Defendant is a Nurse Practitioner working at a college infirmary.
Medical malpractice claims may be asserted against any healthcare provider, including nurse practitioners. This case study involves a nurse practitioner working at a college infirmary.
Presented by NSO and CNA
Legal Case Study with Risk Management Strategies
Failure to secure an adequate history; failure to secure a thorough examination on a patient; failure to warn and advise a patient of risk involved in the use of medications; failure to properly monitor a patient on a medication that can cause organ failure
(Monetary amounts represent only the indemnity settlement payment and/or legal expenses incurred on behalf of the treating nurse practitioner.)
An insured nurse practitioner, working at a college infirmary, was asked by a maintenance employee at the clinic for a terbinafine prescription for fungal toe infection. The nurse practitioner advised him to see his primary care provider for the prescription, but the employee explained that his primary care provider would not see him because of money owed. The insured reluctantly agreed to a one-time prescription but informed the employee that he would need to arrange with his regular practitioner for any further treatment.
Later that day, the pharmacy contacted the nurse practitioner about changing the prescription from terbinafine ($400) to ketoconazole ($40). The insured agreed to the medication change but told the pharmacist that the employee would need bloodwork prior to beginning the prescription. The following day the nurse practitioner ordered baseline serum liver enzymes, which were normal. She then verbally instructed the employee to avoid alcohol and contact his primary care provider for monitoring and follow-up.
A month later, the nurse practitioner left her employment at the college and had no further contact with the employee, who never followed up with his primary provider. He eventually suffered liver failure and needed an organ transplant due to acute hepatotoxicity.
When the lawsuit was filed against the insured, she stated she never thought of the employee as a patient and had only prescribed him the medication as a favor.
Risk Management Comments
The insured nurse practitioner testified that she approved an one-time refill of the prescription, which the employee filled. No liver functions were performed before or after the refill and the only time the employee sought medical attention when was he was in liver failure. The employee was never able to work after his liver transplant and had three minor children living at home.
After several attempts to resolve the matter for a compromised amount, several of the co-defendants would not agree to mediation. After six-years of defending the claim, it was eventually resolved with a mutual agreement with the employee and his family.
Risk Management Recommendations
- Discuss with the patient the need to be compliant of medical treatment and appropriate follow-up. Use language (spoken, written) the patient can understand.
- Use caution when prescribing medications with known toxicity side effects, if a patient has difficulty being medically adherent.
- Order and follow up with all indicated monitoring tests and document results in the patient healthcare information record.
- Consult with a pharmacist as needed, documenting all communication.
- Remain current regarding clinical practice, medications, biologics and equipment related to the diagnosis and treatment of illnesses and conditions encountered in one’s specialty.
- Be cautious about treating or providing care to family, friends or co-workers. While it is not always easy to say no to requests from relatives and friends, the situation may cloud professional judgment and lead to ethical lapses.
- Politely decline any suggestions or recommendations from a patient that could jeopardize their safety or lead to later questions about one’s clinical expertise and/or judgment.
- Refrain from personal relationship outside of the care setting with patients and their family members.
Guide to Sample Risk Management Plan
Risk Management is an integral part of a healthcare professional’s standard business practice. Risk Management activities include identifying and evaluating risks, followed by implementing the most advantageous methods of reducing or eliminating these risks — a good Risk Management Plan will help you perform these steps quickly and easily!
to access the Risk Management Plan created by NSO and CNA. We encourage you to use this as a guide to develop your own Risk Management Plan to meet the specific needs of your healthcare practice.
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