YourName
This case study presents J.W., a patient who went to the emergency room of the Community Hospital due to a persistent and severe headache over the last couple of days. Patient displayed signs and symptoms that her condition required blood testing and a head CT scan. However, Nurse Jackie, the nurse assigned to handle the patient’s case, only charted the symptoms but did not act on it or report it. The triage nurse, together with Nurse Jackie, also interviewed J.W. about previous neurological problems, headaches, or incidences of cerebral hematoma. But due to J.W.’s disorientation caused by pain, she denied all past histories of her health problems. The attending physician, Dr. James, has a full-time practice in family medicine and only works at the emergency department when the need arises. He has not worked full time at the emergency department in the last 10 years. Thus, when he checked on J.W., he only recommended morphine for the headache, but no other further tests. Nurse Jackie did as she was instructed and noted that there was a reduction in pain, but no changes or improvement in other symptoms. After another set of rounds, Dr. James noted that J.W.’s pains was reduced and discharged her. About 4 hours later, J.W. was rushed back to the hospital and died due to severe brain hemorrhage.
In a negligence suit, the following elements must be present: duty, breach of duty, damages, and causation. In the health care industry, duty refers to the service owed to the patient. Breach of duty occurs when the duty or service owed to the patient is violated or broken. On the other hand, damages pertain to injury or harm resulting from the breach. Causation is the direct cause and effect to an injury or event (Morales, 2012). In these situations, the burden of proof is on the plaintiff or the party that filed the complaint. If any of these elements is not present, then negligence or malpractice cannot be proven. In the case of J.W., all the elements were present so this is a clear malpractice and negligence issue.
In terms of standard of care, the question is always “what type and level of care an ordinary, prudent, health care professional, with the same training and experience, would provide under similar circumstances in the same community” (Withers, n.d.). Thus, if another person in a similar capacity applied a different and more appropriate treatment method to the patient and the patient survives, then it may be a case against the health care practitioner (Moffet & Moore, 2011). In this case, Dr. James and Nurse Jackie should have asked for head CT scan and blood testing to check the condition of the patient. Additionally, Nurse Jackie should have informed Dr. James about the symptoms she has observed and discussed it with the doctor, if she was not sure about the significance of her observations.
If a negligence case will be filed, a plaintiff and defendants need to be identified. A plaintiff is some who complains and files the case, while the defendant is the one being sued or the party who is trying “to protect himself from allegations” (Dye, 2016). Clearly, the plaintiff in this case would be J.W., but since the patient died, she may be represented by her family in filing the case. The defendants are Nurse Jackie, Dr. James, and the Community Hospital. The hospital’s involvement is because of the fact that both nurse and doctor were working for the hospital and the situation happened while inside the premises of the facility. Considering the situation, the plaintiff will more likely point out that the nurse and the doctor were negligent in taking care of the patient and providing the necessary treatment option, especially that the case resulted to death of the patient.
For each defendant, there are several evidences that may be presented that will point out their negligence. For Nurse Jackie, considering that she was the initial person that J.W. had contact with, she only charted her observations about J.W. without discussing her observations with the doctor. This is especially important because supposedly, this is her first solo shift and she did not thoroughly understand the significance of the symptoms. Additionally, since the patient was looking a bit disoriented due to the pain, the more the nurse should have tried to find out the patient’s past history or if there was anyone, a relative perhaps, who could assist in providing the patient’s medical history. In the case of Dr. James, considering that he has not been working fulltime in the hospital particularly in the emergency department, he should always take extra precautions when dealing with patient in the E.R. He also instructed that the nurse give the patient morphine without having clear diagnoses about the patient’s symptoms. Also, despite giving morphine to the patient and showing some signs of improvement, he should have talked to the patient about symptoms and medical history that could have contributed to the pain. Thus, he could have instructed for more tests for J.W.
The defendants could raise the following as defenses:
For Nurse Jackie – Contributory and Comparative Negligence (Sanbar, 2006, p. 265). She can raise this as defense against a possible malpractice suit by saying J.W. contributed to the resulting medical issue by not answering the triage nurse’s and her questions coherently. J.W. was interviewed prior to being admitted in the Emergency Department and was asked questions pertaining her medical history, recurrence of the headaches, and other related questions, but J.W. was not able to establish how often she experiences the neurological problems. Thus, the nurse only acted based on information provided by the patient.
For Dr. James – Absence of Duty (Sanbar, 2006, p. 265). Dr. James can claim that J.W. was not his regular patient, thus, “there is no duty owed to the patient by the physician” (Sanbar, 2006, p. 265). He can invoke that there is no physician-patient relationship between them, thus he has no duty towards J.W.
In my case, I would like to know why Nurse Jackie did not inform anyone about her observations regarding J.W.’s symptoms. This is very important because it could have spelled the difference between life and death and the type of medical treatment that J.W. received from the onset of her hospital visit.
In terms of responsibility, I would say that Nurse Jackie held the biggest responsibility of all because she was the one who received J.W. She also performed the interview and the initial information gathering, but was not able to completely get the information regarding J.W.’s medical history. Also, considering that J.W. was already exhibiting symptoms such as incoherence and disorientation, in addition to her headache symptoms, Nurse Jackie should have not just charted her observations. She should have also consulted with other physicians about it since she was not sure about the significance of her observations. She should also have stressed to Dr. James what her observations were since he was only an “on call” doctor and did not really work in the Emergency Department.
Finally, if I will apportion fault by percentage, I would say that 70% of the blame should be placed on Nurse Jackie for being the sole receiver and initial contact of J.W. and not providing the necessary information to the attending physician, and 30% of the blame should be placed on Dr. James.
References
Dye, F. (2016). What is the difference between a plaintiff and a defendant. WiseGeek. Retrieved from http://www.wisegeek.com/what-is-the-difference-between-a-plaintiff-and-a-defendant.htm
Moffet, P., & Moore, G. (2011). The standard of care: legal history and definitions: the bad and good news. Western Journal of Emergency Medicine 12(1): 109-112. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088386/
Morales, K. (2012). The 4 elements of medical malpractice in nursing. Retrieved from http://www.nursetogether.com/4-elements-medical-malpractice-nursing
Sanbar, S.S. (2006). Medical malpractice defenses. Retrieved from http://www.ablminc.org/Model_Curriculum_LMME_2010/BOOK_MedMal%20Survival%20Handbook_2007/Ch24-A04438.pdf
Withers, Shad. (n.d.). What is the medical standard of care in a malpractice case. NOLO. Retrieved from http://www.nolo.com/legal-encyclopedia/medical-standard-care-malpractice-case.html
