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Nurses failed to `advocate' for their patient. (Nursing Law Case of the Month).

CASE ON POINT: Rowe v. Sisters of Pallottine Missionary Society, 2001 WL 1585453 S.E.2d -WV

ISSUE: Ordinarily nurses are not in a position to question physicians' orders. However, there are exceptions! There are some cases in which not only do nurses have a "right" to question physicians' orders, but they have an absolute "duty" to immediately report to their superiors whenever they are convinced that there has been a failure to make an appropriate diagnosis or render appropriate treatment. The failure of nurses to act as "patient's advocates" may result in liability not only for nurses' employers (as was the situation in this case) but could result in liability for individual nurses.

CASE FACTS: On the afternoon of Sunday, September 6, 1987, 17-year-old Brian Rowe lost control of his motorcycle. The motorcycle fell on Rowe's left leg, injuring his knee. He was transported by ambulance to the emergency room of St. Mary's Hospital, which was owned and operated by the Sisters of the Pallottine Missionary Society. The patient arrived at the hospital's emergency room at approximately 4:05 pm. His left leg was examined by emergency room nurses. Over the course of the next 2 1/2 hours, the nurses made extensive notes in the patient's chart. The notes indicated that the patient complained of severe pain in his left knee and numbness in his left foot. Nurses were unable to find a pulse in the patient's left leg and foot after repeated attempts by both palpitation as well as with the assistance of a portable Doppler ultrasound device. The patient was also examined by a hospital emergency room physician Dr. Willard Daniels. Dr. Daniels noted tenderness and swelling in the patient's left knee and lower leg. However, he had difficulty finding -- but claimed he did find -- a pulse in the patient's lower left leg and foot. One nurse told Dr. Daniels that she was unable to detect a pulse in the patient's foot and asked Dr. Daniels why. Dr. Daniels replied: "I don't know[,]." While x-rays showed fragments of bone in the patient's knee joint, Dr. Daniels charted that the patient had a "severe sprain, [left] knee." The patient was discharged at 6:20pm to be taken home by his mother with instructions to elevate his left leg and apply ice to the knee. The patient was told that nurses could not find a pulse in his lower leg but that this condition was probably caused by swelling, and that a pulse would return when the swelling went down.

The patient was instructed to make an appointment with an orthopedist several days later, and told to return to the hospital's emergency room if his pain continued or became worse. That night the patient's knee and leg continued to swell, and the pain intensified. The patient was seen the next morning at the emergency room of another hospital. An examination revealed a dislocated knee and lacerated popliteal artery. The treating physician contemplated amputation. However, after extensive surgery, the patient's leg was saved. The patient was hospitalized for 35 days and sustained significant impairment in the use of his leg. The patient brought suit against Dr. Daniels and the hospital. Dr. Daniels settled the suit against him for $275,000.00. The suit against the hospital proceeded to trial. The plaintiff presented evidence that hospital policy and the guiding standard of care for all emergency room nurses was that when a nurse "believe[d] that appropriate care [was] not being administered to a patient by a physician," the nurse was to report the situation to a supervisor who would discuss it with the physician. If that did not alleviate the problem, the matter was to be referred "up the chain of command." The patient sued the hospital for the negligence of the nurses. After trial, a jury returned a verdict for the patient in excess of $880,000. The hospital appealed.

COURT'S OPINION: The Supreme Court of Appeals of West Virginia affirmed the judgment of the lower court entered on the jury verdict. The court found, inter alia, that the nurses failed to advocate for the patient since they knew that the circulation to the patient's left leg had been compromised. In spite of that, the nurses failed to attempt to intervene on the patient's behalf.

LEGAL COMMENTARY: One nurse said she made notes "I guess basically to cover myself." All nurses involved failed to advocate for the patient. Nurses must be patients' advocates. Making notes in charts to "cover" does not suffice. This case is a classic illustration of what nurses should not do when faced with physicians who obviously have failed to properly diagnose and treat patients who are consequently in danger of serious injury or death.

A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 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 and Marquis Who's in American Law.
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Author:Tammelleo, A. David
Publication:Nursing Law's Regan Report
Article Type:Brief Article
Geographic Code:1USA
Date:Jan 1, 2002
Words:903
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