¶ … clinical cases and examine malpractice perspectives. Background Info

Concerns over mounting healthcare expenses have resulted in increased inquiry into medical practices. With the rise of malpractice risk and medical liability to unprecedented levels, the field of medical law has influenced defensive medical practice as healthcare providers endeavor towards liability risk mitigation (Nahed, et.al, 2012).

Elements Needed to Prove Malpractice

Medical malpractice is associated with four fundamental elements, all of which have to be present for forming the base for any claim. For any case of medical malpractice to succeed, an attorney is required to prove all four aspects, which are: duty, causation, damages, and breach (What are the Elements of a Medical Malpractice Claim? n.d.). The first element -- Duty -- implies that health care professionals owe their patients the duty to take reasonable and appropriate action; i.e., the practitioner is accountable for delivering some form of treatment or care to the patient. Breach implies that the practitioner in question has violated whatever duty was owed to a certain patient; i.e., the healthcare provider has fallen below or deviated from care standards. Causation implies the healthcare provider's violation of care standards contributed to or caused some degree of harm to this patient. Lastly, Damages imply that the practitioner's mistake resulted in patient harm.

Case 1

Background- An elderly woman aged 86 allegedly fell, bottom first, from a table in the operating room of a large medical training center. This fall caused severe head injury to the patient, culminating in her demise 7 days later. American daily, Boston Globe, reported in its January 29, 2008 issue that a gap present in the orthopedic surgery table resulted in the fall; one of the nurses on duty had detached the safety strap fastened across the patient's torso when preparing to transfer her to an in-patient hospital bedSurgical tables are designed especially for these procedures and have special boots for immobilizing patients' feet; also, the large opening present towards the lower half of their torsos is intended for enabling easy access when taking x-rays. The Massachusetts State public health department is investigating the case. The patient's family has lodged a "wrongful death" lawsuit, against a resident anesthetist, two nurses, and a resident orthopedic doctor.

Elements Met/Or Not- In this case, each of the elements required for proving medical malpractice have been met. The aforementioned four defendants in the case (resident anesthetist, two nurses, and a resident orthopedic doctor) owed a responsibility to the deceased patient (Writer Thoughts). A duty breach was caused by the nurse when she removed the torso safety strap, leading to the patient's fall and subsequent death due to injury from the fall.

Legal Responsibility of the Nurses- The resident anesthetist, Guzman, informed investigators of the case that, when the blood pressure (BP) cuff started deflating, he was standing at the surgical table's head. He states, as is documented in investigators' reports that, he glanced up to see the BP monitor and was shocked when, upon glancing back down, the patient had fallen (Saltzman, 2008). According to investigation report, the hospital (where the incident occurred) performed its own independent "root cause analysis," whose results showed that the involved nurses and physicians were all engrossed in their respective tasks and there was no verbal communication of the safety belt's removal from the patient's torso. The nurse was responsible for ensuring proper communication with regard to the next action, rather than taking action independently, without others' consultation.

Perspective of Patient or Family- If one considers the patient's perspective, or that of her family, it is completely understandable that they would wish to take legal action, and ensure such an incident does not recur (with another patient) (Writer Thoughts). Hence, filing a wrongful death claim, as the patient's family has done, is completely appropriate. The lawsuit was filed in the Superior Court of Suffolk County and names the following four individuals, who were apparently present in the operation theatre when the tragedy happened, as defendants: Resident anesthesiologist, Dr. Carlos Guzman; Orthopedic resident, Dr. John Pryor; and nurses Ingrid Rush and Harvinder Miller (Saltzman, 2008).

Risk Management Perspective- A Boston Medical Center spokesperson, Ellen Berlin states that the Center's management extended the hospital's sincere sympathy to the O'Donnell's (the patient's) family. Medical center procedures were improved for ensuring similar accidents do not happen again in future; however, she did not specify exactly what changes were brought about (Saltzman, 2008). A protocol has been adopted by the hospital which requires all doctors and nurses to hold patients prior to detaching the safety strap, and ensure individuals are present on either side of the operating table when the transfer is being carried out.

He received local 'saddle' anesthesia. (This form of anesthesia acts on those parts of an individual's body that are in contact with a saddle when one sits in it). The surgery was successful. Upon discharge, he was instructed to take sitz baths using "tepid" (i.e., lukewarm) waterA month later, the patient returned to the center for an evaluation; during the examination in this visit, the surgeon noticed scarring on his proximal thighs and buttocks. The surgeon further observed, large patches of cured burns and accompanying skin changes. Upon inquiring from the man and his wife, the surgeon found that they mistook the work "tepid" for "scalding hot," and used water at such extreme temperature for his sitz baths. Apparently, the slow-resolving local saddle anesthesia (which keeps the body partially numb for about 24 hours) blunted the patient's response to scalding water.
Elements Met or Not- One cannot definitively state whether every element was met in this instance. For example, in the course of the operation, the patient was accorded proper care. Nevertheless, the patient ought to have been provided with detailed and clear-cut instructions while being discharged as well as for his follow-up appointment. This was the responsibility of every involved healthcare provider (Writer Thoughts). The patient in question presents a unique challenge -- a language barrier; he misunderstood the healthcare terminology (though 'tepid' is a commonly understood word) used. Instructions ought to be accompanied by illustrations and examples making it amply clear and ascertaining that the patient had understood the meaning clearly, as communicated by the healthcare official.

Legal Responsibility of the Nurses- The case did not involve any nurse.

Perspective if Patient or Family- The challenges of language barrier and the patient's health literacy have perceptibly contributed to his misunderstanding of doctor's instructions during discharge (Writer Thoughts). When one looks at the patient and his wife's perspective, it is rather exasperating when one fails to comprehend a healthcare professional's directions on account of language barriers and lack of knowledge of medical terminology.

Risk Management Perspective- Despite personal follow-up not being necessary in 24 hours after discharge in most cases, hospitals must consider special patient follow-up in cases where local or regional anesthesia has been administered. This follow-up action would enable monitoring of patient adherence to postoperative instructions, for avoiding unintentional injury, as was the case here. Follow-up will also help alert healthcare professionals to unforeseen postsurgical neurological symptoms, which can range from trivial neuropathies to acute complications (Kurreck and Twersky, 2012). The focus of follow-up must be early indicators of potential infection, particularly after continual infusions using indwelling catheters. Use of local or regional anesthesia as well, is a key instrument in ambulatory anesthesia, aiding early patient discharge with effective pain control. However, it is associated with a certain amount of risk, and is not advisable for all scenarios and patients. In the case in question, saddle block might have been an erroneous choice, considering the patient's communication difficulty and lack of health literacy, together with lack of prompt follow-up. Proper procedures and policies will help facilities ensure patient safety. The hospital where this incident occurred ought to consider implementing policies that incorporate the aforementioned aspects (Kurreck and Twersky, 2012).

Legal Defense for Patient/Family- The patient and his family members can adopt the defense of language barrier, which resulted in his misunderstanding (Writer Thoughts).

Legal Defense for Doctor/Nurses/Hospital- The hospital can assert that it provided adequate care during the surgical process. The patient chose not to follow-up for a month after discharge, and hence, the hospital cannot be held responsible for his injuries (Writer Thoughts).

Product Liability- This case is not linked to any product liability (Writer Thoughts).

Case 3

Background- Bobby Jones, a toddler aged 2 years, diagnosed with 'croup' was admitted to a pediatric ward. The boy's crib was situated close to the nurses' station, in an in-patient room. On the day following his hospitalization, Bobby's mother,…