Articles Posted in Hospital Care

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A Pittsburgh jury awarded the estate of 24 year old Michael Rettger $2.5 million for wrongful death damages, but refused to award any money to his brothers for survival damages after stating on the jury form that “no amount of money will adequately punish” the hospital for Mr. Rettger’s death. The case began when Mr. Rettger was admitted to the University of Pittsburgh Medical Center at Shadyside for a large, swelling mass in his head that was found after he complained of vomiting and headaches. Three days into his hospital stay, Mr. Rettger showed signs of a brain rupture, which his attorneys argued was ignored by the night nursing staff and/or the doctor in charge of his care.

The medical records showed that the nurse on duty noted that Mr. Rettger had a dilated pupil, which is a warning of impending brain rupture, and then called the neurosurgeon in charge of Mr. Rettger’s care. The testimony of the nurse and the neurosurgeon differed as to what occurred during the telephone call, with the nurse testifying that she told the doctor about the dilation and the doctor testifying that he was only told that Mr. Rettger’s other eye was sluggish. The nurse aruged that she followed the doctor’s instructions and the doctor argued that he would have come to the hospital immediately if the nurse had told him about the dilated pupil.

Mr. Rettger’s attorneys argued that the nurse erred in not reporting the condition to her supervisors when the doctor did not do anything in response to her call and that the hospital’s policy regarding the chain of command for nurses tending to neurosurgical patients was flawed. In addition, Mr. Rettger’s attorneys presented evidence that if Mr. Rettger had survived, he would have earned between $4-$15 million in his lifetime. The jury concluded that they believed the hospital’s “policies, culture and lack of competent supervision resulted in the death of Michael Rettger,” but awarded no survival damages to his brothers because “no amount amoung of damages” would adequately punish the hospital. Although the jury awarded $2.5 million for wrongful death damages, Mr. Rettger’s attorneys are appealing the jury’s decision as against the weight of the evidence and the legal instructions it was given prior to deliberation.

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I recently filed a Medical Malpractice Complaint against Beebe Hospital on behalf of a woman who was declared dead, left on a guerney waiting to be taken to the morgue and then noted by a nurse (almost an hour later) to be breathing. In this case, Judith Johnson initially went to the hospital for severe indigestion and pains in her chest. In fact, she was suffering from a heart attack. During her evaluation in the emergency room, Mrs. Johnson became unresponsive and after attempts to resuscitate her, she was declared dead. Mrs. Johnson’s body was then pushed against a wall until someone could take her to the morgue. However, almost an hour later, someone noticed that Mrs. Johnson, who still had a a breathing tube down her throat, was alive.

Although Mrs. Johnson survived the incident, she suffered brain damage that has resulted in memory loss, speech problems, seizures and personality changes. In addition to malpractice claims, Mrs. Johnson has also filed a claim for the Hospital’s violation of the Emergency Medical and Active Labor Act (“EMTALA”), alleging that she was not provided the same medical screening examination as other patients with similar medical conditions and/or was not appropriately stabilized.

You can read more about this case at: http://www.delawareonline.com/article/20081007/NEWS01/810070365 or http://www.foxnews.com/printer_friendly_story/0,3566,433830,00.html

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Delaware has become the third state in the nation that will not bill patients or their insurance companies for certain medical errors. Delaware hospitals identified 9 serious mistakes for which they will no longer bill:

(1) performing surgery on the wrong body part;

(2) performing surgery on the wrong patient;

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A new study published in The Journal of the American Medical Association reveals that the likelihood of patient survival after cardiac arrest (when the heart stops) in a hospital is significantly impacted by the time of day the attack occurs. This study follows earlier studies that demonstrated that patients fare worse during weekend care than they do during care received during the workweek for the same health problems.

In the recently-published study, almost 87,000 patients who suffered from cardiac arrest were studied at 507 hospitals during 7 years. Typically, when a patient’s heart stops, a team of medical professionals is called urgently to the patient’s bedside to begin rendering care from a “crash cart” that contains equipment such as a defibrillator and various drugs. As a practical matter, patients who suffer from a cardiac arrest are usually very sick and even at the best of times the rate of survival is fairly low (among the studied patients, approximately 20% of those who suffered a cardiac arrest during the day shift survived to the point of hospital discharge), but something about the night shift seems to make the chances of survival even worse. In the study, only 15% of those patients who suffered a cardiac arrest during the 11 p.m. – 7 a.m. shift survived long enough to be discharged from the hospital.

This study would suggest that the level of patient care received a night is subpar – either because the night shift workers are too tired to react as efficiently as the day shift workers or because there is less staff during the night hours such that they can’t check patients as often and react to problems as quickly or because the experience and skill level of night shift workers is lower than that of day shift workers. Whatever the explanation, it is reasonable to conclude that differences in care are not limited to cardiac arrest situations.

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Evidence showed that poor nursing care at Pennsylvania Hospital of the University of Pennsylvania Health System, including failure to contact a physician as ordered when the patient’s blood pressure dropped below 100 and the absence of documented nursing care for a 16.5 hour period after surgery, resulted in the death of a 55 year old woman following a routine hernia operation. At trial, medical records presented to the jury showed that after surgery, a resident examined the patient and noted in her chart that nurses should call a physician if the patient’s blood pressure dropped below 100. The same records showed that later the same day, at 5:15 p.m., a nurse recorded a blood pressure of 90/60, but did not call a doctor. This was the last nursing note written in the chart for the patient until 9:45 the next morning, reflecting a gap in documented care of 16 and 1/2 hours. The 9:45 a.m. chart noted that the patient was “extremely sedated, requiring painful stimuli for arousal and with a blood pressure of 90/58.”

Following the 9:45 a.m. note, the patient’s morphine pump was stopped and she was transferred to the intensive care unit, where she died two and a half days later. Attorneys for the woman’s family argued that the nurses violated the standard of care by not calling for a doctor when the patient’s blood pressure dropped below 100. Although attorneys for the hospital disputed that the nurses’ care was negligent, a nursing supervisor employed by the hospital testified that a doctor should have been called when the patient’s blood pressure dropped below 100.

In addition to the allegations that the nurses were negligent for failing to call for a doctor, the plaintiff’s attorneys argued that the patient was over-medicated with morphine. Evidence presented at trial showed that people with compromised livers, which this patient had because of a chronic alcoholism condition, process morphine 50% slower than patients with a healthy liver. Attorneys for the hospital essentially argued that the patient was caused by her alcoholism and related medical problems such as liver disease and high blood pressure.

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The Estate of 77 year old man was awarded $1.7 million by a Philadelphia jury after he slowly suffocated on Ventilator with a mucus plug that went untreated. Simple proper suctioning by his nurses would have prevented his death. Temple University Hospital was found negligent through the failure of its nurses to properly care for the elderly man on a ventilator in the Intensive Care Unit, who was suffering from angioedema (a type of allergic reaction). The patient, who was conscious and communicated with his family and staff by writing notes, had twice given notes to his daughter telling her that he was having difficulty breathing. This information was passsed onto the nurses, who failed to provide breathing medication of Albuterol, which was ordered, and failed to provide needed suctioning of the patient. The verdict, which was unanimous, also found that the physicians caring for the patient were not negligent and attributed full responsibility to the Temple University Hospital.

Testimony included details of the two notes written to the patient’s daughter and how the information and concern about breathing was communicated to the hospital nursing staff. Later that evening, the patient was sedated and restrained, making him unable to communicate further with the nursing staff. There were admissions by the physicians that the failure to have given the breathing medication Albuterol would have been below the standard of care. The mucuc plug that formed in the breathing tube was determined to be the cause of death. Apparently, the jury interpreted all the failures as nursing staff responsibilities that were not properly fulfilled. Testimony was also presented describing how the elderly man slowly suffocated over a period of several hours, until he finally arrested and died.

Despite this verdict, defendants are planning to appeal the decision and it will likely be some time until the family sees any money. This case represents an unusual situation when an elderly individual is fully compensated for his pain and suffering resulting in his death. It is also an unusual case in that the doctors were all found not negligent, but the nursing staff and hospital were found responsible. One reason why the verdict was so high was the quality of the plaintiff, who was described as a World War II hero and three time cancer survivor, who cared for his sick wife, who was on dialysis, and did the housework and cared for his grandchildren. There were no offers to settle the case before trial.