In a recent appeal of a 2010 case, the importance of a cardiac nurses duty to report any changes in a cardiac patients care immediately to the physician or physicians was underscored.
Around 4:15 a.m., a 50-year-old male patient came into the hospitals ED complaining of chest pains and shortness of breath. He was admitted to the hospital around noon that same day in stable condition from the ED. The patients differential diagnosis was acute coronary syndrome, congestive heart failure, pneumonia and hypoxia.
During the day of the admission to the hospital, the patient was examined by an internist and a pulmonologist. The internist believed the patient was suffering from pneumonia despite some type of cardiac component. The pulmonologist disagreed, detecting a murmur in the patients mitral valve, which was causing cardiac decompensation. The pulmonologist examined the patient at about 5 p.m., described him as a really sick guy and expected the patients care would be handled by a cardiologist.
The patients attending physician, who was a cardiologist, saw him at 9 p.m. At that time, the patient was receiving oxygen and the attending ordered Lasix to help reduce the fluid in his lungs. The attending also detected mitral-valve regurgitation and made arrangements for his partner to perform a transesophageal echocardiogram the next morning. The attending left the hospital, and his on-call physician was to cover the care of the patient.
While under the care of a cardiac care RN on the unit, the patients condition deteriorated. Urine output was well below what was expected, and his oxygen saturation was consistently below the minimum level of 90%. The nurse changed the patients oxygen nasal cannula to a mask hoping the oxygen concentration would be increased. The nurse consulted with the charge nurse and the respiratory therapist about the patients condition but did not contact any physician about his status until the next morning when the physician who was to perform the TEE contacted the nurse.
When the pulmonologist examined the patient the next morning, he found the patients condition was significantly worse than when he had seen him the day before. The patient was admitted to the ICU. A consultation with a cardiothoracic surgeon was done, and the patient was intubated.
The TEE indicated the patient had suffered a papillary muscle rupture that required surgery. An intra-aortic balloon pump was inserted before surgery, the mitral valve was repaired, but the patient ultimately died from complications and infections because of his condition at the time of surgery.
The patients wife filed a wrongful death action against the hospital, alleging the hospital and the attending physician involved in his care negligently caused his death. The jury found the hospital was 60% responsible for the patients death because of the nurses negligence and awarded damages totaling $600,000.
The hospital appealed the decision of the trial court, and the appellate court upheld the decision of the lower court. In upholding the lower courts decision, the appellate court ruled the nurses failure to contact the appropriate physician or physicians in a timely manner resulted in the delayed treatment of the patient.
In examining the nurses conduct, the appeals court reviewed the testimony of the plaintiffs nurse expert who was a cardiac nurse. The expert testified the nurse caring for the patient did not meet the standard of care of a cardiac nurse by failing to report the patient had been placed on a nonbreathing device without improvement; failing to report his oxygen levels were consistently below the minimum level despite his receiving the maximum possible of supplemental oxygen; and failing to report the patients poor response to Lasix, which was evident two hours after it was administered.