Did nurse fail to monitor post-angiogram patient?

CASE ON POINT: Lake Cumberland v. Dishman, No. 2006CA136 (Ky.App. 04/06/2007) S.W.3d -KY

CASE FACTS: Vena Dishman had a history of non-insulin dependent diabetes, chronic obstructive pulmonary disease, and colon cancer. After complaining of worsening dizzy spells for several months, on June 25, 2001, Vena, age 67, was admitted to Lake Cumberland Regional Hospital for a bilateral Carotid artery angiogram to further evaluate her condition. The angiogram was completed at 1:30 p.m. without complication. Vena was returned to her in-patient hospital room at approximately 1:45 p.m. The standard of care for a post-angiogram patient includes monitoring and observation for the onset of stroke symptoms. According to the plaintiffs, hospital employees, including Vena's assigned Nurse, Nurse Lou Ellen Ward, failed to properly monitor and observe the patient during the period following the angiogram procedure. At some point, (most likely, around 2:20 p.m. according to the patient's family, most likely, nearer to 7:10 p.m. according to hospital employees), Vena suffered a stroke. At 7:10 p.m., following a shift change, Nurse Ward went off duty, and Nurse Irene King came on duty and was assigned to Vena. Nurse King discovered Vena suffering from stroke symptoms. After being informed, Dr. Magdy ElKalliny, Vena's assigned post-procedure physician, ordered a CT scan, the results of which indicated that Vena had suffered an ischemic stroke, brought about by a blood clot in the arterial system. A "clot busting" drug known as t-PA is available to treat an ischemic stroke victim, but it must be administered within three hours of the onset of the stroke. The drug can substantially reduce the damage caused by a stroke, though it is successful in only about 30% of the patients who receive it. Regardless of what time the stroke occurred, the drug was not administered to Vena. As a result of the stroke, Vena lost her ability to walk, became mentally confused, and could not use her left leg or left side. She remained a patient at the hospital until July 18, 2001, at which time she was transferred to a nursing home. She died at the nursing home on July 27, 2003. Meanwhile, on May 31, 2002, Vena and Joe Dishman filed suit against the hospital alleging that the hospital failed to properly monitor Vena and delayed in administering t-PA to her. After Vena's death, the administrator of her estate, Scottie Dishman was substituted as a party in Vena's place. After a jury trial, the jury returned a verdict for nearly $1 million dollars. The hospital appealed.

COURTS OPINION: The Court of Appeals of Kentucky affirmed the judgment of the lower court in part, reversed it in part, and remanded the case back to the trial court.

LEGAL COMMENTARY: In reviewing a verdict, all appellate court is restricted to determining whether the trial judge erred in failing to grant a motion for a directed verdict. The reviewing court must consider all evidence favoring the prevailing party as true and is not at liberty to determine the credibility or weight that should be given to the evidence. An appellate court is required to consider the evidence in the strongest light possible in favor of the opposing party. After completion of the evidentiary review, the decision must be affirmed unless the verdict rendered is "palpably or flagrantly against the weight of the evidence so as to indicate it was reached as a result of passion or prejudice." The court rejected the hospital's contention that it was entitled to a directed verdict because regardless of when the stroke was discovered, t-PA should not have been administered to the patient in this case because the drug is contraindicated for a post-arterial incision patient. There was expert medical testimony to the effect that t-PA, as an anti-clotting drug, is contraindicated for a post-arterial incision patient because if a hemorrhage occurs at the incision site, the t-PA's anti-clotting characteristics may result in an inability to stop bleeding. However, there was also expert medical testimony to the effect that the contraindication was only applicable to non-compressible sites and that the femoral artery incision on the patient's leg was a compressible site. The court found that this expert testimony established that because the site was compressible, t-PA was not contraindicated. The court rejected the hospital's contention that the trial court erred in "permitting a loss of chance recovery without giving the jury a loss of chance instruction." Finally, the court rejected the hospital's contention that the trial court erred in refusing to give a "loss of chance" instruction. Accordingly, the court affirmed the judgment of the lower court on the issues raised by the hospital. It reversed the judgment of the lower court on the issues raised by the Dishmans and remanded the case for the entry of a judgment reinstating the medical expenses awarded by the jury.

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health cave law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island 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 Luw's Regan 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 Who in American Law, Who's Who in America and Who's Who in the World.