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Special Edition Legal Case Study


Nursing Professionals and Medical Malpractice: A Case Study with Risk Management Strategies

Medical malpractice claims can be asserted against any healthcare provider. Although there may be a perception that physicians are held responsible for the majority of lawsuits, the reality is that nursing professionals are more frequently finding themselves defending the care they provide.


Nurse Edition

Case Study: Medication Administration Error and Failure to Monitor

A 23-year-old woman with no significant medical history presented to the emergency room with flu-like symptoms. She complained of generalized body ache and had a fever of 102.6. For the past two weeks, she self administered over-the- counter medications with no relief. Instead, her condition deteriorated and she developed both shortness of breath and a cough. Her worsening symptoms motivated her to seek care a local emergency room... Read the Full Case with Risk Management Recommendations

Nurse Practitioner Edition

Case Study: Failure to Assess Resident and Failure to Inform the Physician of Resident’s Unstable Condition

This case involves the treatment and subsequent death of a 78-year-old female resident of a nursing home. She had a number of medical conditions including hypertension, chronic anemia, chronic renal failure, congestive heart failure and morbid obesity. She was prescribed the anti-coagulant drug Coumadin because of atrial fibrillation and the related risk of blood clot formation... Read the Full Case with Risk Management Recommendations




March 2009 Legal Case Study

Failure to Check Prescription for Morphine at Time of Admission - Woman Suffers Morphine Toxicity and Dies - Confidential Settlement With Nursing Home - $600,000 Verdict Against Hospital Where Order Originated.

The plaintiff's decedent, age eighty-one, was admitted to a Medical Center in December 2003 for treatment of sciatic pain after a fall. Fifteen milligrams of morphine sulfate controlled release tables (MS Contin), twice a day, was prescribed. Shortly before the decedent was transferred to a skilled nursing facility for pain management and rehabilitation an increase in the MS Contin to thirty milligrams was ordered. The hospital’s case manager recorded the increase of MS Contin to thirty milligrams, twice a day, without striking out the previous order for fifteen milligrams twice a day. Transfer orders contained two separate orders for MS Contin.

The skilled nursing facility’s nurse telephonically reviewed the medication orders with one defendant, a nurse practitioner, acting in her capacity as Long Term Care’s on-call employee. The nurse practitioner recommended verification of the accuracy of the transfer orders with the Medical Center Pharmacy. The plaintiff claimed that the skilled nursing facility administered forty-five milligrams of morphine twice a day. This caused hallucinations, lethargy and twitching. The woman died of acute morphine intoxication a couple of weeks after admission. The medical examiner noted a blood alcohol level of .09 percent, which the plaintiff attributed to postmortem alcohol production, not ingestion of alcohol.

The plaintiff claimed that the nurse practitioner was negligent in approving the medication orders admitting the decedent to the skilled nursing facility and in not checking the accuracy of the order herself. The plaintiff also claimed that Long Term Care and defendant should not have permitted a nurse practitioner to approve the admission orders, but should have had a system in placed which would have a physician notified immediately on new patient admission.

The plaintiff also claimed that the Pharmacy was negligent in dispensing the morphine and should have recognized that the order was excessive and contacted the ordering physician to verify the accuracy of the order. The skilled nursing facility settled for a undisclosed amount. The court granted partial judgment, as a matter of law, to the Long Term Care and defendant, leaving them in the case only as to vicarious liability for the defendant nurse practitioner.

The defendants claimed that the skilled nursing facility was solely at fault, that the order was not obviously incorrect, and that the nurse practitioner had acted properly in recommending verification of the morphine order. According to The Trial Reporter, a jury awarded $6 million, but found Long Term Care and defendant, the nurse practitioner and the Pharmacy not at fault. The jury found the Medical Center ten percent at fault and the settling skilled nursing facility ninety percent at fault. That resulted in a $600,000 recovery from the Medical Center.

With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.

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Recently Posted Legal Case Studies

ISSUE DATE
DESCRIPTION
September 2010
Internal Medtronic Pump for Pain Control Not Properly Serviced by Home Health Nurse, Leading to Overdose of Plaintiff - Plaintiff Has Short Hospitalization - Confidential Settlements With Some - $6,000 Verdict Against Home Care Defendant.
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March 2010
Nurses Fail to Inform Surgeon of Pain and Numbness Following Laminectomy - When Epidural Hematoma is Diagnosed Hospital Fails to Provide Operating Room Emergently - Elderly Woman Rendered Paraplegic - $1.8 Million Verdict.
February 2010
Nurse Administers Part of Epinephrine Intravenously Instead of the Ordered Subcutaneous Delivery - Woman Kept Overnight for Observation - Claims Heart Damage - Defendant Claims All Tests Were Normal - Defense Verdict.
January 2010
Man Gets Out of Bed Alone After Nurse Fails to Respond to Request for Assistance to Bathroom - Fall When Bed Moves as He Returns to Bed - Fractured Hip With Decline and Death - $125,000 Settlement.
December 2009
Failure to Treat Lack of Blood Flow in Leg and Foot Following Trauma to Leg - Amputation Above Knee Ultimately Required - $2 Million Settlement.
November 2009
Woman Falls and Fractures Hip After Waist Restraint is Removed - Plaintiff Claims Nurses Removed It - Defendant Claims Plaintiff Removed It - $127,188 Verdict.
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Failure to Properly Respond to Fetal Distress During Labor - Emergency Cesarean Section Ultimately Performed, but Baby Dies - $325,000 Settlement.

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