One of the basic principles of both law and nursing is that those who perform the duties of each profession are responsible and accountable for their conduct.
It is extremely difficult to attempt to shift the burden of liability of a patient injury or death to another member of the healthcare team, as many professional negligence cases show. A second basic principle of both law and nursing is that nursing care documentation is relevant when a judge or a jury is determining liability. I discussed this in my blog, "Nurse Documentation Contributes to Lawsuit Dismissal". A third basic tenet in law and nursing is the requirement stating when a patient injury or death is alleged due to professional negligence, expert witness testimony is required to help educate the judge or jury as to what the standard of care is in a particular situation. The following 2020 case, Wicks, et al. v. Antelope Valley Healthcare District includes these three principles.
Details of Mr. Wicks' Care
Mr. Wicks presented at the hospital's ED complaining of "stomach pain and a tight chest." His vital signs were taken, and the patient graded his pain level of seven out of 10. The triage nurse noted Mr. Wicks' height and weight and BMI index of 33.9, and his complaints of "neck pain, cough, sore throat, and chest congestion" prior to coming to the ED. She also noted the patient was alert, denying chest pain or shortness of breath, speaking normally, and ambulating without difficulty.
Another nurse evaluated Mr. Wicks several minutes later, after he was placed in a bed in the ED. Her notes indicated the patient was alert, cooperative, did appear to be in distress due to pain, and that he described his pain in his upper chest/throat as "something being 'stuck' in his throat." He also complained of epigastric pain before coming to the ED.
This nurse placed him on a cardiac monitor, established an infusion site, and drew blood specimens, which she sent to the hospital laboratory. A physician then evaluated the patient and ordered an ECG and a chest X-ray. A radiologist reviewed the X-ray and indicated there was no radiographic evidence of acute cardiopulmonary disease, no significant interval change, and a mild enlargement of the heart. A second physician cared for Mr. Wicks. Additional tests were done, including another ECG. Around seven hours after the patient's presentation in the ED, the second physician decided to discharge him after seeing him for a second time. Vital signs were normal, pain was reduced to four out of 10, and the physician noted Mr. Wicks' condition as improved.
Discharge instructions were given, including a referral to a cardiologist the next day and follow-up with his primary care physician. The discharge diagnosis was "chest pain of unclear etiology." Mr. Wicks died approximately eight hours after his discharge. The cause of death was "acute dissection of aorta."
Mr. Wicks' wife and daughter filed a wrongful death action against the hospital, alleging the hospital was negligent in "the selection, training, retention, supervision, and hiring" of the two ED physicians who treated the patient. They also alleged the hospital's ED nursing staff were professionally negligent in the care and treatment of Mr. Wicks. No details were alleged by the plaintiffs in the complaint.
Professional Negligence Case Takes Shape
The hospital filed a Summary Judgment Motion. In doing so, it relied on the testimony of three physicians, two who were expert witnesses for the hospital and one for the family, respectively. In addition, the testimony of a physician, who was asked to review the case from a cardiologist's perspective and what he would do if he were asked to consult on the case, was heard. The physician's testimony centered upon whether or not the hospital was negligent. The hospital's expert witness attested to the nursing staff's conformity with the standard of care, including their documentation, and that no actions or inactions by the nursing staff caused or contributed to the patient's death.
The expert witness for the family's opinion was quite different. Among other points, the family's expert witness professed that the nurses:
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Failed to assess the cardiac risk factors of the patient.
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Failed to review, document, and inform the ED physician of the patient's history of cardiovascular risk identified in an earlier admission at the hospital. If they had informed the ED doctor of the patient's cardiovascular history, a cardiologist consult would have occurred. A CT scan with IV contrast would have been done showing there was an aortic dissection, and surgery would have been performed immediately.
The cardiologist's testimony, relying on the hospital expert witness's testimony as true, stated a CT scan with IV contrast would have been ordered and if the surgery had been performed, the patient would have survived. The trial court granted the hospital's Motion for Summary Judgment. The family appealed that decision.
The Appellate Court Opinion
The Court held that the family did not meet its burden in showing the granted Motion for Summary Judgment was improper. It affirmed the trial court ruling. The trial court decision was based on facts supported by the hospital's physician expert witness. Moreover, the Appellate Court held, the nurses' conduct did not contribute to the patient's death.
How Does This Case Affect Your Practice?
Even though this case was decided in California, these aspects of the case are worth considering in your own practice:
- The plaintiffs did not allege any details in their complaint, which proved fatal. Their case was speculative and based on "if only" this had been done by the nurses, the patient would be alive today.
- Even though the case was based on conjecture, it had to be defended, which is emotionally and financially costly.
- Professional negligence cases can be characterized as battles of the experts.
- An attempt to shift the burden of liability to another is an uphill battle, especially when no facts are alleged in support of such a case.
- No nurse expert was utilized by either party concerning the nursing staff's care. In my opinion, this is unusual in professional negligence cases in which nursing care is at issue.
- The nurses were not named as defendants, but their questioned care resulted in the hospital being named as a defendant under the theory of respondeat superior.
- Accurate, clear, and complete documentation of nursing care is essential and can help you avoid liability.
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