Medical malpractice cases are among the most challenging cases to try. In the United States, medical malpractice is typically defined as failure to provide the degree of care another clinician in the same position with the same credentials would have performed, resulting in injury to the patient. Medical malpractice cases require deep insight related to technical skills and medical issues and an understanding of the standard of care for that medical specialty. A simple mistake or medical error does not constitute medical malpractice. To effectively argue a case, a medical malpractice attorney (plaintiff) must establish and prove the four elements of malpractice, which include:
Duty to the patient: Was the doctor or medical professional responsible for the patient’s care? This element of malpractice establishes the relationship between the patient and the medical provider as it relates to the injury.
Negligence or breach of duty: Was the doctor or medical professional negligent in caring for this patient? This element of malpractice considers the standard of care. The standard of care is defined in terms of what care a reasonable provider in the same community with similar training or experience would have provided for the patient.
Causation: Did the act or omission of the act cause a poor outcome for the patient? This element of malpractice is established by proving the medical professional’s action or inaction directly resulted in an adverse outcome.
Damages: This refers to compensation for loss or injury, medical bills, and punitive damages incurred to the patient due to the injury sustained in the medical malpractice claim.
Medical malpractice cases are usually never straightforward. They are often complicated by the substantial amount of resources required, the complexity of the evidence, the difficulty in explaining technical and medical concepts in a digestible manner to lay people, and the inherent bias towards healthcare providers.
Despite these medical-legal intricacies, a legal nurse consultant is perfectly positioned to be the bridge point in navigating the complexities of medical malpractice cases by:
Providing medical expertise: LNCs understand medical terminology, procedures, and standards of care, allowing them to analyze medical records in a timely and consistent manner.
Case analysis: LNCs can interpret complex medical information and distill it into “need-to-know” information, identify potential areas of negligence deviations in the standard of care, and effectively communicate medical issues within a medical-legal context.
Case strategy support: LNCs don’t just regurgitate information that a layperson can otherwise find in the medical record and research on Google. LNCs can simplify complex information, maximize understanding of medical issues, translate intricate medical details, and identify potential “red flags” the defense may find that are specific to the client.
Case Study:
A 69-year-old man was admitted to the emergency department for shortness of breath after missing his last three hemodialysis appointments.
[Hemodialysis is a treatment that filters water and water from your blood mechanically due to kidney failure. Dialysis usually occurs several times a week, on a consistent schedule, and lasts about four to six hours. If dialysis is missed, toxins, fluids, and electrolytes build up in the blood and body. This can be fatal depending on the level of kidney function and overall medical condition].
At 1:00 PM, in triage, Mr. B’s initial vital signs were:
| Blood Pressure | 178/95 (normal is 120/80) |
| Heart Rate | 90 (normal is 50-100) |
| Oxygen Saturation | 79% (normal is 95-100% on room air) |
| Temperature | 98.4 |
[Mr. B has critically low oxygen saturation levels on room air].
At 1:05 PM, Mr. X was assigned an emergency severity index level (ESI) 2 and transported to a high acuity level treatment room, where Nurse T assumed care. Due to Mr. B’s low oxygenation levels, Nurse T placed Mr. B on a non-rebreather mask at 10 liters of oxygen and connected him to the cardiac monitor.
[A non-rebreather mask delivers high-flow oxygen concentrations to maintain optimal oxygen levels]. Mr. B’s oxygenation rose to 93%.
At 1:10 PM, Doctor K, an emergency room physician, evaluated Mr. B, and the physical examination revealed diffuse swelling to bilateral lower extremities, shortness of breath, crackles throughout the bilateral lung fields, and anxiety. Dr. K ordered lab work, an EKG, chest X-rays, and breathing treatments.
At 1:45 PM, a respiratory therapist administered breathing treatments.
At 2:00 PM, Mr. B’s lab and radiology reports were as follows:
| Labs | Radiology |
| Sodium: 130 L (137-145) | Chest X-ray: Bilateral dense consolidation. The heart is enlarged. Pneumonia. Bilateral pleural effusions. |
| Potassium: 11.5 H (3.5-5.1) | EKG: Tachycardiac with peaked T-waves, no STEMI. |
| Chloride: 96 L (98-107) | |
| Glucose: 155 H (74-108) | |
| Creatinine: 14.50 H (0.50-1.10) | |
| Anion Gap: 30 H (14-24) |
At 2:03 PM, a laboratory technician called the nurse’s station and requested to speak to Mr. B’s nurse to report a critical lab value. The nurse was unable to take the call at that time. The laboratory technician called again at 2:15 PM and 2:30 PM. The nurse was unable to take the call at that time.
At 2:45 PM, the laboratory technician called the charge nurse to report the critical lab value. The charge nurse received the critical lab value and reported a critically high potassium level directly to Dr. K.
The emergency room physician placed the following orders to be administered STAT:
- Calcium gluconate
- Sodium bicarbonate
- Insulin
- Albuterol
- Kayexalate
[Mr. B has hyperkalemia (high potassium levels) and, if left untreated, can cause cardiac arrhythmias or arrest. Hyperkalemia is managed based on the potassium level, degree of symptoms, and cause of the hyperkalemia. The medications Dr. K ordered help protect the heart and stabilize the cardiac response by lowering the potassium levels until dialysis can be achieved].
At 3:15 PM, the emergency room nurse assistant reports to Nurse T a change in Mr. B’s vital signs:
| Blood Pressure | 100/70 (normal is 120/80) |
| Heart Rate | 48 (normal is 50-100) |
| Oxygen Saturation | 90% (normal is 95-100% on room air) |
| Temperature | 98.4 |
Nurse T acknowledged the vital signs verbally.
At 3:45 PM, Mr. B’s heart rate dropped to 24 beats per minute, and another nurse called code blue.
The code blue was unsuccessful, and Mr. B unfortunately passed away.
Our experienced nurses at Bridge Point Legal Nurse Consulting provided crucial insight into the deviations in the standard of care. Including:
Failure to communicate:
Timely and accurate communication of critical lab findings is crucial for patient safety and well-being. Critical lab results indicate conditions that require immediate attention and intervention. The charge nurse failed to communicate with the primary nurse that Mr. B has a potassium level of 11.5. She received the critical lab value and reported it to Dr. K. Dr. K then placed orders without informing the primary nurse. This failure in communication and the breakdown of communication norms caused a delay in treatment, which resulted in the death of the patient.
The best practice would be for the charge nurse to directly inform the primary nurse that she took the critical lab value from the laboratory technician and reported it to the doctor. This should have prompted the primary nurse to follow up on the doctor’s orders.
There was a delay in treatment from 2:03 PM (initial lab value) to 3:45 PM (time of death).
Failure to reassess:
The primary nurse failed to reassess the patient in a timely manner. The nurse’s assistant informed the primary nurse that Mr. B’s vital signs had changed at 3:15 PM. A heart rate of 48 beats per minute requires prompt attention as this is considered bradycardia and was a marked change from his 1:00 PM vitals signs. Patient reassessment is a critical component of nursing practice to monitor a patient’s condition, identify changes, and ensure appropriate care. An immediate assessment and chart review were required to identify cardiac issues that required intervention and prevent further deterioration.
Mr. B had a critically high potassium level and was showing signs of cardiac changes, as evidenced by the EKG revealing peaked T waves. Delay of treatment, assessment and reassessment points to a breach of duty and causation that caused Mr. B’s death.
Our registered nurses can help medical malpractice attorneys comprehensively evaluate cases involving alleged deviations from the standard of care. Out nurses have an intimate understanding of the intricacies that can help simplify and strengthen your case.
References
Bono MJ, Wermuth HR, Hipskind JE. Medical Malpractice. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470573/
Simon LV, Hashmi MF, Farrell MW. Hyperkalemia. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470284/
