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Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.
The court clearly recognized that a pregnant patient with active vaginal
bleeding and abdominal pain could have presented a medical emergency.
Follow-up assessment and further action on the part of the nurse was not
a matter of Nursing "judgement," it was mandatory.
It noted that the woman was in fact in the early stages of a miscarriage
and gave a classic symptomatology & presentation.
"Bleeding and cramping are the most common symptoms of miscarriage.
Pregnant women with these symptoms should consult their physicians
immediately. A physical examination, ultrasound testing and blood tests
gauging hormonal levels are used to ascertain whether the fetus has been
The court observed that according to the documentation of the event,
the nurse assessed her condition and made decisions based on the
single taking of a pulse.
In assessing the abdominal pain of a actively bleeding pregnant patient,
standards of care as defined by the state Nurse Practice Acts would clearly
have dictated a more detailed assessment and physician notification.
The nurse whether inexperienced with the situation or indifferent towards
the patient's symptoms was clearly negligent. Prudent assessments
including a blood pressure, auscultation of bowel sounds & fetal heartbeat,
location/duration of abdominal pain, temperature, and respirations were
omitted from her evaluation. No physician (or applicable supervisory)
notification of the possible medical emergency was made.
There was no question that the "prudent nurse," that is an average nurse
in the same situation, would have taken more thorough steps to assess
the situation and evaluate the patient's condition.
By failing to take appropriate actions, the nurse allowed a potentially
life-threatening condition to go untreated.
It is worthy of note here that complaints against the nurse's license would
be expected (either by the plaintiff or the facility later). If the facility was
compelled to defend the nurse under an existing employer's malpractice
policy, it is likely that a subrogation action could be initiated afterwards.
If an award was made because of the nurse's negligence, the hospital could
try to recover that amount by suing the nurse as an individual. Filing a
complaint and having action taken against the nurse's license, in addition
to firing her would strengthen their position.
It is certain, that the employer would not defend the nurse against a
State Board of Nursing inquiry. A nurse with a separate personal malpractice
policy (An average cost today for a 1-3 Million Dollar Policy is near $80/year),
would have an attorney hired by the Nurse's insurance company and looking
out for his/her interests, not those of the employer. Specific malpractice
companies will also provide an attorney if a nurse is called before the
State Board of Nursing at no additional fee. This is a benefit you should
ask for when obtaining a personal malpractice insurance policy.
July 25, 1999: Premature Child of Cocaine Addicted Mother Survives Abortion.
Physician Order: Leave To Die?
The premature birth of a child under normal circumstances requires highly
skilled nursing and medical care if the child is to survive. The birth of a
premature child to a known Cocaine addicted mother greatly increased the
risks of mortality. In this case, a child intended to be aborted is born alive.
When the physician orders that the child be to left to die, it miraculously
survives on its own. Were the nurses liable for "following orders?"
Hartsell v. Fort Sanders Reg. Med. Ctr. 905 S.W. 2d 944 - TN (1995).
May 30, 1999: Patient Left Unrestrained, Patient Injured. Nurses Judgement Call
The decision to use or not use restraints must be made with caution and good
judgement. Their intended purpose must be to protect either the patient or
others who may be injured by the patient including the staff caring for the client.
The ultimate determination of necessity is left with the physician. Often, the
moment to moment necessity is determined by the nurse. In this case a nurse
did not feel restraining the patient was necessary. When an injury occurred,
the patient sued.
Gerard v. Sacred Heart Medical Center - 937 P. 2d 1104 (1997)
Related Link Sections:
Clinical Charting and Documentation, Nurses Notes
Direct Patient Care Links
Medical Legal Consulting Nurse Entrepreneurs:
Miscarriages, Education & Support, Pregnancy Obstetrics & Gynecology
Nurse Practice Acts
Neonatal Intensive Care Unit (NICU) Nurses
Premature Infants, Low Birth Weight Babies :
Created on August 5, 1999
Last updated by Andrew Lopez, RN on March 23, 2017
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