Legal Review & Commentary: Death at nursing station leads to $850K settlement
Death at nursing station leads to $850K settlement
By Jan J. Gorrie, Esq., and Blake J. Delaney, summer associate
Buchanan Ingersoll Professional Corp.,
Tampa, FL
News: A patient with stab wounds to the abdomen was taken to an emergency department (ED). He was admitted, and a series of tests were ordered. Once on the floor, his condition deteriorated rapidly. His father came to visit and found his son in a wheelchair at the nurse’s station. After inquiring as to his condition, the son suffered cardiopulmonary arrest and died in front of the nurse’s station.
The estate brought suit against the hospital and attending surgeon. Both settled prior to trial for a combined $850,000.
Background: The patient had been involved in a violent altercation and was taken to the ED about 10:05 p.m. with stab wounds to his abdomen. After ED personnel assessed the patient, he was admitted to the hospital under the care of a surgeon. At admission, his vital signs were stable. The surgeon ordered NPO — nothing by mouth — status for the patient and requested a series of tests and evaluations to determine the nature and extent of his injuries. However, this assessment regimen was not carried out.
Shortly after admission, the patient had a drastic change in condition. His white blood count increased significantly. He also developed increased abdominal pain, hypertension, agitation, diaphoresis, and the inability to move his bowels. Notwithstanding these adverse changes in light of his known abdominal injuries, no one ordered an initial CAT scan and no additional CAT scan or other such tests were ordered. Further, no exploratory laparotomy was performed. The patient continued to report serious symptoms and made numerous requests for help.
Once admitted, his care and treatment was limited to the institution of prune juice therapy to ostensibly resolve his bowel blockage/constipation. Early the next morning, the patient became so frustrated that he telephoned his father, and asked him to come as soon as possible to check him out of the hospital. When his father arrived, he found his son sitting in a wheelchair at the nurse’s station.
At that time, no physician or surgeon had seen the patient since his admission to the hospital from the emergency room and nothing had been done for him other than to give him prune juice. When his father asked, in his son’s presence, if a physician was present that could assess and treat his son, he was told that the doctor was otherwise occupied and could not see him. However, the nurse advised the father to take his son back to his assigned room so that a physician could see him later. As this conversation took place, the patient suffered a cardio-pulmonary arrest. Physicians who had been unavailable moments ago materialized. But the patient could not be resuscitated.
The plaintiffs brought suit claiming that the decedent was ignored by his attending physician and others as his condition steadily deteriorated. They claimed that had more appropriate tests been ordered and provided, or even that had those ordered been performed, the man’s life would have been saved. The case settled prior to trial for $850,000.
What this means to you: "From a risk management and quality improvement perspective, there are a variety of concerns that are evident from the moment the patient arrived at the emergency room. The patient was not properly evaluated and stabilized upon initial presentation, physicians did not promptly treat the victim, the nursing staff failed to carry out the diagnostic assessments ordered by the admitting physician, and the patient’s request to see a doctor fell on deaf ears," says Diane Giraudi Perry, PhD, LHRM, of Bon Secours Health System Inc. of Venice, FL.
First, the ED staff failed to adequately assess the victim’s condition and ensure that the patient was stabilized immediately upon presentation. "The staff knew the victim had been stabbed several times in the abdomen and should have explored whether the stabbing had caused injuries beyond those superficially apparent. Because it was foreseeable that the patient could have had solid and hollow organ damage, for example, the staff should have immediately ordered a CT scan and initiated antibiotic therapy," says Perry.
Furthermore, the ED staff did not investigate the patient’s condition more fully to make certain he was stabilized, even though he had stable vital signs, adds Perry. The Emergency Medical Treatment and Labor Act is a federal statute that governs medical treatment provided to patients in need of emergency care. The statute imposes an obligation on health care providers to determine if a patient has an emergency medical condition and, if so, affirmatively requires providers to administer treatment until the patient’s condition has stabilized. To stabilize a patient, emergency medical personnel must ensure that it is unlikely that there will be any material deterioration of the patient’s condition during, or as a result of, a transfer to another hospital or to another unit.
"In this case, it appears the patient did not receive an appropriate medical screening and was not stable upon transfer from the emergency room to the hospital’s inpatient unit. The emergency room staff had an obligation to assess the patient’s condition and ensure that it would not worsen before transferring the patient. In light of his rapid and drastic change in condition upon arrival at the inpatient unit, it appears the staff had not stabilized the patient," says Perry.
"The second concern growing from this case is the delay in a physician evaluating the patient," says Perry. After the admitting surgeon requested the staff to administer a series of tests to determine the nature of the man’s injuries, the surgeon did not see the patient again. After admitting the patient to the hospital, he failed to see if the tests had been performed and, if so, what the results were. In fact, the patient was in the facility approximately 12 hours before a doctor other than the emergency room physician actually saw the victim, and that was only after the man had suffered from cardiac arrest.
Third, the nursing staff for the inpatient unit failed to properly treat the patient.
"The rapid decline in the man’s condition apparently went unnoticed by the nursing staff and was not relayed to the physician. The patient was NPO, yet was given prune juice to relieve the patient’s bowel blockage/constipation. In a victim of abdominal wounds, no one appeared to be concerned that the discomfort may have been due to the trauma to the abdomen. The inpatient unit nursing staff also failed to carry out the diagnostic assessments ordered by the physician. Although the physician clearly should have ordered other critical tests, the nursing staff did not even comply with the physician’s initial orders," adds Perry.
The fourth and final concern from a risk management and quality improvement perspective is that the father’s request to see a doctor was not satisfied. When the father requested a physician assess his son’s condition, he was told no one was available. However, the unavailable physician was able to see the patient when he arrested moments later.
"The nursing staff should not have blocked the father’s request to see a doctor. Just as importantly, though, the treating physician should have seen the patient earlier to prevent the eventual cardiopulmonary arrest," says Perry.
"There appears to be widespread negligence throughout this patient’s care. The failures in performance and processes by the hospital, nursing staff, and doctor’s staff are evident and provide multiple opportunities for improvement," says Perry. This hospital should develop a sounder initial evaluation process, improve the timeliness and quality of treatment by its physicians and staff, and implement a policy for interacting with patients in a professional, sensitive, and effective manner.
A patient with stab wounds to the abdomen was taken to an emergency department. He was admitted, and a series of tests were ordered. Once on the floor, his condition deteriorated rapidly. His father came to visit and found his son in a wheelchair at the nurses station. After inquiring as to his condition, the son suffered cardiopulmonary arrest and died in front of the nurses station. The estate brought suit against the hospital and attending surgeon. Both settled prior to trial for a combined $850,000
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