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Failure to follow Dr.'s orders: post-op orthopedic Pt. injured.

CASE ON POINT: Redel v. Capital Region Medical Center, 2005 WL 1084105 S.W.3d--MO

ISSUE: If you don't know how to do a procedure--don't do it! That is the lesson that should be learned from this Missouri case, in which at least one nurse was not familiar with utilizing a Continuous Passive Motion (CPM) machine. Had the nurse spoken up and made the fact known to her superiors, the patient involved in this case might not have sustained injuries and the hospital, which was subjected to suit, might not have incurred liability for damages sustained by the patient.

CASE FACTS: On October 26, 1998, Vincent Redel underwent bilateral knee replacement surgery at St. Mary's Hospital. Upon completion of the surgery, the patient's orthopedic surgeon, Dr. Timothy Galbraith, ordered that the patient receive physical therapy, including therapy through the use of a CPM machine. A CPM machine moves the knee joint through a predetermined range of motion without requiring the patient to use leg muscles to do the work. The application of the CPM machine was intended to prevent the patient's knees from becoming stiff due to lack of movement following surgery. During the five days the patient remained at the hospital after surgery, the patient made steady progress in his recovery. On October 30, he had 110 degrees of flexion in both knees and could walk with minimal assistance. The patient was discharged from St. Mary's on October 30 and transferred to Capital Region Medical Center for continued rehabilitative treatment. When the patient arrived at the hospital, he initially was able to ambulate 20 feet with minimal assistance and had almost normal ankle strength. However, the oxygen level in the patient's blood began to drop that evening, rendering the patient hypoxic. The hospital admitted him into its intensive care unit (ICU). While in the ICU, the patient was anemic and suffering from an abnormally high heart rate. The patient was also confused, disoriented and agitated, and was unable to recognize Dr. Galbraith, and was eager to get out of the ICU and go home. Beginning at 7:00 pm, on the evening of October 31, Nurse Cynthia Mote took charge of the patient. According to Dr. Galbraith's notes, the patient was to receive CPM therapy. Nurse Mote was not familiar with the administration of CPM therapy and asked for assistance from Nurse Jennifer Moyer. At some point, Nurse Mote asked the patient whether he would allow her to administer CPM therapy and he refused. According to the patient's wife, sometime in the morning, Nurse Mote explained to her that the patient had to undergo CPM therapy and had Nurse Moyer help apply the first CPM machine to one of the patient's legs. After Nurse Moyer left the room, Nurse Mote had trouble putting second CPM machine on the other leg. The patient's wife helped her. With both machines moving the patient's legs, the patient became confused and disoriented. He kept moving around, tossing, and pulling himself by the bed handles, so that they were knocked out of alignment. The machines continued to move the patient's legs. Dr. Galbraith arrived at the hospital while the patient was strapped onto the CPM machines lying sideways rather than on his back. Dr. Galbraith took the patient off the machines and stated that the patient was so confused that he could not express the degree of pain he was in. Dr. Galbraith was also disappointed that hospital personnel failed to follow his verbal orders "to watch [the] patient closely" because of his disorientation and to only place one CPM machine at a time. About two hours, after the CPM incident, physical therapist Mary Rakestraw discovered that patient had "drop loot," a condition meaning that the patient lost all dorsiflexion in both ankles so that he could no longer lift either of his feet up by the ankle. Shortly after his discharge from the hospital, the patient was fitted with special braces to hold his feet in place so that he could walk. In addition, over time, neurologists assisted him in finding pain medication to reduce the severe pain the patient experienced since his stay at the Capital Region Medical Center. The patient and his wife filed suit against the hospital based on the allegedly negligent treatment of the nurses that allegedly caused the "drop foot." After a jury trial, The plaintiffs were awarded $1 million. The hospital appealed

COURT'S OPINION: The Court of Appeals of Missouri affirmed the judgment in part and reversed it in part. The court reversed only that part of the judgment regarding the manner in which future damages were to be paid.

LEGAL COMMENTARY: The case presents a classic illustration that when a nurse is unfamiliar with equipment she should not attempt to use that equipment. The failure of a nurse to speak out when she is not familiar with particular equipment can have catastrophic consequences. Had Nurse Mote, who acknowledged that she was not familiar with the CPM machine, not gotten involved in attempting to utilize it (contrary to both doctor's orders as well as the patient's refusal to allow her utilize the machine) the injury to the patient would probably not have occurred. It is incumbent on nurses to speak up when not familiar with a procedure or equipment.

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 achievement 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.
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Title Annotation:Nursing Law Case on Point
Author:Tammelleo, A. David
Publication:Nursing Law's Regan Report
Geographic Code:1USA
Date:May 1, 2005
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