Ethical and moral dilemma

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Specializes in ICU step-down, Med/Surg Trauma ICU.

I work in med/surg/trauma ICU at an inner city level ! trauma hospital. I had a pt. the other day that came in from a cardiac event and required the hypothermia protocol.

He was 58 and living in an ECF when his ICD fired off 77 times non warranted due to a recalled fractured lead. According to the interrogation of his ICD his heart was never in a shockable rhythm. I'm assuming that the shocks caused an S on T rhythm or an ischemic event throwing the heart into asystole.

This patient was warmed back up and ran through the brain death protocol and finally pulled off the vent and pronounced yesterday.

My dilemma is that the family does not know about the fractured lead in his ICD and that's what ultimately killed him. Obviously this could cost the company millions of dollars and bad business fro the hospital so I was instructed by the cardiologist and upper management to not disclose this information to the family. However I know if it were my father lying dead on that hospital bed I would sure want to know the truth.

What would you do?

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wow...that is a tough call.

don't you think the family will wonder why the icd couldn't cardiovert him?

i mean, won't there be questions?

what if they try and sue the hospital?

all that aside, i honestly don't think i could sit on that information...

but don't know how i'd approach it.

i just read your thread, so let me think about it.

i usually have a big, big mouth-

but would need to carefully consider the repercussions and/or benefits of disclosure.

wow.

leslie

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Why is it bad business for the hospital? I'm assuming that's where it was put in, but you guys didn't make it. Unless it was your responsibility to inform the pt of the recall and that never happened. Did they ask for an autopsy? I would think that info would be discovered through that. It also seems like that would be something that would be reportable to some sort of agency. Does your hospital have an ethics committee? If they do, you should be calling them. I hope someone has more info for you - I would sure want to know!

And it might not cost the company millions - if the pt was informed of the recall and chose not to do anything about it, I'm not sure the company could be held responsible. There are too many factors in this case to be able to assign blame now.

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Specializes in ED, ICU, PSYCH, PP, CEN.

Unless you know, beyond the shadow of a doubt that this is the reason he died then I would not say anything.

If you absolutely know that this is what killed him then you really do have an ethical dilema that is way to big for me to figure out.

I wish you all the best with your decision.

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Specializes in Critical Care, Education.

Pdaddy,

Refer this to your hospital ethics committee immediately. As an RN, it is your responsiblity to take actions when you believe that there has been a breach of clinical responsiblity. But your responsibility ends with reporting. Let the ethics committee take it from there.

BTW, I agree with previous posts - there is just no way that the hospitalor its employees could be charged with negligence unless there were problems with the resuscitation attempts.

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Specializes in ER, ICU, Education.

Is the family asking for an autopsy? If one is done it will certainly be discovered. Now the question is what caused the fractured lead?

It could have been a malfunction or it could have been something the pt did that caused it or something else. You really don't know, do you?

I feel like there something missing in this story... why would the hospital and MD's ask you not to say anything?

Why would you talk about it to anyone? If you did you would be breaking all sorts of confidentially laws.

Something just doesn't seem right...

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

I agree with rbezemek- contact your ethics committee ASAP. I would find out if a report was sent to risk mgt as well. If not, you may need to let them know what is going on, too. :twocents:

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I work in med/surg/trauma ICU at an inner city level ! trauma hospital. I had a pt. the other day that came in from a cardiac event and required the hypothermia protocol.

He was 58 and living in an ECF when his ICD fired off 77 times non warranted due to a recalled fractured lead. According to the interrogation of his ICD his heart was never in a shockable rhythm. I'm assuming that the shocks caused an S on T rhythm or an ischemic event throwing the heart into asystole.

This patient was warmed back up and ran through the brain death protocol and finally pulled off the vent and pronounced yesterday.

My dilemma is that the family does not know about the fractured lead in his ICD and that's what ultimately killed him. Obviously this could cost the company millions of dollars and bad business fro the hospital so I was instructed by the cardiologist and upper management to not disclose this information to the family. However I know if it were my father lying dead on that hospital bed I would sure want to know the truth.

What would you do?

I would ask myself the following questions:

What is my role as part of the team?

Am I qualified to determine what killed him?

What is my assessment of the cost based upon?

What would be the purpose of knowing one nurses opinion of the cause of death or "truth", if my father were lying dead?

Am I accusing myself or my team of malpractice? Of negligence?

How would I describe my relationship with my team?

Do I think that the feeling is mutual?

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Specializes in Advanced Practice, surgery.

In the UK this would be treated as an unexpected death and a sentinal event and investigated thoroughly, this would include the coroner and the family would have access to all of the information.

Sentinal events:

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response.

http://www.jointcommission.org/SentinelEvents/

You must have a similar process in the US

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Specializes in ICU step-down, Med/Surg Trauma ICU.
wow...that is a tough call.

don't you think the family will wonder why the icd couldn't cardiovert him?

i mean, won't there be questions?

what if they try and sue the hospital?

all that aside, i honestly don't think i could sit on that information...

but don't know how i'd approach it.

i just read your thread, so let me think about it.

i usually have a big, big mouth-

but would need to carefully consider the repercussions and/or benefits of disclosure.

wow.

leslie

Well I did tell the family that his heart never went into a shockable rhythm according to the interrogation; that's why they think it didn't fire.

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Specializes in Home care, LTC, subacute/acute rehab.

I agree with everyone that said you must have a ethics commitee that you can consult as well as risk management. I think the family has a right to know, I just don't think it's your responsibility to give that info out.

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Informing the family of a death and related concerns such as cause,is the responsibility of the doctors.

In a situation like this, I would imagine myself in front of a judge and try to answer the likely questions: "How did you know what the cause of death was? Do you have special knowledge of the mechanics of the device? Did you see this device for yourself?

I agree with the other posters about calling risk management and reporting it there.

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