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RNs failed to follow Dr.'s orders, inform Dr. or chart failure.

BENNIE JOE POTEET HAD BEEN ARRESTED FOR DUI. When he failed to appear in court on the designated date, a warrant was issued for his arrest. He was arrested and taken to Polk County Courthouse and sent to jail where he remained overnight. At 9:40 a.m., on November 11, 2004, he was observed by other inmates collapsing to the floor and suffering a seizure. He continued to suffer seizure symptoms while being transported to the hospital by paramedics. At 10:50 a.m., upon arrival at the hospital, he was still unresponsive and "shaking all over." According to a history provided by ER staff, by paramedics, and a jailer who had accompanied Poteet to the hospital, Poteet had a long history of alcohol abuse and had gone for more than 24 hours without alcohol. Hospital records revealed that he had exhibited other medical conditions on earlier visits to the hospital. Initially, Poteet was seen by Dr. Hugh Caldwell, an emergency room physician, who had seen him on other occasions. On examination, the only type of injury, which was apparent was a tongue abrasion and/or laceration. There was no indication of any injury to his head, neck or extremities. At 10:55 a.m., Poteet experienced further seizure activity in the ER and began vomiting with clenched teeth while still in a comatose-like state. Rapid sequence intubation was performed to protect his airway after vomiting. He was given medications, including Norcuron, Versed, and Ativan, which rendered him motionless. He was moved to a cardiac area in the ER. He was placed in soft limb restraints and a CT of the head, without contrast, was ordered by Dr. Caldwell. The CT was interpreted by Radiologist, Dr. C.A. Kyle, III, as "negative non-contrast CT of the brain." The hospital had an MRI unit at the time. Although the MRI is more sensitive at detecting acute changes in the brain, including, intracranial hemorrhage, an MRI can also detect lack of blood flow in the arteries, and possibly the formation of a clot in the vertebral artery. Additionally, the hospital had the capability to perform a diagnostic catheter angiogram, the best test for seeing blood clots in the vertebra-artery system. However, the hospital did not offer interventional radiology. The hospital did not offer interventional radiology. Transport to Erlanger Medical Center in Chattanooga was required for that procedure. Following his examination. Dr. Fall requested a neurological consult. The patient was admitted to the ICU at 1:40 p.m., at which time Dr. Fall, a hospitalist at the hospital, ordered ICU nurses to temporarily interrupt sedation medication daily at 4:00 a.m. However, this was not done, nor did the nurses report that they failed to follow Dr. Fall's order, nor did nursing notes reflect this. Ultimately, the patient had a severe stroke. However, intervention by Neurologists after the patient's transfer to hospital, saved the patient's life. He had suffered severe catastrophic consequences from the stroke, resulting his placement in a long term care facility for the remainder of his life, with locked-in syndrome! The Patient's estate filed suit against Dr. Fall and Cleveland Community Hospital. After a jury trial, the jury returned a verdict for the defendants. The patient's estate appealed.

THE COURT OFAPPEALS OF TENNESSEE AFFIRMED THE JUDGMENT OF THE TRIAL COURT, WHICH ENTERED JUDGMENT ON THE JURY VERDICT FOR THE DEFENDANTS. The court held, inter alia, that despite the plaintiff's contention to the contrary, it was compelled to find ample material evidence provided by the defendants and demonstrated in the record as well as more than a sufficient number of witnesses who testified for the defendants to sustain the jury's finding of no negligence on the part of Dr. Fall.

THERE WAS LITTLE REFERENCE TO THE FACT THAT THE ICU NURSES FAILED TO FOLLOW DOCTOR'S ORDERS TO STOP THE DESIGNATED MEDICATION EACH DAY AT 4:00 P.M. Further, there was no reference to the fact that not only did the nurses fail to disclose to the doctor who gave the order that they did not follow it, but, to compound what they had done, they failed to chart it or report the fact that they failed to follow doctors orders to anyone! Editor's Note: There is absolutely no reference as to what, if any, impact this would have had in enabling the attending physicians to better evaluate the patient's condition, which may have led to a better understanding of the patient's true condition. Can anyone say with certainty that this would have made a difference in the outcome to the patient? Can anyone say that, more likely than not, it would, or would not, have made a difference in the outcome to the patient? Most likely the answer is no! However, the fact that the nurses did not follow doctor's orders, nor did they notify the doctor that they failed to follow his orders, as well as the failure to chart the fact that (hey did not withhold the designated medication as ordered, should have been of concern! Poteet v. National Healthcare of Cleveland, Inc., E2009-01978-COA (4/19/2011)-TN
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Publication:Nursing Law's Regan Report
Date:Jun 1, 2011
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