Nurse Case Study: Failure to perform an appropriate assessment on a patient that had undergone extensive surgery

Failure to perform an appropriate assessment on a patient that had undergone extensive surgery; Failure to properly evaluate and monitor a patient that had undergone extensive surgery; Failure to recognize a known risk of liposuction with abdominoplasty procedures; Failure to take the appropriate measures to assure that a patient received timely medical intervention.

Indemnity Settlement Payment: Greater than $325,000
Legal Expenses: Greater than $230,000
Our insured was a registered nurse employed by a cosmetic surgery practice, who performed on a healthy 60 year-old female patient. The patient was discharged the day of surgery and transported home by the insured and the surgeon that performed the procedure. Both the surgeon and nurse assisted the patient in settling into bed and then instructed the patient’s friend regarding post-operative care including diet, positional requirements and medication regimen.
On post-operative day one, the physician and nurse returned to the patient’s home. Both were concerned that the patient was not following the post-operative care instructions. The patient confessed to using alcohol, not following the postoperative diet and sleeping flat in her bed despite being instructed to sleep reclined.
Regardless of the patient’s noncompliance, the physician concluded that the patient was progressing “reasonably well and on schedule.” The nursing notes indicated that on postoperative day one, the patient appeared stable, having normal vital signs with incision sites and drainage tubes clean and dry. The nurse arranged for a nurse to stay the night with the patient to ensure that she received proper nursing care.
On post-operative day two, our insured nurse returned to the patient home to assess the surgical incisions and receive a patient report from the nurse that stayed the night at the patient’s home. Initially, the nursing notes by our insured nurse and a second nurse indicated that patient was progressing normally. However, as the insured was cleaning the abdominal dressing the patient suddenly and without warning, began vomiting black emesis and lost consciousness. Chest compressions were initiated and 911 was called. No mouth to mouth resuscitation was performed because our nurse indicated that she did not want to come into contact with the vomit.
The patient was taken to the hospital via ambulance and was eventually resuscitated. Her condition declined and later she was taken off of life support. Unfortunately, the patient expired a few days later. The autopsy report indicated the cause of death was cardiac arrest following complications from an infection secondary to a perforated colon.
The patient’s adult son filed a lawsuit against the cosmetic surgeon, our insured and the second nurse that was involved with his mother’s care.
The insured nurse was aware of the risks of going to a trial voiced wishes to have the claim mediated.
Risk Management Comments
During discovery, our nurse testified that she and the cosmetic surgeon were involved in an affair. The insured produced multiple text messages between her and the physician in the days prior to and following the patient’s surgery which detailed the nature of their relationship.
These messages made it clear that the two were aware of the patient’s deteriorating condition. The messages also contained insensitive and callous statements as well as unflattering pictures of the patient.
Our nursing expert opined that without the text messages, she could support the care provided by our insured. However, considering the existence of the text messages, she could not support the care provided. The verdict value was estimated at greater than $2 million.
Risk Management Recommendations for Nurses

  • Maintain competencies (including experience, training, and skills) consistent with the needs of assigned patients and/or patient care units.
  • Maintain thorough, accurate and timely patient assessment and monitoring, which are core nursing functions.
  • Communicate in a timely and accurate manner both initial and ongoing findings regarding the patient’s status and response to treatment.
  • Provide and document the practitioner notification of a change in condition/symptoms/patient concerns and document the practitioner’s response and/or orders.
  • Report any patient incident, injury or adverse outcome and subsequent treatment/response to risk management or the legal department.
Risk Management Recommendations for Nurse Leaders/Managers
  • Establish a social media and electronic communication policy. The policy should include written guidelines that protect patient privacy, prohibit misleading and harassing statements and designate individuals who can speak on behalf of the organization.
  • Provide staff training to all new employees and annually thereafter. Sessions should cover such key concerns as social networking rules and etiquette, parameters for use during working and non-working hours, potential legal perils, patient confidentiality issues and disciplinary consequences for misuse. Training session content and attendance should be documented.
  • Institute an environment that makes it easy for employees to identify misconduct or breaches related to social media and report them in accordance to policies.

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!
Visit 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.
The information, examples and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. Please note that Internet hyperlinks cited herein are active as of the date of publication, but may be subject to change or discontinuation. This material is for illustrative purposes and is not intended to constitute a contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. Use of the term “partnership” and/or “partner” should not be construed to represent a legally binding partnership. All products and services may not be available in all states and may be subject to change without notice. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2017 CNA. All rights reserved.
This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. It reflects general principles only. It is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information. This publication is published by Affinity Insurance Services, Inc., with headquarters at 1100 Virginia Drive, Suite 250, Fort Washington, PA 19034. Phone: (215) 773-4600. All world rights reserved. Reproduction without permission is prohibited.
Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc. (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc. (CA 0G94493); Aon Direct Insurance Administrators and Berkely Insurance Agency; and in NY, AIS Affinity Insurance Agency.
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