Nurse’s patient and family education is under question in lawsuit

By | 2021-03-01T12:53:57-05:00 February 10th, 2020|4 Comments

Effective patient and family education is essential in helping the patient recover, maintain health and avoid potential risks if instructions are not followed.

In the following case — Mason v. Amed-Health Inc. — not providing adequate patient and family education resulted in serious injury and property damage.

The patient, a smoker, had myriad health problems, including PTSD, and recently was hospitalized for pneumonia and congestive heart failure. He was on numerous medications, including Narco, various antidepressants and oxygen at the time.

His physician decided rather than continue hospitalization, the patient could be released to receive hospice care at home.

The patient lived with a male friend, and a female and her two young children. Amed and its medical director, Folasade Ojo, M.D., initiated hospice care.

Ojo ordered continued oxygen and provided a “comfort kit” of medications, including morphine, hydrocodone and sleep aides to let the patient “die in peace.”

A hospice nurse visited the patient in his friend’s home and did an assessment, noting the patient was alert, oriented and able to take his medications.

The nurse specifically told the patient both verbally and in writing about the dangers of smoking while using oxygen.

In addition, warnings were placed on his bedroom wall, the oxygen canisters and the oxygen concentrator near the patient’s bed.

The patient’s friend was aware of the dangers of smoking around oxygen and asked the patient to smoke outside the house. He asked the hospice nurse if the patient should be smoking due to the oxygen and the medications he was taking.

According to the friend, the nurse essentially told him to let the patient do what he wanted since he was going to die soon.

Patient does not follow instructions

While the friend was in the shower, the patient decided to smoke a cigar. It was cold outside so the patient decided to smoke the cigar in the house.

He later stated he knew “oxygen and smoking do not mix,” but thought he had turned the oxygen off before he lit the cigar. He later acknowledged that because of the medications he was taking, he may not have done so.

A fire broke out in the house. The patient, the patient’s friend, the female friend and children were able to escape the fire, but the patient and his friend were burned, requiring treatment at a hospital and burn center.

The friend’s home was completely destroyed along with the personal property in and around the home.

The patient and the patient’s friend (and his family) sued Amed-Health and the physician, alleging negligence and gross negligence arising from the fire.

The trial court granted Amed Health and Ojo a Summary Judgment in their favor and dismissed the lawsuit.

The two plaintiffs filed an appeal.

Appellate court decision

After a careful and lengthy analysis of the law and case law governing medical negligence, the appellate court held there were material issues of fact that required a reversal of the trial court’s decision and sending the case back to the trial court for further proceedings.

Of interest in this blog is the role of the hospice nurses’ roles in patient and family education — specifically, teaching about the dangers of smoking while oxygen was in use.

The patient and his friend’s expert witness clearly testified that not enough patient teaching was done in this situation and, had it been done, the fire could have been averted.

For example, the expert testified the nurse should have been more definitive in her instructions about the dangers of smoking when oxygen was present.

Moreover, the nurse should have discussed with the patient’s physician that the patient was noncompliant concerning the smoking issue and was therefore a high-risk patient in a high-risk situation. The nurse had seen an ashtray in his room with ashes in it.

This was especially so in view of the amount and types of medications he was taking (that affected his cognitive abilities) and his history of depression.

The expert also testified the patient should have been provided with a nicotine replacement program rather than be allowed to continue to smoke when oxygen was prescribed.

The defendants’ argument that they owed no duty to the patient’s friend because there was no healthcare provider-patient relationship was flawed, the court opined. A duty existed to warn those in the home of the hazard presented by oxygen being delivered to and used in their home. A duty also existed to inform them to take reasonable measures to lessen the foreseeable risks they faced.

Final thoughts

Patient and family education is a role that cannot be overlooked or diminished. Regardless of the healthcare setting, you need to ensure that it is done and done correctly.

Assessing the patient’s learning ability as best as you can is essential, especially when, as in this case, medications may hinder this ability.

Using written patient teaching instructions are better than oral instructions. Going over the instructions with the patient and asking the patient to repeat them back to you (“teach back” method) is good practice.

Having the patient and/or the family keep a copy of the instructions also is critical.

Carefully and completely document that you provided patient and family education, including the requisite instructions, in the patient’s record. Inform the patient’s physician and document that notification in the record as well.

Remember, your overall duty in any patient care situation is to avoid an unreasonable and foreseeable risk of harm to the patient and perhaps others, as this case illustrates. Failing to avoid such a risk of harm when it exists can lead to liability.

Take these courses to learn more about patient education:

Using Teach-Back in Patient Education
(1 contact hr)
Knowing whether your patient truly understands and can act on what you have taught him or her is key to their successful self-management of health-related conditions in day-to-day life. This course provides the definition of teach-back and guidance for it into your daily care of patients and their families.

Improving Patient Education for Poor Readers
(1 contact hr)
Health literacy is not limited to the ability to read letters and numbers. It requires a complex group of reading, listening, analytical and decision-making skills, and the proficiency to apply these skills to health situations. This continuing education module provides information to help nurses ensure their patients understand vital healthcare instructions.

Health Literacy and Discharge Education: I Didn’t Understand
(1 contact hr)
How many times have you considered whether a patient truly understood or would remember how to follow through with discharge instructions or prescribed medication instructions? Join this webinar to help increase your understanding of the state of health literacy and learn how to educate more efficiently.

Learn how to expand your nursing education with the Schools Directory.

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About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.


  1. Avatar
    Gregg Christoff February 16, 2020 at 6:47 pm - Reply

    Ridiculous. We nurses work tiredness hours trying to promote good health. I can tell a patient until I am blue in the face about poor health choices. Does not mean they are going to change their behavior. According to the story, there were signs in the house about not smoking due to oxygen use. If the patient does not under this something is wrong. People make choices everyday and have to live with those consequences. It is called personal responsibility.

    • Avatar
      Sonja Trusty March 6, 2020 at 5:56 pm - Reply

      We should just have them sign a document when they are a smoker listing all the things that could go wrong if you smoke and use oxygen and that they refused a smoking patch if they indeed refuse and want to continue to smoke. It’s stupid but it has become a CYA type of society, instead of a be a grown up and take responsibility for your actions type society.

  2. Avatar
    Kim March 7, 2020 at 4:14 pm - Reply

    Are u kidding me?? The only neglect in this situation is that they did not have them sign a paper saying they were educated on this matter. At the end of the day, stupidity is not something nurses or healthcare providers can fix. This is a free country, the last time I checked. We are all accountable for our own lives.

  3. Avatar
    Linda March 10, 2020 at 4:20 pm - Reply

    Ridiculous!!!! I guess no one is responsible for their own actions… let’s blame someone else.

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