Did defendants goof in transferring pt. from ICU?
CASE FACTS: On June 1, 1995, Jesse Johnson suffered cardiopulmonary arrest. He was transported to Loyola University Medical Center where he was admitted to the Cardiac Care Unit (CCU) under the care of Dr. Diane Wallis, a board-certified cardiologist and critical-care specialist. Tests revealed evidence of renal compromise, but no evidence that Johnson had suffered a myocardial infarction. Johnson was removed from the ventilator on June 2, 1995. That same day, Dr. Wallis scheduled a cardiac catheterization for Monday June 5. Johnson said he would rather die than be on dialysis. An angiogram was not done before Johnson was transferred to the medical floor on June 4. The reason given was it was thought best that Johnson be stabilized before addressing his renal condition. On June 4, 1995, Dr. Wallis ordered Johnson's admission to a general medical floor (without continuous telemetry or oxygen monitoring). Dr. Richard Carroll, a board-certified cardiologist, became the attending physician. Further, Johnson's oxygen saturation had been monitored and did not waver. Dr. Wallis' plan at the time of the transfer was to have a renal consultant talk to Johnson to reassure him that the fear behind his failure to give consent to anything which might lead to his being on dialysis treatment was exaggerated. Dr. Carroll saw Johnson on the morning of June 5, 1995. He ordered a dobutamine stress test to evaluate Johnson's cardiac status. The stress test would allow a determination as to whether an angiogram was necessary. That night, Johnson suffered another cardiopulmonary arrest. There was a question as to exactly what happened. Two staff physicians stated that Johnson was found unresponsive in his chair, with a heart rate of less than 30. However, Sandra Walshon, Johnson's nurse for the night maintained that at 9 p.m., Johnson called her into his room and complained of shortness of breath. This was documented in hospital records. After Johnson was stabilized, an emergent catheterization and angiogram were performed. A neurology assessment showed that Johnson suffered prolonged oxygen deprivation and irreversible brain damage, never to regained consciousness. He died. His wife individually, and as Administratrix of his estate, brought suit for survival and wrongful death against the hospital, Dr. Carroll and Dr. Wallis. A jury returned a verdict for her for $1.4 Million against all defendants except Dr. Wallis. The trial judge entered Judgement (for the defendants) Notwithstanding the verdict (JNOV). The Administratrix appealed.
COURT'S OPINION: The Appellate Court of Illinois reversed the judgment of the trial court, which entered JNOV for the defendants, and ordered that the trial court enter judgment for the Administratrix on the original .jury verdict fur the plaintiff (against all defendants except Dr. Wallis). The court held, inter alia, that "the only issue presented to the jury was whether the defendants were negligent when they" failed to maintain Jesse Johnson in a Cardiac Care Unit or telemetry unit with continuous EKG and 02 Sat. Monitoring." The court found that there was sufficient evidence for the jury to find for the Administratrix and that the trial court erred in entering JNOV.
LEGAL COMMENTARY: The court simplified the issues in the case by recognizing the fact that the only question presented to the jury was whether the defendants were negligent when they tailed to adequately monitor the patient. That, in fact, was exactly the crux of the plaintiff's expert witness' testimony, to wit, whether the defendants failed to adequately monitor the patient and whether the failure was the proximate cause of the patient's injury and death. There is little question that had the patient been in the CCU or ICU when he suffered the second episode, he would have been continuously monitored by the state of the art telemetry systems designed to immediately alert staff that something was wrong. Consequently, there is little question that nurses and all other staff, including physicians and other health care providers would have immediately attended to the patient, thus either preventing the occurrence or immediately responding to the patient's condition so that even under the worst possible scenario, wherein the patient was deprived of oxygen, it might not have been for so long a period of time so as to ensure that he had been without oxygen for too long, thus, sealing his fate as being brain dead and doomed. There is absolutely no doubt that had this patient been in the CCU or ICU, he would, at the very least, have had a chance of survival. To those of us who have worked in the CCU or ICU of a modern hospital, the difference in telemetric patient monitoring as well as nursing care compared to a medical floor is like the difference between night and day. If you have any doubt, just observe the difference in the quality of monitoring and care your loved one receives when in a CCU or ICU, and is later transferred to a medical floor.
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 tale lay, 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 Law'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 all attorney and lecturer, have won him recognition ill Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, Who's Who in America and Who's Who in the World.
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|Title Annotation:||Hospital Law Case of the Month|
|Author:||Tammelleo, A. David|
|Publication:||Hospital Law's Regan Report|
|Date:||Jun 1, 2008|
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