Legal Eagle Eye Newsletter for the Nursing Profession (6)3 Mar 98

 

Quick Summary: The nurses’ notes reflected the patient was assessed ten times by the nurse on duty between 3:00 and 11:15 p.m.

   The nurses took her blood pressure and vital signs, which were within normal limits. Her urine was negative both for glucose and albumin.

   The physician phoned at 4:15 p.m. The nurse who answered reported mild nausea and some vomiting, from the chart.

   The physician’s provisional admitting diagnosis was pregnancy at term and possible gastroenteritis.

   At 11:15 p.m. the temp had risen to 99.3o, the abdomen was distended, the patient complained of diffuse abdominal pain, and she vomited a dark green liquid.

  The nurse notified the physician immediately. He ordered a STAT amylase level and a nasogastric tube to suction the stomach. The amylase came back high, indicating mild pancreatitis. The physicians decided not to go ahead with a cesarean, unless monitoring of the fetus should indicate distress had set in.  COURT OF APPEAL OF LOUISIANA, 1998.

 

   The lawsuit was filed against the physicians for medical malpractice. The nurses and the hospital were not named as defendants in the parents’ lawsuit. However, the Court of Appeal of Louisiana felt it was important to point out the highly competent medical-surgical nursing care the patient got in the hospital to bolster its decision to exonerate the physicians.

   The patient had intermittent labor contractions and was slightly dilated on admission to the hospital. However, pancreatitis, not explained by her history, showed up in the hospital. The physicians decided the pancreatitis did not threaten the fetus, but kept up monitoring the fetus for signs of distress. When signs of fetal distress, i.e. decelerated heartbeat, did appear, an emergency cesarean was done, but not quickly enough to rescue the fetus from hypoxic neurological damage.

   Although the patient was admitted to deliver her child, the nurses were alert to the possibility that another medical condition could manifest itself. It was the nurses who first spotted the signs of pancreatitis and alerted the physicians. They were very diligent in closely monitoring and assessing the patient, the court indicated.

   After the patient was transferred to the ICU by a physician, after the night nurse called the physician at 4:45 a.m. with that recommendation, labor and delivery nurses took charge of watching the fetal monitor.

   The labor and delivery nurse on duty paged all the physicians at once when the fetal heart rate dropped later that morning, and a cesarean was done immediately.

   Although there were catastrophic complications to the baby, the court could not find evidence it was caused by any error or omission by the physician/defendants. The court indicated it had a good deal of respect for how closely the nurses had cared for this patient and for how competently they had communicated with the medical staff. Pugh vs. Mayeaux, 702 So. 2d 988 (La. App., 1998).