Here is what happened. An elderly hospitalized man was confused. He wandered out of the hospital on the evening shift one cold night in March. Wearing a patient gown that opened in the back (and no bottoms) he knocked on doors in the neighborhood near the hospital until someone recognized the situation and returned him to the hospital. The evening nurse contacted the physician, who ordered a chest restraint and wrist restraints.
The night nurse came on duty at 11:00 PM, got report, and then asked the licensed practical nurse to go into the patient’s room with her to check the man. The RN and LPN verified the chest restraint was on, and then the LPN went off to take care of the patients on her wing of the nursing unit. The RN, who was assigned to the man, began preparing her midnight medications. When she went into the patient’s room at 12:30 AM, she found the bed empty, the screen removed from the window, and no sign of the patient. He had climbed out the window, walked across the roof and fell onto the parking lot in front of the emergency department. The staff scooped him up and brought him to the ICU.
The man’s wife overheard a conversation between two doctors standing in the hallway: “We’ve got to keep him alive so he can be discharged”. On the day the patient went home, the wife went down to the Administration office. She wanted an apology. The receptionist told her that no one could see her, which the wife interpreted as being ignored. She filed a nursing malpractice case.
The attorney who contacted me was defending the LPN. I asked him one key question: “Was the LPN assigned to the patient?” When he found out that she was not, the ways to defend her became clear.
To my absolute shock, I found out I was expected to testify at trial in January 1988, two months after I received the case. I remember calling my best friend and wailing, “I wanted to be an expert but I never expected to have to testify on the second case I ever reviewed!” I was so nervous the day of the trial that I think I could have flown to the courtroom on sheer adrenaline.
After my direct examination, which went smoothly, I braced myself for the cross-examination. The plaintiff attorney asked me only one question: “Did the chart state the nurses applied wrist restraints?” I had to answer, “No it did not.”
The jury found the LPN not negligent, but did return a verdict against the RN.
I often wonder if the wife’s reactions would have been different if someone had taken the time to speak to her while her husband was in the hospital – to apologize or express concern. There was no requirement to do so in the mid 1980s, when this incident occurred. (See “Will apologies drive medical malpractice attorneys out of business?) But sometimes you need to do the right thing anyway.
Pat Iyer MSN RN is president of Med League. She reviewed cases as a liability expert for 20 years.