Negligence

							Negligence
Cecilia Marie M. Holguin, RN
N
E     (Lat. negligentia, from negligere, to
G    neglect, literally "not to pick up") is a
L   legal concept in the common law legal
I       systems usually used to achieve
G        compensation for injuries (not
                   accidents).
E
N    Negligence is a type of tort or delict
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N
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    A heated IV bag was placed under the
S   armpit of the sixty-six year-old patient for
I   about two hours during hip-replacement
T   surgery.
U   After the procedure the patient had a very
A   uncomfortable burn wound which required
T   more than a year of treatment with topical
I   steroid creams.
O
    The patient's lawyer argued there was no
N   plausible explanation for the injury other
    than negligence by the hospital's certified
#   registered nurse anesthetist who used the
1   IV bag to position the patient.
S
I
T   The jury in the Circuit Court, Dade
U   County, Florida awarded the patient
A   $350,000. Rodriguez v. Palm Springs
T   General Hosp., 2007 WL 4247300 (Cir.
I   Ct. Dade County, Florida, November 21,
O   2007).
N

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    The patient had just had orbital
S   decompression surgery. The post-surgical
I   orders included an ice pack to control
T   postoperative swelling.
U   A nurse filled a surgical glove with ice and
A   secured the ice pack in place over the
T   operative eye with a Velcro strap.
I   When the surgeon later removed the strap
O   and the ice pack and checked the patient's
    vision he found total blindness in the eye. The
N   patient's medical experts related the damage
    to the eye to excessive pressure from the
#   Velcro strap on the ice pack. It was not, the
2   experts said, a complication of the surgery
    itself.
S
I
T
U   The Court of Appeals of Texas ruled
A   the patient had grounds to sue the
T   hospital for the nurse's negligence.
    Baylor Univ. Med. Center v. Rosa,--
I
    S.W. 3d--, 2007 WL 4282433 (Tex.
O   App., December 7, 2007).
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S   The Court of Appeal of Louisiana
I   dismissed a university-affiliated facility
T   and its staff physicians from the
U   patient's parents' lawsuit, ruling that
A   the child's injuries were solely the
T   result of negligence by the medical
I   and nursing staff at the community
O   general hospital where she first
N   presented in the emergency
    department.
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S   The seven year-old was brought in to the
I   E.R. with persistent abdominal pain with
T   diarrhea, vomiting and resulting
    dehydration which had not resolved with
U   antibiotics prescribed to her as an
A   outpatient.
T
I   She had high fever, low blood pressure,
O   rapid heart rate and minimal urine output
    indicating possible renal failure. Her BUN
N   and creatinine levels increased even with
    IV fluids.
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S   Eventually she was transferred to the
I   pediatric intensive care unit at a teaching
T   hospital. She was already in shock. She
    had fluid in her lungs and thirty minutes
U   after being intubated she coded. She is
A   now in a persistent vegetative state.
T
I   Nursing Negligence
O
    The court believed the child belonged in
N   pediatric intensive care from the start and
    the court faulted the nursing care on the
#   first hospital's med/surg unit, where the
3   child never belonged in the first place.
S   An abrupt drop in the child's blood pressure should
I   have been recognized by the med/surg nurses as an
    ominous sign that had to be communicated
T   promptly to a physician, given the child's clinical
U   picture on admission, the court said.
A   No actual harm had occurred when the child's
    blood pressure dropped, the court said. However,
T   failure of the nurses to communicate with a
I   physician was the starting point of a series of events
O   leading eventually to a situation where the child
    could not be hydrated rapidly enough to reverse
N   renal failure, shock, respiratory distress, cardiac
    arrest and irreversible hypoxic brain damage.
#   Franklin v. Tulane University Hosp.,--So. 2d--, 2007
    WL 4304428 (La. App., November 21, 2007).
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S   The first hospital deviated from the standard of care
I   in that the child should have been admitted to a
    pediatric intensive care unit.
T
U   The hospital did not have this level of care.
A   The emergency room physician had enough clinical
    information, that is, the child's tachycardia,
T   elevated BUN and elevated creatinine to realize that
I   the child required intensive care.
O
    Then, once the child was admitted to the hospital's
N   general med/surg floor there was an abrupt change
    in blood pressure noted by the nursing staff on the
#   floor.

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S
I   The blood pressure drop, a major change in health
    status, was not communicated to any physician.
T
U   That omission by the hospital's nursing staff
A   represented a potential beginning of the child's
    impending clinical deterioration.
T
I   There was delay getting the child hydrated to
O   prevent septic shock. When the child did arrive in
    the intensive care unit at a tertiary care facility they
N   could not hydrate her fast enough to prevent her
    from coding.
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    The seventy year-old patient had had
S   prostate surgery ten years earlier. At
I   that time an artificial urinary sphincter
T   was implanted.
U   He was admitted again to the same
A   hospital where he had had the
T   prostate surgery, this time for surgical
I   correction of a small-bowel
O   obstruction.
N   As routine post-operative care a nurse
    inserted a Foley catheter. In the
#   process of inserting the catheter the
4   patient's artificial urinary sphincter
    was damaged.
    The patient now requires an indwelling
    urinary catheter.
S
I   The patient claimed he warned the nurse he
T   "had a pump down there" but to no avail.
U
    Pertinent Records Absent From the Chart
A
T   The court record revealed that the hospital
I   records pertaining specifically to the
O   catheterization were missing from the chart.
N
    The nurse, who could not be identified, was
    not named as a defendant in the lawsuit, nor
#   could the nurse be located to testify in court
4   one way or the other about his or her
    actions.
    Prior Hospital Chart Should Have Been
S   Reviewed
I
T   The patient's attorneys argued to the jury
U   that the hospital staff should have made
    themselves aware of his condition by taking
A
    a complete medical history and by reviewing
T   any and all prior treatment records at the
I   hospital.
O
N   Once his caregivers were aware of his
    condition, a urology consult should have
    been obtained before attempting urinary
#   catheterization, the lawsuit claimed.
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S
I   The jury in the Circuit Court, Lake County,
T   Florida awarded the patient almost $500,000.
U   The hospital was ruled 55% at fault for the
A   nurse's negligence and the treating physician,
T   associated with an independent medical
I   practice group, was ruled 45% to blame. Jacobs
O   v. Leesburg Regional Medical Center, 2007 WL
    1976951 (Cir. Ct. Lake Co., Florida, March 30,
N   2007).

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