Litigation Risk Management!! Must READ!!

  1. This is a reply to a post on this board....I think in this day and age it is essential for All nurses to know how to avoid litigation. One way is to know what a judge and jury will be looking for in order to establish guilt in a medical malpractice case... READ ON!

    In order for there to be a mal practice case against you Four Elements must be satisfied they are:
    Duty, Breach of Duty, Causation, and Damages....here is an explanation:
    1. Duty. Whenever a professional relationship is established between a healthcare provider and a patient the element of Duty is established. So as a nurse, the moment you take report, and take your assignment Duty is established. If your neighbor calls you on the telephone and asks for you to suggest a medication for her "nagging cough" and rather than suggest she see her doctor you tell her to try Maxi Cough Relief, the element of Duty is established. Once Duty is established the nurse is expected to deliver the appropriate standard of care for each patient in her care.

    2. Breach of Duty. A breach of duty exists when the standard of care is not followed. The standard of care is defined in this way: A Standard of Care holds a person of exceptional skill or knowledge to a duty of acting as would a reasonable and prudent person possessing the same or similar skills or knowledge under the same or similar circumstances!!

    *NOTE: Did you know that nurses are legally held accountable to know the Standard of Care as it pertains to the patients in their care??? Ignorance is NOT a defense!!

    3. Causation. Causation states that the healthcare's breach of duty (or deviation from the standard of care) led to the patient being harmed. Example: A nurse fails to follow the hospital policies and procedures (which were written based on the most current and authoritative standards of care) while administering Packed Red Blood Cells to a patient in her care. As a result the patient was given the wrong blood, and died. This nurses failure to follow the standard of care (breach of duty) resulted in, or caused harm/death to the patient.

    4. Damages. Damages consist of the actual harm done, the costs of follow up treatments, medications, lost wages, both present and future. Emotional harm may constitute additional damages. Punitive damages may be rewarded if the judge and jury find that the breach of duty was outrageous or in the extreme.

    Summary: A medical malpractice case is viable before a court (or said to have Merit) when a professional relationship has been established between a healthcare provider and a patient (duty), the healthcare provider fails to follow the established standard of care (breach of duty) which results in harm to the patient (causation & damages).

    Do you know what the Standards of Care are for the patients in your care? AGAIN: Ignorance is NOT a defense!!

    With the little info you provided it sounds like the standard of care was not adhered to on the part of the Lab. Personell, as well as Nurses and M.D.'s especially if lab values were so extremely "out of whack", then one may suggest that the nurse or M.D. should have questioned them, and repeated them. BIG LESSON FOR NURSES HERE!!!
    Duty has been established, Breach of Duty exists (on whose part is the question. More than likely the prosecution will target the Hospital under Respondeat Superior. This is likely if the breach exists on multiple levels from Lab Personell to M.D.'s). Causation and Damages speak specifically to damages or harm done as a result of the deviation from the standard of care! In this case the damage is DEATH.
    The question is...were the deaths specifically related to the coumadin overdoses? If yes....then ALL Four Elements have been established! You need to find out if there is a suit, and if you are named in that suit. That is a good place to start.

    For more info. on Nurses and Malpractice visit my web site at:
    http://www.masslegalnurse.com Click on Healthcare Provider Info> then Articles!!
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  2. 1 Comments

  3. by   tonchitoRN
    I read with interest your info. re: malpractice. But please include that just because you are not named in a suit does not mean you are not involved. Many times any and all those who laid eyes on the patient are asked questions in a deposition. Many times the plaintiff lawyer is looking for the weak link to take advantage of.
    As far as documentation goes, it is now probably your best defense. However, the reality is that no one can document 100% of everything that is done. Regardless of what you write down there is always something you did not so the adage "If you did not document it then you did not do it" screws you from the beginning.
    Also, it is helpful to know the nurse practice act and your job description to know where you stand. However, although I do not have a copy of the act I noticed my job description is so vague with legalese that I can be held accountable for most anything.
    Maybe one day I will understand it all.

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