Health Care Law.
Case
Two
A
24-year-old mother of a 10-year-old son was seen by her FP for swelling
of her legs. Medical reviewuation revealed the presence of 4+
proteinuria. Patient underwent renal biopsy, which revealed a mesangial
glomeropathy on ultra microscopic examination. Light microscopy was
normal. Patient was offered, but refused, steroid therapy for her
Nephrotic syndrome. Patient was subsequently seen over the next year by
her FP, during which time, she remained medically stable until an
reviewuation in creatine increased from .9 to 2.3. Patient then agreed
to steroid therapy. Prednisone, 40 mg was begun and subsequently at one
month tapered to 30 mg every other day to mitigate potential for side
effects as per the patient’s request.
Patient and her mother were fully
informed of the potential benefits and side effects of her therapy, the
chronic progressive nature of her disease and the probable eventual need
for the dialysis-transplantation. The FP requested multiple nephrology
consultations with the recommendation that the patient receive a course
of IV Prednisolone and subsequently 60mg of Prednisone daily. Over the
Next 8 months, the patient’s kidney function deteriorated and required
dialysis. The patient and her mother then sued for 3 million dollars,
claiming that her had prescribed an inadequate dosage of medication. In
their view, this was the probable cause of the renal failure.
The expert for the FP testified at the
deposition that treatment was adequate and met the standard of care.
Four other experts agreed with the defendant’s expert. Plaintiff’s
expert testified that the treatment was totally inadequate, did not meet
the standard of care and was the probably cause of the renal failure.
Health Care Law & Policy
Case Three
Healthcare Risk Management’s
Legal Review & Commentary
Chain
of events leads to brain damage: $4.95 million
By
Mark K, Delegal, Esq., and Jan Gorrie, Esq.
Pennington, Moore, Wilikinson, Bell,
and Dunbar, PA
Tallahassee,
FL
News:
A chain of events left a man catastrophically brain damaged. After
settling with the physician for an undisclosed amount and settling the
claim for loss of consortium, a jury returned a verdict of 4.95 million.
With statutory caps on damages, the recovery actually approaches; the
recovery actually approaches $2 million.
Background:
A 37-year-old plaintiff was being treated at a Colorado hospital for
reflex sympathetic dystrophy (RSD). The man had developed RSD as a
result of the amputation of a finger arising from a work-related
accident five years earlier. The normal, routine treatment of this RSD
entailed an injection of guanethidine, which dulls the nerve endings.
Because of the severity of his phantom pain, the guanethidine was given
to him several times a week.
Typically, her was sedated during the procedure. However, in this
instance, at his bedside was the chemical phenol (carbolic acid) in a
vial that was identical to his intended medication. Phenol, an acid that
kills nerve tissue, is used rarely as a pain management tool. Another
anesthesiologist, who allegedly disposed of the phenol vial after using
id on another patient, had used it. Contrary to the hospital’s unit
does policy, the vial apparently had not been disposed by either the
physician who had used the material or the nursing staff.
The plaintiff’s anesthesiologist took the vial containing phenol from
the nerve block tray and, although it was clearly marked as phenol, he
injected into the plaintiff. The vial did not have a warning label.
Because the patient immediately ached his back in what the
anesthesiologist thought was pain, he gave the patient a second
injection from the same vial. Several hours later, the patient still
appeared in pain.
The anesthesiologist believed that plaintiff had suffered an allergic
reaction to the guanethidine and said so out loud. Upon hearing the
perceived diagnosis, the head nurse shared that the patient had not been
given the guanethidine. It seems that she had known this for some time
but had not shared the information. The anesthesiologist checked the
sharps box where he had disposed of the vial he had used and discovered
the vial-marked phenol.
As a result of the injection of phenol, the plaintiff had to undergo
emergency surgery. In order to prevent the further development of
compartment syndrome, which could have resulted in the loss of an arm.
The patient had a fasciotomy. The fasciotomy involved making an incision
from his fingertip to elbow.
At the time of the emergency surgery, the patient and his wife were told
the initial mishap. Two days later, the anesthesiologist who had
inadvertently administered the phenol determined that, in order to
decrease the pain during the standard bandage change from the fasciotomy
incision, the patient should consciously be sedated. Against hospital
policy during the conscious sedation, the patient was not placed on
standard monitoring equipment, which included a pulse oximeter,
automatic blood pressure cuff, and EKG machine. Therefore when at some
point after the procedure his heart and breathing stopped, no one was
aware of the situation.
Allegedly, his breathing had stopped for at least five minutes before
his condition was discovered at 8 a.m. The noted time is significant
because, based on hospital’s medical record, the staff nurse
responsible for regularly checking the patient’s vital signs had
seemingly not done so as routinely required. When she went back to amend
the record, she inadvertently posted 8a.m. the patient was alert and his
vital signs were within normal parameters.
The hospitals medical personnel were able to resuscitate him, but the
patient remained in a coma for four days. The patient suffered an anoxic
encephalopathy and will remain catastrophically brain damaged for the
rest of his life. He does not recognize his wife or his child who has
been born several months after the incidents. He lives apart from his
family in a supported-living facility where he receives 24-hour-a-day
supervision and care.
The anesthesiologist admitted to inadvertently injecting the plaintiff
with phenol. He also admitted to declining the standard monitoring
equipment when performing the conscious sedation during the bandage
change and electing instead to monitor the patient, which he admittedly
failed to do. Prior to trial, the plaintiff settled with the treating of
the anesthesiologist pursuant to a confidential settlement agreement.
Health Care Law & Policy
Case Four
Pump insertion causes paraplegia: 3.3
million
Supplement
to HEALTHCARE RISK MANAGEMENT/ July 2000
News:
A women walked into a Florida hospital to have a morphine pump inserted.
She left in a wheelchair when the procedure resulted in injury for her
spinal cord. The physician group settled for $1 million, and the verdict
against the hospital was $2.3 million.
Background:
the 60-year-old, married, retired woman had experienced a physical
trauma that resulted in her having severe chronic lower back pain. In
order to alleviate pain she was seen at the hospital’s Center for Pain
Management, where anesthesiologists determined that she was a candidate
for a morphine pump. She was admitted to the hospital for what was
routinely a two-hour procedure. However, it lasted seven hours because
the two physicians were unable to properly place the pump’s line in
the patient’s spinal column. In the course of seven hours, her spine
was punctured approximately 18 times.
The failed attempts to insert the morphine pump line resulted in sever
swelling and the severing of her spinal cord. She was discharged from
the hospital paraplegic. Her husband cared for her for the next three
years, tending to her every need, cleaning of her bowels, and dressing,
and then she died of unrelated complications.
The plaintiffs alleged that after two hours, the anesthesiologist should
have stopped the procedure and the brought in a consulting neurosurgeon.
The physicians settled suit for their policy limit of $1 million.
However, the plaintiff’s suit against the hospital proceeded to trial.
At trial, the plaintiffs claimed that while the physicians were not
actually employed by the hospital, they were agents of the hospital
inasmuch as the hospital’s representations in there advertisements for
the Center for Pain Management, their signage, and their requirements
for admission would lead reasonable people to believe that they were
being treated by employees and /or agents, real or apparent of the
hospital.
The hospital maintained that he anesthesiologists were independent
contractors and that the hospital was immune form the physicians’
mistakes. The jury saw it differently and delivered a $2.3 million
dollar verdict against the hospital. Initially, there was discussion of
an appeal, but that has not yet occurred.
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