YOU BE THE JUDGE The patient, on the first day postoperative for a transurethral prostate resection, received a unit of packed cells early in the morning on the supposition that he was bleeding internally.

March 02, 2020

Case Study Chapter 9

YOU BE THE JUDGE The patient, on the first day postoperative for a transurethral prostate resection, received a unit of packed cells early in the morning on the supposition that he was bleeding internally. That afternoon at 3:22 p.m., the patient’s wife informed the nurse that her husband was breathing “heavily” and requested that the nurse assess him. The nurse, according to the testimony of the wife, informed her that the doctor was aware of the patient’s breathing pattern and that there was nothing about which she should worry. The nurse did not leave the nursing station. The patient subsequently died related to a shock from the internal bleeding complicated by a reaction to the blood transfusion. In court some years later, this same nurse testified that she had called the surgeon immediately to report that the patient’s respirations were 50, that she had taken vital signs that were within the normal limits for this patient, and that she had obtained a pulse oximeter reading that was acceptable. She also testified that she kept calling the physician’s office to report these findings.

None of this nursing care was documented in the progress notes that the patient’s nurse placed in the patient’s chart the next day. The nurse testified that she had compiled the progress notes from scratch notes she had written during the previous afternoon. The nurse further testified that it was her practice to make handwritten notes during the time that she worked and then to type her progress notes on the hospital system the next day. Additionally, this nurse never documented taking vital signs during the critical 2 hours between the spike in the patient’s respirations and the time he was pronounced. The surgeon’s office nurse testified that a call was received from the hospital at 4:00 p.m. and that the surgeon immediately left the office for the hospital. The surgeon testified that he called the hospital from his car phone and that he immediately called a code as soon as he reached the patient’s room.

1. Did the lack of documentation affect the ultimate outcome of this case? 2. Was there negligence on the part of the nursing staff in the care of this patient? 3. How does the obvious contradiction in the testimony between the patient’s hospital nurse and the office nurse’s and physician’s account of what happened affect your decision in this case? 4. What standards for documentation did the patient’s nurse breach? 5. How would you decide this case?

Using the sample professional liability insurance policy (Guido, p. 193-194), locate the various provisions:

· Limits of liability

· Declarations

· Deductibles

· Exclusions

· Reservation of rights

· Covered injuries

· Defense costs

· Coverage conditions and supplementary payments

· Did you have difficulty finding some of the sections? Would this be a policy that you would consider purchasing for your own liability coverage? Why or why not?

YOU BE THE JUDGE During an unexpected heat wave, the administrator of a nursing home decided against turning on the air conditioner, which resulted in the death of four of the residents of the home. One of the deceased resident’s daughters brought a lawsuit against the home for a wrongful death suit. She was awarded a judgment of $275,000. She then filed a second lawsuit against the nursing home’s insurance company to collect payment on the judgment. The insurance company refused to pay, stating that the judgment underlying the lawsuit was professional liability and the insurance company did not cover the nursing home for professional judgment. The nursing home then filed a lawsuit against the insurance company for payment of this judgment. QUESTIONS 1. What provisions of an insurance policy would you consult to determine whether an insurance company should pay such a claim and what would the limits of the liability be? 2. Is the nursing home insurance company correct in saying that this is a professional judgment issue? 3. Which insurance company (the nursing home’s or the administrator of the nursing home, assuming she has coverage) should pay the court-ordered judgment? 4. How would you decide the case?