Nursing malpractice « Medical-Legal Topics

Posts Tagged ‘Nursing malpractice’

What’s a medical error? Part 1 by Pat Iyer

Tuesday, July 27th, 2010

I was talking to my son and his girlfriend about medical errors and he asked me to define them. Here are some cases we have handled.

* the hospitalized patient who was alert, oriented, and ambulatory until the nurse administered an inappropriate dose of Morphine, resulting in a serious overdose;
* the emergency department patient who developed quadriplegia after the nurse removed the cervical collar without an order and without the spine being cleared;
* the unsupervised nursing home resident on a pureed diet who choked on deli meat he grabbed off another resident’s tray;
* the newborn infant delivered by vacuum extraction who experienced signs of respiratory distress that went unnoticed by the nursery staff until the infant experienced a respiratory arrest and expired due to complications from a brain hemorrhage;
* the critical care sitter who sexually assaulted a patient;
* the intubated patient who pulled out his endotracheal tube because the nurse did not restrain his hands and he could not be re-intubated:
* the paraplegic receiving supplemental nutrition via a nasogastric feeding tube who experienced an aspiration event and died because the RN programmed the feeding pump incorrectly, resulting in the infusion of an excessive amount of feeding over a short period of time;
* the unsupervised emergency department psychiatric patient who jumped off the roof of the hospital while waiting to be admitted to a psychiatric unit
* the medical surgical patient who rolled off the bed while the sheets were being changed because the nurse did not put the side rail up;
* the surgical patient who developed compartment syndrome and nerve damage because the surgery shredded the popliteal artery in his knee and the nurses did not perform neurovascular checks

What are these?

Tags: medical errors, Medical malpractice, nursing error, Nursing malpractice, nursing negligence
Posted in Legal nurse consulting, Medical malpractice, Nursing malpractice, medical errors | No Comments »

What’s a medical error? Part 2 by Pat Iyer

Monday, July 26th, 2010

I was talking to my son and his girlfriend about medical errors and he asked me to define them. Here are some more cases we have handled.

* the oncology patient who suffered from a large extravasation of a chemotherapeutic drug;
* the patient who fell off the operating room table because the nurse did not apply safety straps;
* the patient whose swollen leg was not reported to the physician on the day of discharge, and who died of a pulmonary embolism shortly after discharge
* the man who jumped through a window because the nurse did not recognize the need to start one to one supervision
* the surgical patient diagnosed with a retained sponge despite the “correct” sponge count;
* the nursing home patient scalded in a bathtub;
* the psychiatric patient who had a history of suicidal ideation and attempts, who was unmonitored, left the hospital, and hung himself in the nearby woods;
* the pediatric patient who went into respiratory distress and whose home care nurse asked his father to come home instead of following directions to call 911;
* the nursing home patient who fractured two hips after being dropped out of a hydraulic lift by a nursing assistant, who did not report the incident;
* the postoperative woman who experienced intra-abdominal hemorrhage and subsequent shock that went undetected by the Post Anesthesia Care Unit nurse.
* untold numbers of pressure sore cases

What are these?

Tags: medical errors, Medical malpractice, nursing errors, Nursing malpractice
Posted in Legal nurse consulting, Medication errors, Nursing malpractice, medical errors | No Comments »

Why Doctors Should Not Testify to Nursing Standards of Care by Pat Iyer

Thursday, January 28th, 2010

Nurses are the appropriate expert witnesses in nursing malpractice cases

The Illinois case called Sullivan V. Edward Hospital, 806 NE 645 (Ill. 2004) involved a man who climbed over side rails and was found on the floor with a head injury. The plaintiff attorney supplied a physician as the liability expert. He was critical of the nursing care by stating the nurse should have restrained the patient. He also testified the nurse “missed the diagnosis of delirium completely.”

Until the early 1980s, it was commonplace for physicians to testify about the nursing standard of care. Although this still occurs in some venues, it is becoming much less common. The status of nursing has changed. Not only do physicians no longer have the special knowledge required to testify in all cases of nursing malpractice, but their use as experts may create problems that could be avoided by using nurses as experts in nursing malpractice cases. Nursing and medicine are two distinct professions albeit with some overlapping functions.

The plaintiff won the Sullivan case; the defense appealed. The Sullivan case was appealed to the Illinois Supreme Court. The Illinois Trial Lawyers supported the position of the plaintiff, and the American Association of Nurse Attorneys also submitted an amicus curiae brief in support of the dense. The Illinois Supreme Court held the plaintiff’s physician expert was not competent to testify about the standard of care of a nurse.

In many venues, affidavits of merit and expert witness reports should be prepared by a person in the same specialty as the defendant. An affidavit signed by a physician who is critical of a nurse could be challenged on the grounds that the physician is not in the same specialty. Even though nurses and physicians closely interact with each other, and have a few areas of overlapping responsibilities, they function in two distinct specialties. Woe be it to the nursing expert who utters anything in a deposition or trial that sounds critical of a doctor. The predictable flow of questions follows:

Q: Nurse, you did not go to medical school, right? You did not complete a residency in (name of specialty), right?

Legal nurse consultants may assist an attorney develop questions to challenge the qualifications of a physician who is offered as a liability expert witness in a nursing malpractice case:

Are you eligible to sit for the nursing exam?
Are you are a member of any nursing professional association?
Have you ever worked as a nurse?
Do you have any firsthand knowledge of nursing practice other than for observations made in patient care settings?
Do you teach in a school of nursing?
Do you hold any nursing certification?
Have you written any nursing texts?

A series of “no” answers helps to establish that the archaic practice of allowing physicians to testify about nursing standards of care should be laid to rest.

Part of this post was based on Butler, K. Nursing: Qualifications for Testifying on Standard of Care, Journal of Legal Nurse Consulting, Fall 2004

What are these?

Tags: nursing expert witness, Nursing malpractice, Sullivan v. Edward Hospital, TAANA
Posted in Expert witness, Legal nurse consulting, Medical malpractice, Uncategorized, medical errors | No Comments »

Hospital Professional Liability Claims on the Rise by Pat Iyer

Monday, November 2nd, 2009

A retained clamp is a never event

This is from Business Insurance, October 20, 2009.

According to the 10th annual Hospital Professional Liability and Physician Liability Benchmark Analysis, the number of hospital professional liability claims is increasing and is expected to increase by 1% per year. The study, released by Aon Corp. and the American Society for Healthcare Risk Management, both based in Chicago, polled more than 1,500 facilities to examine trends in claims and loss costs related to hospital and physician professional liability. The study attributes the rise in claims to the economic downturn, less public sympathy toward health care providers, and a 2008 rule that prevents the Baltimore-based Centers for Medicare and Medicaid Services from reimbursing hospitals for certain errors known as “never events” because they are considered preventable and should never happen.

“Worsening economic conditions in 2008 may have influenced individuals to assert claims against hospital systems,” Erik Johnson, health care practice leader for Aon’s Actuarial and Analytics Practice and author of the analysis, said in a statement. The frequency of hospital liability claims had been decreasing for about a decade before this year, the study said. Claims severity, which includes indemnity and defense costs, is now projected to increase 4% per year. Hospital loss costs per occupied bed, which is a major part of the total cost of risk, is anticipated to rise 5% in 2010, according to the study.

One-quarter of all claims and about 24% of hospitals’ professional liability costs are connected to hospital-acquired conditions such as infections, medication errors, objects left in the body after surgery and pressure ulcers, the study said. The market for health care industry professional liability coverage likely will remain stable for the rest of the year, but pricing is expected to increase in 2010, Aon said.

Pat says:
The AON study points out that ¼ of claims are related to “never events”. The never events defined by CMS are deemed outcomes that should not occur. The unwillingness of public and private payors to pay for what is defined as bad care leading to a bad outcome puts financial teeth behind efforts to improve patient safety and care. The definition of these outcomes clarifies concepts of liability. It becomes easy for the medical malpractice attorney to argue that there was a deviation from the standard of care when such an outcome occurs. Who could argue that operating on the wrong limb is acceptable or that leaving a clamp behind is okay? The AON study is important in that it shows the shifting trends. Those in hospitals who are reluctant to implement change, or take a strong position with recalcitrant staff who don’t want to change, need to know that the financial consequences of unsafe patient care will continue. The AON study confirms what we see in the nursing and medical malpractice world-seriously injured people wanting answers to questions and for the system to change so that someone else is not hurt.

What are these?

Tags: AON study, hospital liability, medical negligence, never events, Nursing malpractice, retained instruments
Posted in CMS never events, Damages, Healthcare Risk Management, Medical malpractice, Nursing malpractice, Personal injury, medical errors | No Comments »

Has the Nursing Shortage Gone Away? By Pat Iyer

Wednesday, August 19th, 2009

Your life may depend on a nurse

Prior to the recession, dire predictions about the coming shortages of nurses and faculty stressed the need to recruit and retain more nurses. Then, spouses lost jobs and non-working nurses returned to the workplace. Fully staffed facilities, layoffs, and financial collapse and closure of some hospitals have resulted in difficulty finding nursing positions.

Can we relax about the nursing shortage? Unfortunately not. The numbers are working against us. Both nurses and nursing faculty are aging. Take New Jersey, which is likely typical of the nationwide problem. More than half of New Jersey’s nurses are between the ages of 46 and 60, with an average age of 50. This means that nearly a third of the state’s workforce will reach retirement age in the next decade. Simple- just educate more people to become nurses, right? Unfortunately not. Nursing faculty are in short supply, and their average age is 55. The nursing curriculum requires extensive clinical experience and prevents a large number of students (more than 10) to be assigned to a clinical instructor. Nursing schools must limit the number of students who can be safely supervised. More than half of New Jersey’s schools of nursing already restrict student enrollment because of limited numbers of faculty, and thus are turning away people who want to go into nursing.

Several studies performed by Dr. Linda Aiken of University of Pennsylvania have directly tied the quality of care with the number of registered nurses. The more patients the nurse is responsible for, the worse the care. The availability of well educated and experienced nurses has a direct impact on the quality of nursing care and the outcomes for patients. Many of the medical or nursing malpractice cases our company has been involved are associated in some way with inexperienced nurses.

How are we going to fix the nursing shortage? Some grant money is becoming available to help subsidize education for developing more faculty. Schools must be able to pay faculty a decent wage to compete with the higher levels of compensation earned by nurse practitioners. Work environments must respect the unique contributions of nurses and make them an integral and valued part of the healthcare team. Retention programs must flourish. Let your state elected officials know you support funds for nursing education. Your life may depend on having a nurse at the bedside.

Source of statistics: Innovative public/private partnership launches in state legislative hearing, New Jersey Nurse, July/August 2009

What are these?

Tags: Linda Aiken, Nursing malpractice, nursing shortage
Posted in Medical malpractice, Nursing malpractice, Patient safety, Priorities | No Comments »

Michael Jackson: A Demerol Death? by Pat Iyer

Monday, June 29th, 2009

Michael Jackson- Demerol Overdose?

Reports state Jackson stopped breathing shortly after receiving an injection of Demerol. Attempts to resuscitate him were not successful. Was it the combination of medications or the Demerol which caused him to stop breathing? Toxicology reports are pending.

Recent reports reveal that Michael Jackson took an unusual combination of drugs:

Demerol and Vistaril twice a day- Demerol is a pain reliever, and Vistaril potentiates or accentuates the effects of Demerol.
Dilaudid 3 mg twice a day- Dilaudid is one of the strongest narcotics on the market.
Vicodin- an oral narcotic
Prozac 20 mg –antidepressant
Zoloft -antidepressant
Xanax -treats panic or anxiety disorders
Ritalin -for attention disorders
Prilosec-reduces stomach acid

It is unusual to see a patient taking two antidepressants and even more unusual and dangerous to take three narcotics. The danger lies in the accumulation of the medications in the body. Reports on the Internet also emphasize that the singer had lost weight and was skeletal-thin. The risk of overdose increases as weight loss occurs if the dosage is not also decreased.

Demerol is a narcotic pain reliever that used to be given with regularity in hospitals. (It is still acceptable to use Demerol in the recovery room for shivering.) It has fallen out of favor for a few reasons – there are more effective and safer pain relievers on the market and secondly, it is poorly tolerated by elderly people. Visual hallucinations may occur in this population. I recall my mother telling me that when she received Demerol after surgery when she was in her mid 70s. I advised her to request a different medication. She saw moving figures on the hospital room wallpaper. Days after her last Demerol shot, as she was being driven home, she saw icicles hanging in the sky. Another danger: the metabolites of Demerol can accumulate, and cause oversedation and death.

What you can do as an attorney involved in a medical or nursing malpractice case involving a potential overdose from Demerol (or another narcotic): Look at the weight and age of the patient. Ask a legal nurse consultant to do a timeline. This person will need to review the medication administration records and the narcotic sign out logs to determine how much Demerol the patient was given for pain control. Get a pharmacologist and possibly a toxicologist involved to look at the connection between the Demerol and the death.

I have lectured about the dangers of oversedation. Several years ago I was an expert witness for the plaintiff in a case that revolved around oversedation from Demerol. The case resulted in a settlement for the family of the patient. The article on Med League’s blog includes the actual facts of the overdose.

Susan Hill (fictitious name) was wheeled up to her postoperative medical surgical room at 11:30 AM. Mrs. Hill weighed 120 pounds; she was recovering from a hysterectomy. Her postoperative medications included Demerol (meperidine) 50-100 mg IM every 3-4 hours PRN (as needed), and Phenergan 12.5 mg IV every 6 hours PRN for nausea. The nurse assigned to the patient until 7 PM administered 50 mg of Demerol at 12:30 PM and 100 mg at 2 PM and 5 PM. Phenergan 12.5 mg was given IM at 12:30 PM, 2 PM and 5 PM. The nurse administered Phenergan to potentiate the action of Demerol. Read more.

What are these?

Tags: Demerol, Michael Jackson, Nursing malpractice, overdose, oversedation
Posted in Damages, Legal nurse consulting, Medical malpractice, Medical records, Medication errors, Nursing malpractice, Patient safety | 4 Comments »

What Nurses Think: Patient Safety by Pat Iyer

Monday, June 1st, 2009

2008-09-15

What change in healthcare would lead to the greatest improvement in patient safety? A survey of nurses found these answers:

Mandated staffing ratios: 48.2%
Better communication between nurses and doctors: 29.3%
Electronic medical records: 14.2%
Automated medication administration: 8.3%
Source of study: Advance for Nurses, December 22, 2008

Implications for the attorney/legal nurse consultant: When investigating a nursing malpractice case, ask about mandated staffing ratios. Were there any? How many patients were assigned to the nurse at the time of the incident? Was there a persistent pattern of understaffing? Ask for the staffing sheets and have your expert review them to see if they conformed to industry standards.

According to the Joint Commission’s study of sentinel events/medical errors, communication is the number one factor that results in sentinel events. Miscommunication may occur due to fatigue, distraction, misunderstandings, accents, failure to communicate, hierarchical issues, not having English as a primary language, bullying, and a host of other factors. These factors should be explored to see if and how they contributed to an untoward outcome.

Electronic medical records are coming- but slowly. They improve efficiency and access to information, which may increase patient safety. But there are privacy, security and confidentiality issues that raise concerns among patients and providers. Computerized medical records carry significant cost and operational issues that are major challenges within health care. At a recent meeting of the American Society of Healthcare Risk Management, many of the risk managers told me they were concerned about the quality of information provided by computerized medical records. Critical information about an incident was not always captured by the records, making it difficult to reconstruct what had occurred. Computerized medical records are an improvement over handwritten records, but many agree they are not a panacea. We’ll never eliminate the need for a thoughtful healthcare provider at the other end of the monitor.

The survey results that identify “automated medication administration” as a patient safety feature may refer to one of two patient safety innovations:

The use of an automatic drug dispensing cart, which contains medications in a series of cubicles.
The use of bar codes to identify the correct patient to make sure there is a match with the right drug, dose, time and route of administration.

Although neither of these innovations is fool-proof (or immune from attempts to “work-around” these safety features), both of these innovations have been associated with improved safety in medication administration.

What do you think? What can nurses do to make patient care safer?

What are these?

Tags: medication cart, medication error, Nursing malpractice, Patient safety
Posted in Communication skills, Joint Commission, Legal nurse consulting | 2 Comments »

Medical-Legal Topics

Posts Tagged ‘Nursing malpractice’

What’s a medical error? Part 1 by Pat Iyer

What’s a medical error? Part 2 by Pat Iyer

Why Doctors Should Not Testify to Nursing Standards of Care by Pat Iyer

Hospital Professional Liability Claims on the Rise by Pat Iyer

Has the Nursing Shortage Gone Away? By Pat Iyer

Michael Jackson: A Demerol Death? by Pat Iyer

What Nurses Think: Patient Safety by Pat Iyer

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