In past blogs, I have discussed the importance of adhering to standards of care and how severe the consequences can be if this isn't done. Among some of the topics I've addressed are the failure to report major changes in a patient's condition and the necessity of accurate documentation in a patient's medical record in whatever form. I have also stressed how not adhering to the standards of care can result in liability for your facility. The following case is another great example of how important it is for nursing staff to maintain their standards of care.
Particulars of the Case
A female patient arrived at a facility's emergency room with chest tightness, cough, fever, sinus trouble, and a headache. A physician diagnosed the patient with acute coronary syndrome and ordered a therapeutic dose of an anticoagulant blood thinner. The next day, his diagnosis was changed to "hypertensive emergency" without acute coronary syndrome. The doctor intended to change the therapeutic dose of the anticoagulant blood thinner to a prophylactic dose and documented this in his progress notes. But he did not create a separate physician's order to change the dosing (the facility didn't have a policy about physicians documenting such a change separately). On the third day of the patient's hospitalization, the physician documented that the patient was constipated and had abdominal discomfort. The physician planned to order an abdominal CT scan and brain MRI. On the fourth day, the patient's blood pressure was low and two small hematomas were detected in the abdomen. No further anticoagulant medication was given. The patient suffered an acute and severe hemorrhage on the fifth day and was transferred to the ICU. She was treated with repeated blood transfusions and placed on a ventilator, among other medical interventions, but she died in the hospital two weeks later.
Patient's Husband Files Wrongful Death Case
The patient's husband filed a lawsuit against the physician and the healthcare facility. The husband alleged that the healthcare facility's nursing staff:
- Failed to properly evaluate his wife
- Failed to properly interpret diagnostic data about his wife's condition
- Failed to recognize signs and symptoms of hematoma, renal failure, and a life-threatening bleed
- Failed to properly report the vital clinical and laboratory results to the physician in a timely manner
- Failed to decrease or discontinue administration of therapeutic anticoagulant medication following the physician's order
The husband also asserted that the continued administration of the anticoagulant caused his wife's death. The husband supported his allegations by filing an expert report from a physician who stated how the allegations listed by the husband breached the standards of care for the nursing staff and physician. For the purposes of this blog, the breached standards of care for the nursing staff include:
- Not monitoring the patient's chart for orders and continued care
- Continuing to administer life-threatening anticoagulants for two days contrary to the physician's documented plan of care and when not indicated by the patient's condition
- Not communicating changes in the patient's condition to the physician, including her low blood pressure, in a timely manner
The expert also stated that the therapeutic dose of the anticoagulant medicine, when it was not needed, resulted in the patient's severe bleeding and death. The healthcare facility filed a Motion to Dismiss the husband's complaint and objected to the expert's report. The trial court denied the Motion to Dismiss, and the facility filed an appeal of that ruling.
Appellant Court Ruling
After a review of the applicable law, the court affirmed the trial court's decision denying the facility's Motion to Dismiss and accepting the expert's report as a fair synopsis of how standards of care were breached. The Appellate Court opined that the expert's report contained specifics as to what the nursing staff should have done, based on established standards of care and practice for nurses. The healthcare facility's argument that the report was not detailed enough was not a valid one at this stage in the proceedings. Moreover, the report provided a straightforward link between the nursing staff's breach of their standard of care and the life-threatening injuries suffered by the patient. According to the expert's report, the prolonged administration of the anticoagulant medication caused the death of the patient.
Takeaways to Keep in Mind
- This case illustrates how the required elements of a professional negligence/wrongful death case are evaluated by a court. Those elements include duty, a breach of that duty, proximate cause, and injury/damages.
- More facts will be discovered as the case progresses through the formal phases of a lawsuit. Here, the important issue was whether the case met the state's requirements for a lawsuit to continue. The expert witness' report met those requirements, so the court ruled that the case could proceed.
- The nurses who care for this patient were not named as defendants in the lawsuit. Rather, their omissions in patient care resulted in vicarious (indirect) liability for the healthcare facility. This principle is known as respondeat superior ("Let the master speak."). However, as more facts are discovered, it's possible that members of the nursing staff may be added as defendants by either the husband or the healthcare facility. If so, the nurses could be sued individually as employees of the facility.
- As the case moves through other phases, expert witness reports will be needed for the physician (a physician expert witness) and for any nurses who are added to the suit (a nurse expert witness).
Keep in mind that lawsuits, especially those alleging professional negligence/wrongful death, can take years before a resolution is reached -- whether the resolution is a jury verdict, an agreed settlement, or a dismissal for legal reasons. Also keep in mind that lawsuits are expensive. Depositions, producing documents during the discovery phase, expert witness fees, and other costs can be overwhelming. If you have not done so already, obtain your own professional liability insurance policy. For the cost of your yearly premium, you obtain financial support during the lawsuit, which includes your own attorney whose fees are covered under the insurance policy's contract with you. Grow your nurse support/social circle on our networking app! 
