1. You have just graduated from FSU and receive a paralegal position within a prestigious health care organization, Care 4 You Remotely, incorporated and operating in Louisiana. The organization is a leader in the telemedicine space but is facing a major malpractice lawsuit from a patient. The facts are as follows:

Robin, an elderly woman living alone, fell and hurt her hip. Unable to get to the doctor by car, and with no relatives nearby, she decided to conduct a live appointment using video and audio with Dr. Perot of Care 4 Your Remotely. Dr. Perot verified Robin's identity via questions and showing of her driver's license.

Dr. Perot conducted an appropriate exam by having Robin try to bend, stand and walk. Robin noted that prior to the fall, she maintained a very independent style of living.

While uncertain, Dr. Perot diagnosed the hip as being sprained. He decided that rather than advocating for her to call an ambulance to ensure the hip was not fractured, it would be better to adopt a conservative course of treatment bedrest. He did not mention other alternatives, as it would likely have upset Robin. They set up a follow-up appointment for a week later. All of this was put in Robin's medical record.

Three days later, Robin was still in excruciating pain, and while trying to walk, fell again and hit her head. Sadly, she was found dead on her floor.

Robin's family brought suit on her behalf. At trial, Robin's qualified expert, Dr. Isaacs, testified that the proper course of action, if in an in-person setting, would have been to immediately call the ambulance on Robin's behalf. Dr. Jones, Dr. Perot's qualified expert, testified that under the telehealth standard, bedrest then follow up was a reasonable course of action.

Your boss asks you to identify an analysis of the circumstances and likelihood Robin's family will succeed in the lawsuit against Dr. Perot. He wants you to include the elements to prove a malpractice case, apply the facts at hand, and discuss if Care 4 Your Remotely may face damages. He has provided you with the following snippets from Louisiana statutes for your reference:

LA Revised Statute Sec. 22: 1841 & Sec. 37: 1262. Telemedicine is the practice of health care delivery, diagnosis, consultation, treatment, and transfer of medical data using interactive telecommunication technology that enables a health care practitioner and a patient at two locations separated by distance to interact via two-way video and audio transmissions simultaneously. Neither a telephone conversation nor an electronic mail message between a health care practitioner and patient, or a true consultation as may be defined by rules promulgated by the board pursuant to the Administrative Procedure Act, constitutes telemedicine.

LA Admin. Code 46: XLV. 7503. Louisiana law requires that a physician who uses telemedicine establish a proper physician-patient relationship. Physicians must:

• Verify the identity of the patient. Appropriate contact and identifying information shall be made part of the medical record;
• Conduct an appropriate exam. The examination does not require an in-person visit if the technology is sufficient to provide the physician the pertinent clinical information reasonably necessary to practice at an acceptable level of skill and safety;
• Establish a proper diagnosis through the use of accepted medical practices;
• Discuss the diagnosis and risks and benefits of various treatment options;
• Ensure the availability of follow up care;
• Maintain a medical record.

LA Admin. Code 46: XLV. 7505.Telemedicine, including the issuance of any prescription via electronic means, shall be held to the same prevailing and usually accepted standards of medical practice as those in traditional, face-to-face settings. An online, electronic or written mail message, or a telephonic evaluation by questionnaire or otherwise, does not satisfy the standards of appropriate care.