Physician Negligence

[Djadia]

We currently have a paraplegic on our unit with 2 extensive wounds on his left leg which are currently being managed with a wound vac. During one of the vac changes a few days the surgeon was present during the wound vac change and "took over" the wound care. He encountered difficulty in removing the foam dressing that was packed in the tunneling part of the wound. He picked up a scissors from the patients bedside table (which defineately was not sterile. It was used for cutting tape etc. not to mention - it probably had fallen on the floor several times etc.) and proceeded to make 3 large cuts within the wound to allow him access to the tunneling dressings. Granted this patient had decreased sensation in that leg but could feel pain the deeper one probbed. The surgeon didn't tell the patient what he was intending to do, nor did he ask the nurse to get him a sterile scissors. The issue I have is that I was not the nurse present who witnessed this surgeons actions. The nurse who was - refuses to report the surgeon seeing as though she works with him frequently. In my opinion this is ethically wrong, and it appalls me to think that this surgeon would have done this. It defineately makes me wonder what other things he may do that noone witnesses. Do I have an obligation to report this to our nurse manager or do I stay away from the entire situation seeing as though I wasn't directly involved. I already talked with the nurse who was involved and encouraged her to report the incident however, she declines to do anything further.

[xoemmylouox, ASN, RN]

I'm not understanding what the problem is here. Those actions of the Surgeon clearly fall under the categories of Abuse and Neglect. The witnessing nurse made a statement of allegation of potential abuse and negligence.

Is there not a state or county agency to make your report to outside of your clinical setting? Are you not a mandatory reporter? A paraplegic is by legal definition a disabled person who is protected under the mandatory reporter law.

Mandated reporters are required to file a report whenever there is reasonable cause to suspect or believe any resident of a care facility has been abused or neglected by a staff member of a public or private institution or facility that provides care. Whenever the results of an investigation leads to the conclusion that there is reasonable cause to believe that that there has been abuse or neglect perpetrated by staff, then the institution, school or facility must provide records concerning the investigation to the appropriate investigating agency and/or to the agency that licensed the facility.

Your State should have a Adult Protective Services, Department of Human Services, or a Seniors and Adults with Disabilities agency where you could file a report anonymously to. Also, your State Board of Nursing should also have provisions as well.

In most states, if not all, failing to report abuse is also a criminal offense.

It is your duty and obligation as a Health Care Professional to protect the safety and well being of your patients. It is not your obligation to conduct an investigation or gather evidence.

The problem this person is going to run into is that they did not witness anything. This is all 2nd or 3rd word of mouth.. Unless the nurse who witnessed this will report it or will back you up if you report it, I wouldn't waste my time.. You will be the one left hung out to dry.

[tokmom, BSN, RN]

it is called hearsay, so you have to be careful. Yeah, you could speak up, but it would get you nowhere

[fastwalkslowtalk]

That's why you make the report ANONYMOUSLY to an OUTSIDE agency with the capabilities to conduct an investigation upon the authority of the State or County, such as calling that number on the back of your MANDATORY REPORTER card that pretty much all Professional Healthcare Workers, Police Officers, EMT's, School Teachers, and any other member of society who is considered a "Public Employee" are given when they hired.

I kinda thought we all decided to work in the health care industry because we wanted to make a positive difference in people lives....

I don't understand the ethics here in some of these post's. The authors seem more concerned about protecting their own careers at the expense of someone else's pain, discomfort, dignity, and health.

Someday your health and well being is going to be in another's set of hands. Think about it - would you yourself tolerate this kind "care-less giving?"

[psu_213, BSN, RN]

That's why you make the report ANONYMOUSLY to an OUTSIDE agency with the capabilities to conduct an investigation upon the authority of the State or County, such as calling that number on the back of your MANDATORY REPORTER card that pretty much all Professional Healthcare Workers, Police Officers, EMT's, School Teachers, and any other member of society who is considered a "Public Employee" are given when they hired.

I kinda thought we all decided to work in the health care industry because we wanted to make a positive difference in people lives....

I don't understand the ethics here in some of these post's. The authors seem more concerned about protecting their own careers at the expense of someone else's pain, discomfort, dignity, and health.

Someday your health and well being is going to be in another's set of hands. Think about it - would you yourself tolerate this kind "care-less giving?"

First, I was never, at any RN job, given a 'mandatory reporting card.' Second, I don't really appreciate being lectured on my ethics. Even if I had a phone number to call, I would be telling them "Another nurse told me that Dr. R does not follow sterile technique." If it makes you feel better then call this number anonymously. If you want any chance to go have it go anywhere, then you will have to name names (the other nurse and your own). Even if you do name names, the case will not go anywhere and you have alienated yourself to you coworkers and to many physicians.

While saying something sounds like the ethical thing to do, there is a lot more to the situation. I agree that if this situation went down exactly as described by the OP, then, yes, the pt's dignity, comfort, etc. suffered. But, if you accuse this physician based on second hand information--you are putting your career at risk. There is a lot of talk on this site of protecting you license...well, what good is your license if you throw away your career based on second hand info?

[Guest343211]

My experience is that docs do this sort of thing WAY too often. Sometimes they drag scissors out of their lab coats to cut sterile dressing supplies. Unbelieveable.

You cannot report hearasy.

Keep your eyes open and advocate for your patients by calling docs out on this poor practice habit.

Well, that's b/c you are a fair-minded person. Hearsay getst reported all the time in hospitals. Some of it has some validity and a fair amount of it does not.

I honestly haven't seen a physician cut into someone's tissue with a non-sterile apparatus before. I mean, this is a major violation. I know I wouldn't be able to keep my mouth shut if I saw that. Just. . .wow. . .

[Guest343211]

That's why you make the report ANONYMOUSLY to an OUTSIDE agency with the capabilities to conduct an investigation upon the authority of the State or County, such as calling that number on the back of your MANDATORY REPORTER card that pretty much all Professional Healthcare Workers, Police Officers, EMT's, School Teachers, and any other member of society who is considered a "Public Employee" are given when they hired.

I kinda thought we all decided to work in the health care industry because we wanted to make a positive difference in people lives....

I don't understand the ethics here in some of these post's. The authors seem more concerned about protecting their own careers at the expense of someone else's pain, discomfort, dignity, and health.

Someday your health and well being is going to be in another's set of hands. Think about it - would you yourself tolerate this kind "care-less giving?"

I totally hear what you are saying and agree. The thing is, it sounds like the nurse that actually observed it will not do the right thing. The nurse that heard what is hearsay, even if that "hearsay" was from the observing nurse can try to prevail upon the witness-nurse to do the right thing--even an outside agency, upon investigation, can try to do so with the witnessing nurse. Try, here, is the operative word. The witnessing nurse can choose to deny it until the cows come home; and thus, unless there is another witness, the patient functions as a witness, or the physician owns up to it, nothing much will come of it. Now, if you feel that it is worth it to have an outside entity investigate, for the purposes of putting the hospital (and hopefully it's staff) on notice about this kind of thing, than by all means, launch a complaint. The stirring of investigation itself may cause the insitution and its staff to be more careful about looking out for this sort of thing. But in terms of getting any real action, other than shaking people up to a higher level of awareness and conscientiousness, without a solid witness, nothing else will come of it.

So the OP has to decide if it's worth "getting a stir going"--so that the best standard of care is renewed within the facility. It certain seems like it would be worth it; but we have to be honest and stand up prepared to accept any backlash. If there is backlash to the OP for rousing an investigation, she could make a legal claim of whistleblowing.

At the end of the day, it all comes down to people's level of ethic, and if they surpass the need for "survival" within an institution. Places with a higher level of leadership ethics will not allow bullying or weeding of the OP. But again, heresay that can't be validated in problematic. It could go bad either way. I let my conscience be my guide. I mean the OP can't even go and address the physician about it, b/c she didn't see it, but only heard about it.

The ideal thing of course would be to influence the witnessing nurse to address the issue. Frankly, if she is talking in or around me about, as if gossip, but she is addressing it, since she was there, that tells me a ton about her, and I would frankly state that to her. "Why are you spreading this around rather than going to the source in question." "If, after you go to the physician, he blows you off, then make a former report." My point is, if I heard her speak about this, I'd put it back on to her; b/c she witnessed it. Total passive-aggressive crap in nursing. She needs the employ ethics in this situation or shut up.

That's essentially what it comes down to IMHO.

[Kooky Korky, BSN, RN]

How is the pt now?