Read the case study presented at the end of Chapter 9 (Guido, p. 185-186).
he patient, on the first day postoperative for a transurethral prostate resection, received a unit of packed cells early in the morning on the supposition that he was bleeding internally. That afternoon at 3:22 p.m., the patient’s wife informed the nurse that her husband was breathing “heavily” and requested that the nurse assess him. The nurse, according to the testimony of the wife, informed her that the doctor was aware of the patient’s breathing pattern and that there was nothing about which she should worry. The nurse did not leave the nursing station. The patient subsequently died
related to a shock from the internal bleeding complicated by a reaction to the blood transfusion. In court some years later, this same nurse testified that she had called the surgeon immediately to report that the patient’s respirations were 50, that she had taken vital signs that were within the normal limits for this patient, and that she had obtained a pulse oximeter reading that was acceptable. She also testified that she kept calling the physician’s office to report these findings. None of this nursing care was documented in the progress notes that the patient’s nurse placed in the patient’s chart the next day. The nurse testified that she had compiled the progress notes from scratch notes she had written during the previous afternoon. The nurse further testified that it was her practice to make handwritten notes during the time that she worked and then to type her progress notes on the hospital system the next day. Additionally, this nurse never documented taking vital signs during the critical 2 hours between the spike in the patient’s respirations and the time he was pronounced. T he surgeon’s office nurse testified that a call was received from the hospital at 4:00 p.m. and that the surgeon immediately left the office for the hospital. The surgeon testified that he called the hospital from his car phone and that he immediately called a code as soon as he reached the patient’s room.
Did the lack of documentation in the admitting nurse’s assessment and notes affect the ultimate outcome of this case?
Was there negligence on the part of the nursing staff in the care of this patient?
What could the nurse have done differently to facilitate a different outcome in this case?
How would you decide this case?
Using the sample professional liability insurance policy (Guido, p. 193-194), locate the various provisions:
DECLARATIONS Policyholder’s Name: Judy Doe _________________________________ Covered Professional Occupation: Registered Nurse; Staff position Acute care institution or community health/home health Coverage Period: May 1, 2008 through April 30, 2009 Duties in Event of a Claim: If there is a claim, you must do the following: 1. notify us and our program administrator, in writing, as soon as possible; 2. specify the names and addresses of the injured party(s) and any witnesses, information on the time and place of the event; 3. verbally discuss the nature of the event with our claims representative; 4. immediately forward all documents that you receive in connection with the claim to us: 5. fully cooperate with us, or our designee, in the consummation of settlements, the defense of suits or other proceedings, enforcing any right of contribution or indemnity against another who may be liable to you because of injury or damage. You shall attend hearings and trials, assist in securing and giving evidence, and obtaining the attendance of witnesses; 6. refuse, except at your own cost, to voluntarily make any payment, assume any obligation, or incur any expense. Limits of the policy: $1,000.000 per claim/$3,000,000 aggregate
In consideration of payment of the premium, in reliance upon the statements in the declarations and subject to all of the terms of this policy, agrees with the named insured as follows:
COVERAGE AGREEMENTS The company will pay on behalf of the insured all sums that the insured shall become legally obligated to pay as damages because of:
COVERAGE—INDIVIDUAL PROFESSIONAL LIABILITY Injury arising out of the rendering of or failure to render, during the policy period, professional services by the individual insured, or by any person for whose acts or omissions such insured is legally responsible, except as a member of a partnership, performed in the practice of the individual insured’s profession described in the declarations including service by the individual insured as a member of a formal accreditation or similar professional board or committee of a hospital or professional society.
EXCLUSION This insurance does not apply to: 1. Liability of the insured as a proprietor, superintendent, or executive officer of any hospital, sanitarium, clinic with bed and board facilities, laboratory or business enterprise other than as stated in the above declarations; 2. Liability of the insured as a nurse-anesthetist or as a nurse midwife.
LIMITS OF LIABILITY Individual Professional Liability The limit of liability stated in the declarations as applicable to each claim is the limit of the company’s liability for all damages because of each claim or suit covered hereby. All claims arising from the same rendering of or failure to render the same professional services shall be considered a single claim for the purposes of this insurance. The limit of liability stated in the declarations as aggregate is, subject to the above provision respecting each claim, the total limit of the company’s liability under this coverage for all damages. Such limits of liability shall apply separately to each insured.
SUPPLEMENTARY PAYMENTS The company will pay, in addition to the applicable limit of liability:
What provisions of an insurance policy would you consult to determine if an insurance company should pay such a claim, and what would the limits of the liability be?
Is the nursing home insurance company correct in saying that this is a professional judgment issue?
Which insurance company (the nursing home’s or that of the administrator of the nursing home, assuming she has coverage) should pay the court-ordered judgment?
How would you decide the case?
Please combine all of these responses into a single Microsoft Word document for submission
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You are not required to adhere to the 500-1000 word count for each of the responses, but please be thorough in your responses so that you adequately address all aspects of each question.
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