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News: After delivering her third child, a woman was taken to a hospital room. Soon afterward, her husband said, she stopped breathing and turned blue and that he then immediately called for the unit nurse. The unit nurse did not attempt to treat the patient. She called a code, and the code team resuscitated the patient. As a result, the plaintiff claimed that she suffered a hypoxic event, which caused a brain injury. She brought suit against the providers, and a jury awarded her $350,000.
Background: The woman was admitted to the hospital for the birth of her third child. During the course of a difficult labor and eventual cesarean section, she was given pain medications, sedatives, and anesthesia. After delivery, she was taken to her hospital room, where a nurse gave her another shot of morphine. The plaintiff’s husband testified at trial that shortly after receiving the additional dose of medication, his wife stopped breathing and turned blue. The floor nurse testified that the plaintiff did stop not breathing, but merely had depressed respirations and was nonresponsive.
When the patient’s husband alerted the floor nurse, both the husband and nurse agreed that the nurse called a code but failed to attempt any corrective measures herself. Minutes later, the plaintiff was resuscitated by the code team but the plaintiff claimed that in the interim, she suffered a hypoxic event — lack of oxygen to the brain, which resulted in brain injury to the right frontal lobe. In addition, she claimed to suffer from negative affect disorder, depression, tremors, and profuse sweating. The patient brought suit against the providers for the failure to timely and appropriately treat her respiratory arrest. The jury awarded her $350,000.
The plaintiff’s expert testified that the claim was valid, saying the nurse violated the standard of care by failing to properly evaluate the patient’s condition and by failing to administer oxygen or attempting to resuscitate the patient while waiting for the code team to arrive. The expert said this resulted in the patient’s brain damage and generalized anxiety symptoms.
The defense argued that the plaintiff never stopped breathing, but that she had depressed respirations and was merely nonresponsive. The defendant’s expert averred that the plaintiff was not deprived of oxygen for a sufficient period of time to sustain the injury alleged by her, and that the plaintiff’s symptoms were, in fact, the result of earlier traumatic life events triggered by postpartum depression.
The jury sided with the plaintiff, awarding her $350,000.
What this means to you: Difficult labor mixed with various medications can lead to complications. This case illustrates what can happen when seemingly routine situations, such as the post-labor and delivery care of a three-time mother, are not carefully monitored.
"This patient was undoubtedly at risk for depressed respiratory effort, but that risk was seemingly not addressed by her caregivers," states Cheryl A. Whiteman, RN, MSN, CPHRM, a risk manager for Cigna Healthcare of Florida Inc., whose opinion does not necessarily reflect Cigna’s. "It would be a reasonable assumption that her difficult labor had exhausted her. During her labor and ultimate cesarean section, she was given pain medications, sedatives, and anesthesia. The cumulative effects of these various drugs are difficult to predict. Once another dose of morphine was administered on the unit, the unit nurse should have checked on this patient frequently, assessing vital signs and mental status. The combination of multiple drugs and exhaustion had an obviously negative impact on her patient."
Even though patients generally maintain contact with their admitting physician throughout their hospitalization, nurses are the principal caregivers in most instances. While physicians issue standing orders, there are no such orders to resuscitate patients that stop breathing. It is simply a nurse’s duty to attempt to revive a patient unless there are specific "do-not-resuscitate" orders, which was not the case here.
"It would be difficult for the defense to justify the floor nurse’s actions. Certainly the standard of care demands an assessment of the patient’s condition regardless of how many children the patient had previously birthed," Whitman adds. "Interestingly enough, the hospital maintained that the patient never stopped breathing. However, if this were the case, one wonders why the nurse summoned the code team. In evaluating a code situation, the first step is to try to elicit a response from the individual using both verbal and physical stimulation. For example, the nurse should have shaken the patient by her shoulders while asking if she were all right. A code is generally called when the patient is unresponsive and in the absence of a pulse, absence of respirations, or absence of both. Had the patient experienced a respiratory arrest, the nurse should have called for help and immediately initiated cardiopulmonary resuscitation, utilizing the one-rescuer technique until help arrived. The administration of oxygen is of no value in the absence of respirations and circulation. On the other hand, had the patient continued to breathe spontaneously, but at a depressed rate, the first line of action would be to administer oxygen and attempt to arouse the patient enough to stimulate deeper breathing.
"It is evident that the nurse did not meet the standard of care. First, there was no assessment of the patient’s true situation," Whitman says. "Second, the appropriate interventions were not initiated based on the assessment. In order to mitigate the occurrence of such omissions in the future, the risk manager could assess the staff’s competence regarding Basic Cardiac Life Support. This certification should be mandatory for bedside nurses, and perhaps for the entire nursing staff. Each staff member should participate in regular refresher courses or drills. In addition, nurses who are responsible for patients in high-risk areas, such as obstetrics, where some patients receive narcotics and anesthesia, should be required to maintain proficiency in understanding the effects of these drugs by themselves and in combination. This could be achieved in a classroom setting or in supervised clinical practice."
• Dickson vs. Barnes, et al., Alleghany County (VA) Circuit Court, Case No. 970000-76. Jeanne M. Hepner of Lexington, VA, for the plaintiff.