Legal Eagle Eye Newsletter for the Nursing Profession (6)1 Jan 98
Quick Summary: Once a blood transfusion has been hung nurses must check the patient at least every twenty to thirty minutes. Five hours after the transfusion was finished the patient coded and died.
Nursing negligence or malpractice, in the form of inadequate monitoring of the patient, was one of the alleged legal grounds for the suit pursued by the plaintiff in this case.
In any healthcare malpractice or negligence case, the patient or the patients representative, as the plaintiff, has the burden of proof.
The burden of proof means that to succeed with a civil case the plaintiff must establish what is the standard of care for the defendant healthcare professional, that the healthcare provider breached the standard of care, and also that the harm the patient suffered was proximately caused by that breach of the standard of care.
There was evidence presented in court of the appropriate standard of care for nursing and that the standard of care was breached.
However, the court record is totally absent of any evidence that this breach was what caused the patients death. COURT OF APPEAL OF LOUISIANA, 1997.
The twenty-three year old man had been diagnosed with sickle cell anemia at six months of age. He had suffered poor health throughout his short life, with continual bouts of pneumonia and repeated sickle cell crises.
He was admitted to the hospital for IV antibiotics and pain medications, and discharged with oral antibiotics after seven days. He was told to report for a follow-up appointment in the hospitals sickle cell clinic set for six days after discharge.
On the morning of his follow up appointment he came in early with chest and abdominal pain. He could not be seen by his physician but was admitted to the hospital through its emergency room with a diagnosis of multiple pulmonary infarcts. His physician did see him later that afternoon and ordered a transfusion of packed red blood cells, which the patient declined for the time being from fear of HIV.
The next day the patient continued to deteriorate. His chest pains and fever were increasing, and antibiotics were having little if any apparent effect.
Early the next morning his physician ordered and the nurses hung two units of packed cells to transfuse over a total of approximately eight hours time, that is, to be completed shortly after 8:00 a.m. By noon the patients temperature was still 103.8o F and he still had chest and abdominal pains. The physician was very concerned, and ordered arterial blood gases drawn.
Ten minutes later the patient suffered cardiopulmonary arrest. A visiting friend called for help. The patient was revived after a lengthy code, but remained comatose in intensive care for a week and then expired.
The hospital and the attending physicians became defendants in a civil malpractice suit filed by the patients mother. The trial judge granted a judgment against the hospital for an undisclosed sum for professional negligence by its nursing staff.
The hospital appealed. The Louisiana Court of Appeal overturned the trial judges ruling.
The Court of Appeal did agree with the trial judges belief that there was evidence of nursing negligence. The courts agreed that once a blood transfusion has been hung, the patient must be physically monitored every twenty to thirty minutes while the blood is hanging. Failure to do this is a breach of the legal standard of care for nursing practice.
The courts apparently believed, although the transfusion had been completed five hours before the patient actually coded, that his continued high fever, chest pains, labored breathing and abdominal pain warranted continued close monitoring by his nurses. Failure of nursing to provide such close monitoring is negligence, the courts indicated.
The courts found a serious problem with the fact there was no nursing documentation in the chart after 10:00 a.m. that a nurse had checked on the patient.
However, the Court of Appeal overruled the trial judge and dismissed the hospital from the case. It ruled the trial judge erred in holding that the nurses negligence was the cause of this patients death. The Court of Appeal ruled the patient died from a cardiopulmonary infarct acutely precipitated by aspiration of vomitus, a very sudden event which could have happened regardless, even with the closest and most conscientious monitoring by nursing and the best of nursing care.
The Court of Appeals discussion of the arguments raised by the physicians attorneys indicated it may have believed this was likely just the end stage of the tragic progression of this patients sickle cell disease. Webb vs. Tulane Medical Center Hospital, 700 So. 2d 1141 (La. App., 1997).