Failure to comply with hospital rules incriminates the nurse in a lawsuit

You know the way vital it’s to rigorously follow each hospital’s policies. This includes chain of command rules when there may be an issue with patient care and you don’t ask your doctor or other health care provider to handle your concerns.

The hospital policy could also be entered into evidence at a hearing to find out whether you’ve gotten met or failed to fulfill your obligations under it.

In a 2020 Maryland Court of Special Appeals case Adventist Healthcare, Inc. et al. v. Susan Mattinglyin its decision, the court highlighted many interesting legal issues, including the importance of following hospital policies to guard the patient.

The patient is admitted

A person was admitted to hospital with abdominal pain. He was diagnosed with diverticulitis and colon perforation. Before admission to the hospital, he underwent sigmoid colectomy and colostomy. During hospitalization, a choice was made to reverse the colostomy and a big intestine anastomosis was performed. The patient needed to be rigorously observed because one in every of the possible risks related to the surgery was anastomotic leakage. Initially, during recovery, the patient’s condition progressed “normally” and he was under medical statement.

However, 4 to 5 days after surgery, the patient complained of pain. Upset and crying, he called his mother, told her that he was dying and asked her to return to the hospital as soon as possible.

When she arrived on the hospital, her son was “panting” and “breathing very heavily.” The patient poured a jug of water over his head and commenced vomiting bile. The mother immediately contacted the nursing staff. Nurse M was assigned to a patient on the day shift and was informed by the night nurse that he was complaining of pain. She assessed the patient and located that his stomach was bloated and tender to the touch. Concerned, she contacted the patient’s doctor. The doctor ordered a STAT x-ray and advised the patient to have NPO aside from ice packs.

The patient’s condition is deteriorating

About half-hour after the initial call to the doctor, Nurse M called again, informing him that the x-ray had not yet been taken and that the patient’s mother was asking about it. The doctor replied that he was “on his way.” After calling the doctor, the patient had a high respiratory rate, difficulty respiration, elevated temperature, high peripheral pulse, and low blood pressure. Nurse M called the doctor again. He said he was on his way and was on the phone with the patient’s mother.

After the x-ray (about two hours after it was taken), the patient returned to his room “in bad shape” and “could barely breathe.” Shortly thereafter, the patient began to foam on the mouth, his eyes rolled back, and he lost consciousness.

Code Blue was called in an try and revive the patient. The hospitalist called the doctor, who had not yet arrived on the hospital, and informed him that the patient had coded. The patient couldn’t be resuscitated and died. The doctor arrived on the hospital about 4.5 hours after Nurse M’s first call.

The mother arranges an autopsy

Due to concerns in regards to the circumstances of her son’s death, the mother ordered a personal autopsy. The autopsy was not recorded, neither the hospital nor the doctor were informed in regards to the procedure, and the people performing it didn’t know whether it could involve any charges of skilled negligence.

The mother files a lawsuit

The mother filed a wrongful death lawsuit and a survivorship claim (on behalf of her deceased son’s estate for predeceased damages) against the doctor for violating health care standards by failing to timely diagnose and treat her son’s postoperative health problems. She also mentioned the name of the hospital, accusing Nurse M, an worker of the power, of negligence as a consequence of failure to comply with the hospital’s policy and calling a “code blue” earlier when the patient’s condition worsened. An expert surgeon testified that the patient died consequently of “terminal septic shock” as a consequence of damage to the surgical anastomosis of the massive intestine, consequently of which “faeces” leaked into the abdominal cavity. Such an event required immediate surgical intervention, which didn’t occur.

The jury returned a verdict at trial in favor of the mother and against each defendants. The defendants appealed against this decision.

Decision of the Court of Appeal

Expert testimony confirming the legal position of each parties is crucial in any skilled negligence or wrongful death case. Since this blog focuses on nursing, I’m mainly specializing in the court’s decision regarding Nurse M’s conduct, based on expert testimony. One of the arguments raised by the defendants within the appeal is that the expert testimony shows that the mother in Nurse M.’s case didn’t provide evidence of a causal relationship. In short, defendants alleged that Nurse M violated her standards of care by failing to follow the hospital’s chain of command policy and failing to call the Code Blue team. Therefore, there have to be evidence that the violation directly caused the patient’s death. The court presented intimately the expert testimony of the mother’s nurse and the expert physician/surgeon.

Their testimony corroborated the indisputable fact that Nurse M’s failure to follow the chain of command and call the suitable code early when the patient’s symptoms included shortness of breath, abdominal pain, sweating, and “extremely disturbing” vital signs was the direct explanation for the patient’s death.

The appellate court upheld the first-instance court’s ruling.

What does this matter mean to you?

Nurse M was truly concerned in regards to the patient’s condition, as evidenced by quite a few assessments of his condition and calls to the doctor.

However, she was unable to trigger the code though she could have just by following the power’s chain of command rules. This failure violated her standard of care and created liability.

Hospital policy gave Nurse M full authority to act on the patient’s behalf. Unfortunately, she didn’t use this power and the patient died. When a patient’s condition continues to deteriorate, affirmative motion have to be taken to stop foreseeable and unreasonable risk of harm to the patient. This is just not only a legal obligation, but in addition an ethical one.

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