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Does your Code Blue team have immunity? (Nursing Law Case of the Month).

CASE ON POINT: Tucker v. County of Los Angeles, 2001 WL 1215868 P.2d - CA

ISSUE: Does your Code Blue team have immunity from liability for negligence? That was the issue with which the courts were confronted in this case in which a severely burned child who was a patient at a County Hospital went into cardiac arrest. There was a question as to whether or not hospital nurses and/or physicians were negligent in causing the patient's endotracheal tube (ET) to become dislodged and pumping air into the patient's stomach rather than his lungs. Would there be a difference if the alleged negligence appeared before the Code Blue was called? Would the outcome have been any different had the negligence occurred after the code blue was called?

CASE FACTS: Two-year-old Kyan Tucker was severely injured in a car fire. He was taken to Martin Luther King Hospital, and later transferred to the Los Angeles County Burn Center at the Los Angeles County/U.S.C. Medical Center. On arrival at the hospital on October 14, 1992, the child was in "critical condition" from an inhalation injury and third degree burns. To maintain the patient's airway, an ET tube was sutured into the patient's mouth, and he was placed on a ventilator. The patient was medicated so that he would not involuntarily dislodge the ET tube. Medical Center personnel regularly checked the position of the tube both visually and by daily x-rays. Two or three weeks following the patient's admission, he suffered increasing episodes of premature ventricular contractions (PVCs) and bradycardia (a slow heart rate). During the early morning hours of October 31, the patient's nurses heard abnormal lung sounds and dysrhythmias. The patient's physicians were alerted. At approximately 11:00am, the patient suffered a bradycardia episode that at first appeared similar to previous episodes. When nurses checked the ET tube, it appeared to be in place. Two physicians (both residents and both members of the Medical Center's Emergency Response Team) examined the patient, checked the ET tube, and administered cardiac medication to restore the patient's heart rate to normal. The patient did not improve. The physicians initiated a "Code Blue." Cardiac chest compressions were begun. Cardio pulmonary resuscitation followed. Dr. William Dougherty, the associate director of the hospital's Burn Unit, concluded that the ET tube had become dislodged so that air was going into the patient's stomach instead of his lungs. Cardiac compressions, defibrination, and more drugs brought the patient's heart rate back to normal. However, the patient's brain was essentially nonfunctional, leaving him paralyzed and severely retarded and in a persistent vegetative state, in which he remains. The patient, acting through others, brought suit against the County for damages alleging that his injuries were caused by the negligence of the Medical Center's personnel. The case was tried before a jury. At trial, the plaintiff's experts claimed that the patient's ET tube was displaced due to negligence while the nurses were changing the patient's burn dressings. The jury returned a verdict in favor of the patient. The trial court entered a judgment for a lump sum of approximately $2 million plus annual payments for additional damages to be made over a 20-year period. The County appealed. The plaintiff cross appealed.

COURT'S OPINION: The Court of Appeals of California reversed the judgment of the lower court and remanded the case for a new trial. The court held, inter alia, that the trial judge committed prejudicial error against the County in refusing to allow the County's request for an instruction that if the jury found that the physicians, nurses, and other employees of the County Hospital were members of a "rescue team," they were entitled to immunity under state law.

LEGAL COMMENTARY: Four physicians and two nurses testified that those who responded to the Code and attempted to resuscitate the patient had been properly trained in cardio pulmonary resuscitation. All had responded to Code announcements in the past. Their position was that if the alleged negligence occurred before the Code was called, the immunity statute did not apply. Conversely, if the alleged negligence accrued after the Code was called, the immunity provision of California Statutory law was triggered. Accordingly, the issue was timing, not identity. The court found that there was ample evidence that the injury to the patient occurred after the Code was called. For these reasons the court concluded that the jury should have been given the opportunity to decide these issues.

Meet the Editor & Publisher: 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 lind 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 Who in American Law.
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Article Details
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Author:Tammelleo, A. David
Publication:Nursing Law's Regan Report
Article Type:Brief Article
Geographic Code:1U9CA
Date:Oct 1, 2001
Words:861
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