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Legal Risks of Nurses Case Study

CHANCE OF SURVIVAL DIMINISHED

On the afternoon of May 20, the patient, Mr. Ard, began feeling nauseous. He was in pain and had shortness of breath. Although his wife rang the call bell several times, it was not until sometime later that evening that someone responded and gave Ard medication for the nausea. The nausea continued to worsen. Mrs. Ard then noticed that her husband was having difficulty breathing. He was reeling from side to side in bed. Believing that her husband was dying, she continued to call for help. She estimated that she rang the call bell for 1.25 hours before anyone responded. A code was eventually called. Unfortunately, Mr. Ard did not survive the code. There was no documentation in the medical records, on May 20 between 5:30 p.m. and 6:45 p.m., that would indicate that any nurse or physician checked on Ard's condition. This finding collaborated Mrs. Ard's testimony regarding this time period.

A wrongful death action was brought against the hospital, and the district court granted judgment for Mrs. Ard. The hospital appealed.

Ms. Krebs, an expert in general nursing, stated that it should have been obvious to the nurses from the physicians' progress notes that the patient was a high risk for aspiration. This problem was never addressed in the nurses' care plan or in the nurses' notes.

On May 20, Ard's assigned nurse was Ms. Florscheim. Krebs stated that Florscheim did not perform a full assessment of the patient's respiratory and lung status. There was nothing in the record indicating that she completed such an evaluation after he vomited. Krebs also testified that a nurse did not conduct a swallowing assessment at any time. Although Florscheim testified that she checked on the patient around 6:00 p.m. on May 20, there was no documentation in the medical record.

Ms. Farris, an expert in intensive care nursing, testified for the defense. She disagreed with Krebs that there was a breach of the standard of care. However, on cross-examination, she admitted that if a patient was in the type of distress described by Mrs. Ard and no nurse checked on him for 1.25 hours, then that would fall below the expected standard of care.

Solution Preview

There are 3 possible guilty parties. Respiratory distress is a medical emergency and the responses to Mr. Ard's shortness of breath alone is enough to implicate the hospital for falling short of anyone's standard of care. In fact, it makes me mad that the hospital will not take responsibility and instead is trying to put all of the blame on the nurse.

Also, how do we know the call light was working correctly? If it took so long for someone to get to Mr. Ard's room, I find it hard to believe that the nurses at the nursing station were ignoring the calls. Conversely, why didn't Mrs. Ard just get up and go to the nurse's station?

The physician could be guilty, too. A progress note ...

Solution Summary

A patient dies from respiratory distress despite frequent use of the call-light by his wife to notify the RN's at the nursing station. Who is to blame: the hospital, the nurses, and/or the physician? The solution is split into presumed liabilities with the hospital blaming the nurses and a particular nurse on duty then for the death.

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