Witness intimidation allegations are risky business

Two registered nurses, one patient care provider and one expert witness changed the course of a lawsuit in the case Stubblefield v. Morristown-Hamblen Hospital Association.

A patient underwent a cardiac catheterization in a hospital and remained for routine post-operative care. The physician’s order was for the patient’s assigned nurse to administer nitroglycerin intravenously throughout the night.

The patient complained to the nurse the nitroglycerin was causing “an unbearable headache and nausea.” She begged the nurse to stop the nitroglycerin. Later, they discovered a hematoma and psuedoaneurysm in the patient’s groin at the catheterization site.

The hematoma continued to enlarge, despite treatment provided by the hospital nursing staff. The on-call physician was notified and a vascular surgeon immediately performed emergency surgery to repair the femoral artery.

The patient filed a medical malpractice action against the hospital, the nurse who provided her care, the hospital consultants and the on-call physician.

The suit also included a separate battery count against the nurse on the basis she continued the nitroglycerin after the patient objected to its administration.

The defendants denied the allegations and filed a motion for summary judgment. The nurse stated the patient consented to the administration when she was told it was medically necessary. Had the patient objected, the nurse continued, she would have called the treating physician for orders.

The nurse also attested the care and treatment she and the other nursing staff provided was in accordance with the standard of care for RNs in the community in which the hospital was located.

The patient asked for more time to respond to the defendants’ motion. She also disclosed two expert witnesses to support her claim, one being a nurse who was “expected to testify, within a reasonable degree of professional certainty, that [the hospital’s] nurses breached the applicable standard of care in their treatment.”

The second expert witness, a physician, was expected to testify in support of the nurse expert’s testimony, opining the cause of the patient’s hematoma and pseudoanaeurysm.

Patient alleges witness intimidation of nurse expert

The patient again requested a continuance of the summary judgment motion, claiming the hospital had unlawfully coerced the nurse expert to withhold her testimony by threatening her with the loss of her job.

The hospital “strongly objected” to the allegations, and stated the nurse expert was not an employee of the hospital in its network where the alleged threat took place. It did concede, however, that the nurse expert was an employee in another hospital in its network.

After the hearing, the court granted the defendants’ summary judgment motion because the patient had failed to file support in response to the motion.

An additional request by the patient to amend or alter the grant of the summary judgment motion also was denied by the court. So, the patient appealed.

Appellate Court decision about witness intimidation

The Appellate Court held the lower court’s denying the patient’s motion for a continuance and an evidentiary hearing on the witness intimidation issue resulted in “extreme prejudice” to the patient.

The subsequent decision to grant the defendants’ motion for summary judgment and leaving the patient without an expert witness was an “abuse of discretion” when it so ruled.

The court reversed the summary judgment as “premature” and remanded the case for further hearing on the two claims alleged against the hospital (witness intimidation) and the nurse.

The costs of the appeal, the court continued, are to be applied equally to the patient, hospital and nurse.

Guidelines to follow as a witness or plaintiff

It remains to be seen what the trial court’s determination will be on the issues remanded to it for a decision.

Even so, this case presents guidelines for you in whatever role you may have in a lawsuit. They include:

1. Remember a lawsuit can allege a breach of your duties along with those of other defendants and also can allege violations of your individual conduct (battery).
2. Never coerce or bribe a witness or any other person testifying in a case in which you are a plaintiff or defendant.
3. Never provide false testimony in a deposition or trial.
4. When a patient doesn’t consent to treatment you are administering, stop the treatment and contact the physician or advanced practice registered nurse (APRN) who ordered the treatment.
5. Document the patient’s refusal, your conduct in response to the refusal and your notification to the physician or APRN.
6. In your documentation, be certain to include the details surrounding the incident and any additional orders you receive.
7. If you are a plaintiff in a lawsuit, pursue all legal options available to you with the help of your legal counsel.

Take these courses related to proper documentation:

Document It Right: A Nurse’s Guide to Charting
(5.2 contact hrs)
From the earliest beginnings of the nursing profession, nurses have carefully recorded their observations of patients and their interventions to help patients recover from illness and achieve optimal health. In the beginnings of the profession, the primary purpose of nurses’ notes was to verify that physician orders were completed. Today, professional nurses are vital partners with other healthcare professionals, and nursing documentation is an essential part of comprehensive patient care. Although documentation has always been an important part of nursing practice, the increasingly complex healthcare environment, litigious society and the diversity of settings in which patients receive care require that nurses pay more attention to documentation. This continuing education module outlines the importance of documentation, different formats and settings for documentation, and what nurses must document, including information about difficult situations.

Document It Right: Would Your Charting Stand Up to Scrutiny?
(1 contact hr)
This module provides nurses with information about the value of laws and standards governing nursing documentation, legal basics for appropriate documentation, and strategies for documenting changes in a patient’s condition. It describes the legal definition of nursing negligence, characteristics of legally credible charting and charting practices that can lead to legal problems.

Every Nurse Is a Risk Manager
(1 contact hr)
Every time you complete an occurrence report for a near-miss medication error or review a clinical policy and procedure with the nurse manager, you are involved in a risk-reduction effort. Healthcare risk management is the process the organization uses to identify, evaluate, and manage risk and potential liability exposure. The objective is for adverse outcomes to be limited by establishing systems to prevent or identify errors before they affect care, and in the event errors occur, to mitigate loss exposure. This module will reinforce and strengthen the understanding nurses have of risk management in healthcare and suggest risk reduction tools to mitigate exposure to professional liability.