Did failure to chart history of TB contribute to death? (Nursing Law Case on Point).

CASE ON POINT: Sullins v. Univ. Hospitals of Cleveland, 2003 WL 195076 N.E.2d -OH

ISSUE: In this Ohio case, a patient who had been a healthcare worker, who was exposed to Tuberculosis (TB), was admitted to a hospital with complaints of arthritis, stomach problems, and ulcers. A history taken did not note 17 other diseases, including tuberculosis. The patient was misdiagnosed. Eventually, she was diagnosed as having tuberculosis. By the time the a correct diagnosis was made, the patient had hydrocephalus. Who was responsible? Was it the treating physician? Was it the nurses who failed to chart the patient's history? Was it the physicians who neglected to run diagnostic tests that would have disclosed TB? These are just some of the issues, with which the courts were confronted in this case.

CASE FACTS: Loretta Sullins was hospitalized at University Hospital of Cleveland (UH) by her primary physician Dr. Van Warren for treatment of pneumonia from September 7, 1998, to September 13, 1998. On September 18, 1998, she returned to Dr. Warren's office complaining of severe pain from chronic arthritis in her hips and knees. The hospital's admitting history and a history provided by Dr. Warren did not include the fact that the patient had previously come into contact with pulmonary TB as a supervisor at Harbor Light, a halfway house in Cleveland, as well as the fact that she was prone to test positive for the condition. Upon admission, she did not exhibit any signs of an active TB infection. The Patient History taken at each admission noted only a history of arthritis, stomach problems, and ulcers, but did not note any history of 17 other conditions/diseases, including diabetes, TB, and kidney problems. Dr. Warren supervised the patient's care and ordered medication to treat her arthritis. On September 23, 1998, he requested materials for a tuberculin PPD (PPD) test to determine whether the patient had ever been exposed to TB. Nurses' notes and the patient's family indicated that she was intermittently disoriented. She also complained of a headache (that seemed to have resolved itself) as well as of a pain radiating into her lower back. On September 27, 1998, Nurse Betsy Sykora (nka Betsy Kirschner) noted that the tests had not been performed. She asked the patient whether she recalled having been given them. The patient replied "no." The patient indicated that she always tested positive on a PPD test and that chest x-rays had been needed in the past to determine the activity status of the dormant TB to which she had been exposed during employment. Nurse Sykora wrote a notation on the patient's medical chart that the tests had not been done and noted the patient's reactor-status to a PPD test. Dr. Moscowitz, covering for Dr. Warren, requested a consultation, known as an "ID" consult from UH's ID Department He requested an evaluation of possible drug treatment for "septic arthritis." Dr. Woolley, an infectious disease fellow in training at UH, answered the call for the ID consultation. He recommended the use of broad, non-IV, non-TB-treating antibiotics. Dr. Woolley claimed that someone from the UH rheumatology department informed him that the consultation was not necessary. Dr. Warren maintained that he never terminated the request. No further ID consultation was either initiated by Dr. Warren or pursued by Drs. Woolley or Lederman. On October 5, 1998, a spinal tap revealed elevated protein and lymphocyte levels in the patients' cerebrospinal fluid which indicated tuberculosis meningitis. TB therapy was initiated. The patient developed hydrocephalus, or "water on the brain." The patient's son agreed to terminate his mother's life support. She died. An autopsy revealed that the cause of death included tuberculous meningitis, progressive hydrocephalus, rheumatoid arthritis, and a subarachnoid bleed caused by a shunt that ICU physicians had placed in the patient's skull. The patient's son brought suit against UH, Dr. Warren and others. Dr. Warren settled. The case proceeded to trial against UH based on the alleged negligence of UH's nursing staff and Dr. Woolley. The Court of Common Pleas of Ohio granted UH's motion for a directed verdict. Judgment entered on a jury verdict. The plaintiff appealed

COURT'S OPINION: The Court of Appeal of Ohio affirmed the judgment of the lower court.

LEGAL COMMENTARY: One judge concurred in part and dissented in part. The dissenting judge noted that upon admission, nurses involved noted only the history of arthritis and stomach problems and showed no history of 17 other conditions including TB. The dissenting judge stressed that Nurse Betsy Sykora noted that the PPD test previously ordered by Dr. Warren had not been performed and wrote on the patient's chart that the tests had not been done and the patient's asserted reactor-status to PPD tests. However, despite this, Nurse Sykora took no action required by the ID-Control protocols that mandate advising the ID department when a potential TB-infection patient enters the hospital. The dissenting judge noted that although a nurse is prohibited from engaging in the practice of medicine, a nurse employed by a hospital is under a duty to keep physicians informed.

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Providence, R.I., firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, and Who's Who in America.