Latex used despite known allergy — cysts develop: $3.75 million GA verdict
Latex used despite known allergy — cysts develop: $3.75 million GA verdict
By Jan J. Gorrie, Esq.
Buchanan Ingersoll PC Tampa, FL
News: Prior to surgery, a patient informed the hospital of her allergy to latex. Despite this warning, a latex catheter was used and she subsequently developed interstitial cystitis. She brought suit against the health care providers and was awarded $3.75 million in damages.
Background: Upon admission to the hospital for abdominal surgery, the 53-year-old woman advised the hospital that she was allergic to all latex products. Though the surgery required she be catheterized, a latex catheter was inserted into her bladder. The patient suffered an allergic reaction and she subsequently developed interstitial cystitis, which rendered her disabled and in constant pain.
Although the defendant hospital admitted that the latex catheter was used after notification of the allergy, it proceeded to defend the case claiming that the reaction could not have caused her interstitial cystitis. The jury sided with the plaintiff and awarded her $3.75 million in damages.
What this means to you: "Latex allergies were rare, if not unheard of, until the last 20 years or so. As time progresses, the incidence of recognized latex allergies increases. Sometimes these allergic reactions are misdiagnosed and sometimes the diagnosis is a reaction to soap or powder rather than to latex. In the health care arena, the allergic reactions are usually attributed to the latex gloves commonly used by health care workers, where the distinction between dust, powder, and latex may be muted. For instance, the powder in the gloves can carry the latex molecule, which is why air ducts must be periodically cleaned in areas where powdered latex gloves are used. Regardless of the source of exposure, some latex allergies are so severe they result in death, and so providers beware," says Leilani Kicklighter, RN, ARM, MBA, CPHRM, CHT, past president of the American Society of Healthcare Risk Management, and director of risk management services for the Miami Jewish Home and Hospital for the Aged in Miami.
The prevalence of latex allergies in the health care setting is recognized as a risk to employees and patients, "so much so that some organizations have banned any type of balloon except the foil type because of the latex and other types of risks. Many health care organizations have converted to powderless gloves or to a latex-free environment throughout. As a part of this initiative, hospitals and ambulatory surgery centers have set up latex-free carts and processes as they relate to surgery and patients with known latex allergies," she notes. "In the case at hand, the patient notified staff and the organization upon admission of her allergy to latex, and it is standard practice that the medical record is clearly and visibly noted with any reported or known allergies and for the patient’s arm band to be noted as well. In the case of a patient with a known latex allergy, other notices may be posed on the door and in the room since so many common everyday products have latex.
"Typically when a facility is aware of a patient’s latex allergy, surgery is usually scheduled as the first case of the day in a room that has been prepared to deal with a patient with a latex allergy. The preparation commonly includes terminal cleaning of the room and cleaning of the room’s air ducts prior to the scheduled surgery. Usually operating rooms have latex-free carts made up with latex-free equipment normally used in surgeries, including latex-free catheters, tape, and other materials. Some things are made only latex free, such as NG tubes and ET tubes," notes Kicklighter.
"When a patient presents with a known allergy, and that condition is apparently duly noted but for some reason not considered in the care of the patient resulting in an untoward outcome, it warrants a root-cause analysis to identify what happened, why and how to prevent recurrence," she says.
"What this means to risk management is to revisit this issue in your own institution to verify that there are policies and procedures in place, to deal with, not only latex allergies, but all reported allergies" notes Kicklighter. "Particular emphasis should be placed on how patients with known allergies are identified and how the medical record is notated. A validation audit should be conducted to verify that staff and the physicians are aware of their duty to inquire and to address any known allergies of a patient and follow-up so that the information is actually reviewed so appropriate preparations are made," says Kicklighter. "As it relates in particular to latex allergies, it would be prudent to conduct inservice sessions with all employees as to the significance of this particular allergy in the face of so many products that are used in everyday life that are made of latex. The operating room staff should [have inservice training] regarding the process for doing surgery on patients with latex allergies, and policies and procedures governing these cases should be revisited.
"If the organization does not have a task force to address latex allergies, consideration to implementation of one should be given. Latex allergies affect employees as well as patients and all areas are risks to the human factor and the organization. The operating room policies, procedures, and practices undertaken when a patient with a latex allergy is scheduled for surgery should be revisited and modified as necessary in light of this type of situation. In addition, the department of surgery should be encouraged to establish a task force focusing on latex allergy and educational programs for continuing medical education should be arranged," adds Kicklighter.
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"Risk management should verify that the employee health program has established a process to obtain information of known allergies or initial post offer employee processing and annually thereafter, with particular emphasis on latex allergies. The medical director of the employee health program should become well educated in this condition and be involved in this process. Because of the frequency of misdiagnosis of true latex allergies, when an employee indicates they are allergic to latex, further information should be obtained. This sometimes may require the employee health physician to make contact with the employee’s physician to discuss the diagnosis. Depending on where the employee is assigned to work, if possible, a latex-free work area will need to be developed, or the employee reassigned," says Kicklighter.
"If a particular organization has not yet evaluated the risks, costs and benefits of a powder-less or latex free environment, it should be considered. Risk management should lead the evaluation task force. In addition, OSHA has established latex allergies as one area of emphasis as it relates to the workplace. Risk managers should become educated about the risks of latex allergies and be familiar with all rules and regulations relating to latex allergies in particular," notes Kicklighter. "It would appear that this organization was lucky this patient did not have an anaphylactic reaction to the latex in the urinary catheter."
Reference
- DeKalb County (GA) Superior Court, Case No. 020CV-7285.
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