or altered.” Id, 4-5.
In Fernandez-Rajotte v. Dartmouth Hitchcock Medical Center, 2014 WL 12540494, (N.H. Super. 2014), the plaintiff brought an action for medical malpractice based on complications arising from surgery. The plaintiff requested that the defendant produce an un-redacted copy of the audit trail for the medical records related to her surgery. The court found the medical records pertinent to the surgery were at the heart of the action and the audit trail represented a log of the employees accessing the records, the parts of the records accessed, and the actions taken with the record. The court ordered disclosure of the audit trail since it would “demonstrate whether a [medical center] employee had edited or modified [the plaintiff’s] medical records in any way, which would be relevant to the veracity of the information contained in her records.” Id. at 5. In Osborne v. Billings Clinic, 2015 WL 141626 (D.C. Mont. 2015), the hospital argued that audit trails were implemented for quality control purposes and were therefore not “healthcare information” required to be included in a “designated record set” per 45 C.F.R. § 164.524(a)(1). The court rejected this argument, and held that the audit trail “data” related to the patient’s hospital care and treatment was discoverable. In Hall v. Flannery, 2015 WL 2008345 (D.C. Ill. 2015), the hospital argued that audit trail logs and metadata associated with the patient’s medical chart were subject to peer review privilege and work product doctrine. The court disagreed, and held that State statutes providing the privilege did not bar access to the audit trail information, nor was such information protected by the work product doctrine.
In Gilbert v. Highland Hospital, 52 Misc. 3d. 555, 558-59 (Sup. Ct., Monroe County, NY 2016) the court dismissed the defendant’s argument that the plaintiff’s request for the audit trail was a “fishing expedition.” Instead, the court granted the plaintiffs motion to compel the production of the audit trail to show the sequence of events related to the use of and access to the decedent’s medical records. In finding that the request was not a fishing expedition, the court recognized that the plaintiff requested the audit trail to determine the level of involvement of the emergency room doctor with the decedent’s care knowing that it existed because it was mandated by federal law. Id. In a lengthy opinion, the Court recognized that any medical provider maintaining an electronic records must also maintain an audit trail pursuit to the requirements of 45 C.F.R. § 164.312. The court rejected defense arguments that the audit trail information was not “material and necessary”, that the plaintiff’s request for the documentation constituted a “fishing expedition”, and that plaintiff was required to make a showing that there was an issue about authenticity of the hospital records already produced as a predicate to obtaining the audit trail information. The Court stated that “if the authenticity of a document is questioned, or if establishing who received what information and when is important to the claims or defenses of a party,” then the system metadata is inarguably relevant and the defendant was required to produce it. Id. at 400; emphasis in original.
In discussing the discoverability of audit trail documentation, the court characterized the information it contains as follows:
[An] audit trail is a form of metadata created as a function of the medical provider’s computerization of medical records. Metadata is “’secondary information,’ not apparent on the face of the document, ‘that describes an electronic document’s characteristics, origins, and usage’” (Matter of Irwin v. Onondaga County Resource Recovery Agency, 72 AD3d 314, 320, 895 NYS2d 262 [4th Dept 2010]), or, to put it more succinctly, metadata is, “data about data.” In discussing the audit trail for computerized medical records, one commentator described it as follows:
“The audit trail is a document that shows the sequence of events related to the use of and access to an individual patient’s EHR [electronic health records]. For instance, the audit trail will reveal who accessed a particular patient’s records, when, and where the health care provider accessed the record. It also shows what the provider did with the records – e.g., simply reviewed them, prepared a note, or edited a note. The audit trail may also show how long the records were opened by a particular provider. Each time a patient’s EHR is opened, regardless of the reason, the audit trail documents this detail. The audit trail cannot be erased and all events related to the access of a patient’s EHR are permanently documented in the audit trail. Providers cannot hide anything they do with the medical record. No one can escape the audit trail.” (Alice G. Gosfield, Health Law Handbook § 10:9[2011 ed] [“The positive effect of EHRs on reducing health care provider liability – The audit trail”].)
Id. at 556-557.
The court granted the plaintiff’s Motion to Compel the audit trail documentation over defense objections.
In Picco v. Glenn, 2015 U.S. Dist. LEXIS 58703, 2015 WL 2128486 (D.C. Colo. 2015), the Court held that the plaintiff was authorized to have his expert witness conduct a complete forensic examination of his medical records maintained on the hospital’s electronic records system, specifically including any audit trail information. In reaching its holding the court cited the following provisions of federal law requiring the maintenance of audit trail records: 45 C.F.R. §§ 164.105, 164.304, 164.306, 164.308, 164.312, and 170.210, setting forth the types of information a hospital is required to record and maintain; 45 C.F.R. § 164.306(a)(1), commanding a hospital to “ensure the confidentiality, integrity, and availability of all electronic protected health information [that it] creates, receives, maintains, or transmits”; 45 C.F.R. § 164.304, providing that “availability” in this context means “that data or information is accessible and useable upon demand by an authorized person”; 45 C.F.R. § 164.308(a)(7)(ii) provides that a hospital … must “[e]stablish and implement procedures to create and maintain retrievable exact copies of electronic protected health information”; 45 C.F.R. § 164.312(b) provides that a hospital … must “[i]mplement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information”; 45 C.F.R. § 170.210(b) requires that “[t]he date, time, patient identification, user identification … must be recorded when electronic health information is created, modified, accessed, or deleted; and an indication of which action(s) occurred and by whom must be recorded”; 21 C.F.R. § 11.10(e) provides that a hospital shall employ procedures and controls including the “[u]se of secure, computer generated, time-stamped audit trails to independently record the date and time of operator entries and actions that create, modify, or delete electronic records” and that “[s]uch audit trail documentation shall be retained for a period at least as long as that required for the subject electronic records …”; 21 C.F.R. § 11.10(k)(2) states that a hospital shall employ appropriate controls over systems documentation including “[r]evision and change control procedures to maintain an audit trail that documents time-sequenced development and modification of systems documentation”; 42 U.S.C. §1320d-2(d)(2) provides that a hospital … “shall maintain reasonable and appropriate administrative, technical, and physical safeguards-(A) to ensure the integrity and confidentiality of the [health] information; (B) to protect against any reasonably anticipated-(i) threats or hazards to the integrity of the information; and (ii) unauthorized uses or disclosures of the information …”; and 42 U.S.C.§1320d(6) [provides that] “individually identifiable health information” is defined to include “any information … created or received by a health care provider … [that] relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and . . . identifies the individual; or . . . can be used to identify the individual”.
Courts around the country, including in Connecticut, have also required production of metadata in native format, so that the metadata is reasonably usable.
Accordingly, the court will grant the plaintiff’s request for native format. See, e.g., In re Porsche Cars North America, Inc. Plastic Coolant Tubes Products Liability Litigation, 279 F.R.D. 447, 450 (S.D.Ohio 2012) (court granted plaintiffs’ request for native format “absent a showing by [defendant] that such a production would be unduly burdensome); Romero v. Allstate Ins. Co., 271 F.R.D. 96, 107 (E.D.Pa.2010) (“the Court finds that Plaintiffs are entitled to have documents produced in native format with their associated metadata” where defendants do not allege that they will be financially burdened or prejudicially harmed by the production of metadata); Camesi v. Univ. of Pittsburgh Med. Ctr., No. CIV.A.09–85J, 2010 WL 2104639, at *7 (W.D.Pa. May 24, 2010) (ordering defendants to produce ESI in its native format “absent a clear showing of substantial hardship and/or expense”); In re Netbank, Inc. Secs. Litig., 259 F.R.D. 656, 681–82 (N.D.Ga.2009) (“Although the Defendants have listed a number of hypothetical problems with providing documents in native format, they have not asserted these to be actual problems arising in the present case…. [T]he court is confident that the precision of record citations can be appropriately dealt with should [plaintiff] desire to use any of the documents at issue as exhibits or evidence…. The Defendants having given no good reason why they should not produce [plaintiff’s] requested documents in native format, the Motion to Compel production of ESI information in native format is granted.”).
Saliga v. Chemtura Corp., No. 3:12CV832 RNC, 2013 WL 6182227, at *2 (D. Conn. Nov. 25, 2013). See also Innis Arden Golf Club, Inc. v. O’Brien & Gere Engineers, Inc., No. CV106006581, 2011 WL 6117908, *3 (Conn. Super. Ct. November 18, 2011) (Metadata is an important part of the orderly production of the electronic disclosure).
Native format production also complies with the Federal Rules of Civil Procedure and this case’s ESI order. Moreover, the Court finds that metadata and native format production are relevant and proportional to the needs of discovery. It is untenable to assert in this technology-driven age of litigation that images of electronic documents provided in TIFF and PDF form offer all of the relevant information possible. The metadata that is not visible in TIFF and PDF productions, but is visible in native format production, is relevant information. Therefore, the Court GRANTS Plaintiff’s motion on this issue.
Bailey v. Alpha Technologies Inc., 060117 WAWDC, C16-0727-JCC (W.D. Wash June 1, 2017).
E. Full and Fair Discovery Requires the Production of the Audit Trail
In the present case, the relevance of these documents is not reasonably in question. The primary defense by the [DEFENDANT] as now asserted by [DOCTOR] is that he did not intend to document in his report hyperechoic bowel in either fetus. This position is wholly inconsistent with the report produced, which [DOCTOR] himself signed off on, and which clearly indicates in bold letters “HYPERECHOIC BOWEL”. [DOCTOR] now apparently claims that he committed a “scrivener’s error”. The defendant asserts that while the ultrasound technician entered “hyperechoic bowel” as a finding for both babies, [DOCTOR], upon review of the ultrasound images, claims he found no evidence of the same. As such, [DOCTOR] claims to have intended to delete the findings from both babies’ charts, but accidentally only deleted it from Baby B. The audit trail will either confirm or deny [DOCTOR]’s story.
In order to reconcile the discrepancies between the disclosed records and [DOCTOR]’s newly developed theory, and to discover fully what occurred during the ultrasound procedure and subsequent care, the plaintiff must be permitted to conduct full and fair discovery – including a review of the electronic medical record and associated audit trail. Moreover, the plaintiff is entitled to such discovery under the provisions of HIPAA and the Connecticut Practice Book. Audit trails are part of the plaintiff s medical records. Electronic Medical Records replace paper records with computerized record-keeping to document and store a patient’ s medical information. The audit trail is the metadata for a patient’s electronic chart that documents every time the chart is accessed or altered. “Every time a user views, edits, prints, deletes, downloads, exports, or otherwise manipulates any part of a patient’s electronic medical record (EMR), the system makes a contemporaneous record of that activity as it occurs. This audit trail provides direct evidence of exactly what was done – when, where, and by whom – to a patient’ s EMR.” It is a precise and dynamic system of how patient care information is created. The EMR keeps audit trails of every edit of the record. An audit trail also “includes the identification of the terminal used to access the record and the date, time and author of the change or addition to the electronic medical record.” The audit trail is the only objective account of when and how a patient’s data was viewed, charted and/or altered. The metadata related to the medical record, in short, cannot be separated from the record itself.
Therefore, the audit trail in this case, which details modification, accessions or deletions of the chart, is well within Connecticut’s discovery parameters allowing parties to obtain information that is likely to lead to the discovery of admissible evidence. A full and complete EHR audit trail is the only way to authenticate an electronic medical record. Without an audit trail, the record cannot be authenticated as complete and free from alteration. Its production is essential for evidentiary purposes, without exception.
Therefore, the plaintiff respectfully requests that the Court issue an order requiring the defendant to produce any and all audit trail evidence, in its native format, for full and complete compliance with the plaintiffs’ requests for production.
 Federal regulations governing electronic health information and records require audit trails to be developed and maintained. See, e.g., 21 C.F.R. § 11.10(e) (requiring, in order to ensure the authenticity and integrity of electronic records, the “[u]se of secure, computer-generated, time-stamped audit trails to independently record the date and time of operator entries and actions that create, modify, or delete electronic records.”); 45 C.F.R. § 164.312(b) (directing healthcare providers to implement audit controls “that record and examine activity in information systems that contain or use electronic protected health information.”); 45 C.F.R. § 170.210(e) (Secretary of U.S. Department of Health and Human Services adopted “standards to protect electronic health information created, maintained, and exchanged,” including audit logs to record the date and time of the access event, the patient identification, the user identification, and the type of action).
 The plaintiffs’ experts agree that a finding of echogenic bowel should have triggered further testing that would have revealed the CMV. The defendant’s experts do not seriously dispute this [DEFENDANT]ment.
 For Fetus B, the report notes: “Prominent bowel – see twin A anatomy comments”; see Report, attached hereto as Exhibit B.
 See excerpt of [DOCTOR] deposition, attached hereto as Exhibit C.
 See defendant’s responses dated July 25, 2019 to the Requests for Production dated April 29, 2019, attached hereto in relevant part as Exhibit D.
 See generally John B. v. Goetz, 531 F.3d 448 (6th Cir. 2008); Ford Motor Company v. Edgewood Properties, Inc., 257 F.R.D. 418 (D.N.J. 2009); William A. Gross Construction Associates, Inc. v. American Manufacturers Mutual Insurance Company, 256 F.R.D. 134 (S.D.N.Y. 2009); Aguilar v. Immigrations and Customs Enforc. Div. of U.S. Dep’t of Homeland Sec., 255 F.R.D. 350 (S.D.N.Y. 2008).
 ASTM refers to the American Society for Testing and Materials, which is an international standards organization, that develops and publishes consensus technical standards.
 “Health care provider”, “health information”, “transaction”, “protected health information” and “business associate” are all defined terms under 45 C.F.R. § 160.103.
 “Native Form” is defined as the original medium in which such data was created and stored/preserved.
 Jennifer Keel, ” Follow the Audit Trail,” The Journal of Legal Nurse Consulting, Vol. 25, No. 2 at p. 26 (May 2014).
 Jeffrey L. Masor, ” Electronic Medical Records and E-Discovery: With New Technology Comes New Challenges,” 5:2 Hastings Sci. & Tech. L.J. 245, 254 (Summer 2013).
Recent news reports claim that coronavirus cases are resurging across the nation. Despite those reports, Connecticut remains on track to reopen. Along with businesses, many courts are also reopening across the state. This is good news for many individuals who have pending personal injury lawsuits. However, COVID-19 has taken a toll that could continue to affect cases in the future.
How Will Coronavirus Affect Personal Injury Lawsuits?
In May, the National Safety Council (NSC) released a startling report. Since the beginning of the pandemic, motor vehicle fatality rates jumped 14 percent. This is surprising considering traffic has dropped due to stay-at-home orders.
Safety officials believe this increase is due to an increase in reckless driving. More people are speeding, failing to stay in their lane and driving while distracted. This has already led to more severe accidents despite fewer drivers being out on the road. With states reopening and traffic increasing, pandemic driving habits could lead to even more crashes. This means more personal injury claims could be heading to court soon.
When Should I File a Claim for the Injury I Suffered During the Outbreak?
If you suffered an injury during the pandemic, filing a lawsuit may not be on your mind. With reports of offices and courts closing, you may have decided to delay your claim. This is a mistake.
The longer you wait to gather evidence, the harder it will be to collect. This is why waiting is never a good option when it comes to personal injury lawsuits. Also, the statute of limitations on filing a personal injury claim has not changed. That means you need to talk to an attorney to ensure your claim is ready to go. An attorney can help you gather evidence and ensure you do not miss important deadlines due to the current situation.
Is It Okay to See My Doctor During the Coronavirus Pandemic?
Did you visit the doctor after your accident? Did you avoid the doctor’s office due to COVID-19? These issues are also important to your case. Medical records help prove that you suffered damages due to another party’s negligence. If you cannot prove that you sought medical attention for your injuries, it may be harder to prove your claim.
If the doctor recommends delaying your treatment due to coronavirus, follow those instructions. However, do not neglect the doctor’s orders due to the pandemic. Voice your concerns with your physician and work with him or her to get the medical treatment you need.
Do You Still Have More Questions?
These unprecedented times are making it difficult to navigate the legal system. That is why our Hartford personal injury law firm is ready to answer your questions. You can reach us at (860) 785-2011 or by filling out our online contact form.
Millions of people in the US receive treatment in emergency rooms each year. In fact, statistics published by the Centers for Disease Control and Prevention (CDC) show there were 141 million visits to the ER during 2014 alone. Emergency rooms are a critical aspect of our health care system, but they are also a place where medical errors may occur. Medical errors can be more likely to occur in emergency rooms because staff may spend less time with patients.
Emergency Room Medical Error #1: Diagnostic Errors
Diagnostic errors are the most common type of medical mistake in the US, but they are especially common in emergency rooms. An emergency care physician may spend less time with patients and may not order tests that are necessary to produce an accurate diagnosis.
Heart attacks may be mistaken for gastrointestinal problems. Meningitis could be confused with a migraine or the flu. These are only a handful of examples. A misdiagnosis could lead to a lack of treatment or the wrong type of treatment. Both outcomes could cause further harm to patients.
Emergency Room Medical Error #2: Medication Mistakes
Hospital staff may give patients the incorrect medications. This can happen when hospital staff confuse two patients or mix up drugs with similar-sounding names. In other cases, staff may provide a patient with too much or too little of a medication.
Another common mistake involves incorrectly administering medications. For instance, providing a patient with an IV form of a medication instead of an oral version of the drug.
Emergency Room Medical Error #3: Poor Supervision
There are multiple types of supervision-related mistakes that can occur in an emergency room setting. For instance, emergency physicians must provide adequate supervision to doctors who are undergoing their residencies. Resident doctors may make mistakes due to long work schedules and a lack of experience.
There are also patient supervision mistakes. In these cases, hospital staff may not properly monitor patients. High-risk patients, such as those who are prone to falls, could suffer serious harm if they are not adequately supervised.
Can I Sue for an Emergency Room Medical Error?
You may be able to recover compensation if a medical mistake harmed you or a loved one. The Connecticut medical malpractice lawyers at Walsh Woodard, LLC can help you determine whether it would be possible to file a lawsuit. To schedule a free consultation, call us at 860-785-2011 or describe your situation by using our online case review form. You can read more about our success with medical malpractice cases by continuing to explore our website.
To know whether or not you have the right to file a claim for wrongful death, you need to understand exactly what it is.
Wrongful death is a claim that can be filed when a person (or a company) is at fault for the death of a person. There are a variety of reasons to file this type of claim, such as medical malpractice, vehicle accidents caused by another driver, a defective automobile, dangerous roadways, and even abuse. Any fatal accident which has been caused by negligence can cause a wrongful death claim to be filed.
In the United States, this is the only method of suing a company when a death has been caused by their actions instead of those of an individual. Around 400 lawsuits were filed against Toyota when their broken gas pedals caused cars to accelerate and crash.
So do you have a case for a wrongful death lawsuit? If your loved one was killed in an automobile accident caused by another driver or caused by a failure in their car, you could have a case. If they died during surgery or another medical procedure, you should consider pursuing a civil lawsuit– especially if the doctor has a history of medical malpractice. Essentially, if you have lost a loved one in a way that you feel could have been prevented and you know who’s at fault, consider filing a wrongful death claim.
You can contact Walsh Woodard LLC for your civil litigation needs online or call us at 860-785-2011 for a free consultation.
Manufacturing or design defects in vehicles can cause catastrophic injuries or deaths. For instance, many recalled vehicles contain Takata’s airbag inflators, which are associated with multiple deaths and catastrophic injuries. The inflators can explode and send metal shrapnel flying into the cabins of vehicles. This is only one example that highlights the importance of knowing whether your vehicle is under recall.
A recent Carfax study found that 63 million vehicles with safety defects are being driven on roads across the country. Although automakers are required by law to inform their customers of recalls, there are several reasons why owners may not receive repairs. It can take months to get a vehicle with a Takata airbag fixed. Takata and multiple automakers have been chastised for not doing enough to facilitate more repairs for vehicles affected by the recall.
Vehicle owners may also not receive repairs because they are unaware that recalls have been issued. For whatever reason, they simply did not receive crucial recall notices from their auto manufacturers. Our blog is going to walk you through how to sign up with the National Highway Traffic Safety Administration (also called NHTSA) and how to check the recall status of your vehicle online.
How to Check the Recall Status of Your Vehicle
To check the recall status of your vehicle, you will first need to grab your vehicle identification number. This is also called the “VIN.” Many auto insurance policy cards display this number. It may also be found on insurance documents, your vehicle’s title or on auto shop repair records. If all else fails, you can also check the driver’s side dashboard.
Once you have the VIN, it’s time to visit https://www.nhtsa.gov/recalls. After arriving at the website, type your VIN into the search feature at the top of the page. Search results could inform you of any open recalls associated with your vehicle. However, it may also say “zero recalls are associated with this VIN.”
This search tool covers vehicle safety recalls that are incomplete. It may also display vehicle recalls conducted over the past 15 years. Recalls for light automobiles (for example, if you own an ATV or motorcycle) may also be included. Search results will not cover recalls from more than 15 years ago or completed recalls. International vehicles and very recently announced recalls may also be excluded from the search results.
Even if the website informed you that your vehicle has no open recalls, you should still take action to register your vehicle with NHTSA’s website. Your vehicle could always be recalled later. If you register with NHTSA, you could receive an email notification for future recalls.
What Can I Do if My Vehicle is Under Recall?
If you discover that your vehicle has an unrepaired recall, then it is important to contact your dealership to schedule an appointment for repairs. Automakers are required by federal law to fix recalls at no cost. You could also inquire about a rental vehicle if the dealership does not have the parts to conduct repairs.
If you or a loved one were harmed by a defective auto part, then you should speak with an attorney to discuss legal options. It may be possible to hold the auto manufacturer or other parties accountable for injuries or deaths caused by defects.
Walsh Woodard, LLC has an extensive history of helping individuals who were harmed by the negligent actions of others. To speak with one of our Hartford product liability lawyers, you may call (860) 785-2011 or describe your situation by filling out our online case review form.
Knee replacement surgery is a common procedure many adults undergo. In fact, it is one of the most frequently performed joint replacements in the country. Doctors perform more than nearly 1 million knee replacements each year here in the United States. Most patients getting knee replacements are older adults between the ages of 50 and 80. However, younger athletes and adults also get knee replacements. Unfortunately, knee replacement failure can compromise a patient’s health and well-being. Over the years, manufacturers recalled thousands of knee replacements. This has led to patient trauma and lengthy lawsuits. As such, patients need to remain aware of the signs of knee replacement failure.
Understanding Knee Replacement Recalls
When a device defect compromises the safety of patients, manufacturers often issue a device recall. There are many reasons why a knee replacement manufacturer would recall knee implants. Some of those reasons include:
- Faulty design
- Improper fit
- Packaging errors
- Premature wear
- Wrong components
Studies show that knee replacement complications affect a significant number of individuals. As many as 1 in 5 knee replacement patients will experience a complication or issue with their implant. These complications can occur in the months following surgery, or they can occur years down the road. Knee replacement complications caused thousands of people to need dangerous and painful revision surgery. As a result, these patients file defective product lawsuits against the manufacturers for faulty designs.
Signs of Knee Replacement Failure
If you notice any of these signs and symptoms, you may have knee replacement failure. You should contact your doctor immediately.
- Pain in the joint
- Infection symptoms
- Mobility issues
- Swelling in the joint
- Excess fluid in knee
- Thickened joint tissue
- Joint instability
- Warmth around joint
When a knee replacement fails, it can cause serious pain and reduced mobility. This can result in patients needing revision surgery. However, there are serious risks and complications associated with revision surgery. One of those complications is metallosis. This serious condition occurs when bone and soft tissue are infiltrated by metal debris from the artificial joint. This is most common in metal-on-metal implants.
By far, the most common cause of knee replacements is infection in the joint. In the first fifteen years after surgery, infection caused more than half of all failures. The majority of those infections occurred within the first eight years after the original replacement. Infections can also lead to life-threatening conditions if not caught and identified quickly.
As such, talk to your doctor about your treatment options before proceeding. In addition, an experienced attorney can answer your questions.
Get Help With Your Knee Replacement Recall
If you believe you have knee replacement failure, it is important to examine your legal options. A knee replacement defect can cause serious medical concerns. In fact, due to these medical concerns many companies regularly issue knee replacement recalls. To learn more about knee replacement problems and recalls call Walsh Woodard LLC at (860) 785-2011 or fill out our confidential contact form. Our Hartford personal injury law firm can help you with all your knee replacement issues. We have the resources and experience needed to tackle these complex defective products cases.
The average family vehicle weighs 2,000 – 5,000 pounds. Semi’s hauling tractor trailers can weigh as much as 80,000 pounds. You don’t have to be an expert in math to understand that the odds are against you when you are involved in an accident with these huge machines. Add to the equation ice, sleet, and snow and the results can be catastrophic.
There are half a million accidents involving 18 wheeled vehicles every year. In fact, one out of every eight traffic deaths are a result of just such a collision. Many freight companies are neglectful of the safety standards needed to keep these trucks safe in good weather. When you are talking about winter conditions these lapses in regulation can be disastrous for people who are involved in accidents with these “Big Rigs.”Read More
It’s the most wonderful time of the year. Time for holiday parties and family gatherings. Time for festive holiday traditions and celebrations. Yet for many, the holidays are a dangerous time. Accidents are more common during the holiday season. From falls to car crashes, the holidays may not be so merry for many Americans.
The holiday season can bring a mixture of joy and danger. This holiday, be sure to use extra caution when hanging decorations, visiting family and attending parties. Always designate a sober driver and never drive under the influence of drugs or alcohol.
Falls While Decorating
According to the CDC, 5,800 people suffer injuries in falls directly related to holiday decorating. Hanging lights on roofs, trees, and porches can be dangerous. Numerous individuals suffer serious brain and spinal cord injuries after falling from roofs or ladders during the holiday season. In addition, elderly relatives may suffer serious head injuries or fractures after tripping on extension cords or tree skirts.
Slipping on Snow and Ice
Snow and ice create serious hazards during the holiday season. Sidewalks, driveways, stairs, and parking lots can become treacherous during the winter months. Slip and fall accidents can cause serious injuries, such as brain damage, fractures, and soft tissue injuries. According to the CDC, more than 800,000 people visit the hospital every year because of a slip and fall injury. Many of these injuries occur during the winter months and holiday season.
Car Crashes During the Holidays
Snow and ice make roads dangerous. According to federal statistics, nearly 1.2 million accidents occur because of bad weather like snow and ice. In addition, more people drive drunk during the holiday season. This increases the risk of serious and fatal car crashes. Nationally, an average of 300 people lose their lives in drunk driving crashes the week between Christmas and New Year. In 2016, 781 people were fatally injured in drunk driving accidents in the month of December.
What to Do After a Holiday Accident
If you suffer an injury this holiday, it is important to know what to do. The steps you take after an accident could have a huge impact on your ability to collect the compensation you need. No matter what type of accident you have, it is important to remain calm and seek medical attention quickly. Protecting yourself from further injury can reduce the chances of future complications. As such, call 911 or visit an emergency room if you find yourself injured this holiday season.
If you suffer an injury this holiday season, it is important to take the following steps to protect yourself.
- Seek medical attention
- Call the police
- Fill out an accident report
- Take pictures of the accident scene, injuries, and damages
- Exchange information with the person responsible for your crash
- Contact your insurance company
- Follow your doctor’s orders and treatment plan
- Contact an attorney
Contact Our Hartford Car Crash Lawyers
If you suffered an injury in an accident this holiday season, contact a Hartford car crash lawyer immediately. At Walsh Woodard LLC, our lawyers know that injured accident victims need money now. We know that medical expenses and lost wages can cripple a family during the holiday season. That’s why we work tirelessly for our injured clients from the very start. Call us today at 860-785-2011 or fill out our confidential contact form for more information. We offer free initial consultations so you can seek justice after a holiday accident. Call us today!
A pre-existing injury can refer to any injury or condition you had before your recent car accident. If not handled carefully, your car accident case may be harmed by a pre-existing injury.
To receive due compensation, you need to prove your current injuries came about from the recent accident you were in. But a pre-existing condition can be a stumbling block in the way. This is because your pre-existing injury may be used against you. Pre-existing injuries may be cited by insurance companies as the cause of your current pain. If they can argue this successfully, you will lose out on the compensation you truly deserve.
How Do I Discredit Pre-Existing Injury Arguments?
There are ways to prove that your current injuries aren’t just the remnants of old ones. To do so, you must show that your pre-existing injury and your current injury are not one and the same. Doing so will ensure that you are compensated fairly.
To prove this, you will need to gather as much information about both your current and your pre-existing injuries as possible. This information will offer invaluable details needed to make your case. This is because a comparison of the two may prove that they are separate injuries.
For example, say your pre-existing injury only lasted a couple of days, after an accident which happened 30 years ago. If so, it is highly unlikely that this old injury just spontaneously resurfaced. It is more likely that your recent car accident injured you.
Or perhaps you experienced a different kind of pain, in a different part of your body, before your current accident. Now, instead of a stinging sensation in your back, you feel a sharp pain in your neck. In cases like this, it is again unlikely that a previous injury is currently to blame.
Perhaps the pain of your previous injury has since subsided, and your doctor has already cleared you with a full bill of health. Given this information, it would be hard to pin your current injuries on a previous one.
Particular details will vary by case. What’s important is to find out whether there are discrepancies between your new and old injuries. If there are, you will be better equipped for disputing claims concerning your pre-existing injury.
So What Steps Can I Take to Help My Case?
Discrediting pre-existing injury arguments depends heavily upon key medical information. For this reason, it is important to take certain precautions every time you are injured.
First, you will want to describe your pain as best you can to your doctor. Tell them where your pain is occurring, when it occurs, and what the pain feels like. And of course let them know any particular details you think are relevant to your situation. You should also keep a copy of all relevant medical records, notes, and images. This way, if you are in an accident later, it will be possible to distinguish new injuries from old ones.
When preparing for a legal battle, you will also want to be candid with your attorney. It is important to tell them about any previous accidents you’ve been in. You should also let them know about any pre-existing injuries you’ve sustained. With this information, your attorney can better prepare your case should a pre-existing injury argument arise. They will also be able to ascertain whether an old injury was aggravated by your recent accident, and if you are entitled to compensation for it.
Our Hartford Personal Injury Lawyers Can Help
Proving that your current injuries are the result of your recent car accident is possible. However, it takes careful legal maneuvering to accomplish. Our Hartford personal injury lawyers know how best to handle these situations.
If you’re concerned about how your pre-existing injury will affect your car accident case, contact us here, or by phone at (860) 785-2011. We can help you determine your best course of action as you pursue legal action.