Lawsuit Happy Patients

[snortzmom]

I am one semester away from getting my BSN-RN and also work as an aide. Something happened yesterday that traumatized me, and I'm hoping that more experienced people can give me advice as to what I can do in the future so that this doesn't happen again...

A bariatric patient who has unsuccessfully sued the hospital 2x was in my care as an aide. She was 5 days post op back surgery and accd. to the orders she was "up with assist." PT came (a large man and woman) and got her into a chair and left her. Of course, right when he left the floor she said she had to have a bowel movement. She refused to get up without the assistance of anyone else but PT. Her RN said not to call PT because the patient was capable of getting up with the assistance of floor staff, and there are only 6 PT's in the entire hospital (short staffed). RN says that if she refuses to walk to get a bedpan under her in the bariatric chair. Patient decides instead that she is going to slide from chair to floor because "no one cares" and when "she breaks her kneecaps she is going to SUE THE HOSPITAL." I tried to keep her from sliding out of the chair but she was huge and intentionally trying to slide out. Then the nurse manager came in, it was a huge ordeal, etc. This patient has been a huge problem on the floor, driven out 3 roommates, etc.

I made sure that her legs were in front of her and gently let her down, but now I am SCARED of patients looking to sue (especially when I am a nurse). I was supposed to go to clinical this morning as a student (ironically on the same floor, same patient) and I said forget it and used my 1 call in sick day. It is totally irrational to assume that you can prevent patients that are looking out for ways to sue you. HELP! I DON'T WANT TO GET SUED! ARE THERE A LOT OF PEOPLE LIKE THIS OUT THERE? CAN YOU JUST REFUSE TO WORK WITH PEOPLE LIKE THIS?

[bargainhound, RN]

You did everything you did and it was obvious it was deliberate behavior

on the part of the patient. Documentation is everything in a situation like this.

If you are not one of the ones documenting, at least make notes to yourself

to keep at home........that way you will have a refresher for your memory

in case there ever is a court case. The patient is in the wrong and a lawsuit

would go nowhere. The notes to yourself will allow you to "let it go" so you

can move on and think on other things/be able to function in your roles.

These patients are out there, but they are in the minority.

Just always maintain your professional behavior/follow policy/procedure

and you will be fine.

Always protect yourself in every situation by documenting.

[canoehead, BSN, RN]

She said she was going to sue the hospital, and what she was going to sue the hospital for, before the incident happened. That telegraphs the fact that the patient did it on purpose to any sensible human. Don't worry about it.

[babynurselsa, RN]

WHen you have a patient like this DOCUMENT,DOCUMENT,DOCUMENT. When they make statements such as this I document direct quotes.

pt state "Nobody cares so I am going to fall and sue the hospital." Document clearly each intervention performed. I also file an incident report when patients begin to make such statements. This give the manager and risk management a heads up.

[morte, LPN, LVN]

why was this patient admitted? it would seem a referral to another hospital would have been in order, if she has attempted to sue twice....hopefully YOU werent hurt......if you were, even the slightest, file a report.....since the hospital put you in this position you should be taken care of.....also, has this patient been seen by psych? self injury is not usually considered normal/healthy....

[bargainhound, RN]

babynurselsa

Yes! Definitely file incident report quoting her!

Very good advice!

[snortzmom]

Thanks for your input about direct quotes, incident reports, etc. I will know what to do from here on out. Now I know why they stress documentation so much in nursing school! It really is necessary.

[babynurselsa, RN]

Exactly Kirsten,

Many times it may be years before you could get called up to give a depostion regarding an incident. IF you document clearly and file an incident report you will not have to rely on memory, which an opposing attorney could pick to pieces. You can simply refer to what you charted.

[Daytonite, BSN, RN]

I would have charted that she refused to get up without the assistance of anyone else but PT. When other help was offered she stated (and I would put it in quotations to indicate her own words that she was going to slide from chair to floor because "no one cares" and when "she breaks her kneecaps she is going to SUE THE HOSPITAL.") I would have charted how I attempted to get her to wait for help and what I did to break her fall and prevent her from injuring herself as she slide down. Once any lawyer gets a look at that they are going to have some serious problems taking any case she would want to bring against the hospital--she contributed to her own injury--if she even had any. If you haven't had to take a class in healthcare and the law, you should. Certain elements have to be present for a person to sue and be successful. One element is that they have to have been damaged in some way. The problem with patients like this is that staffs get tired of their shenanigans. That's when a patient like this takes a real nosedive that results in an injury--kind of like crying wolf. So, you gotta watch these types like a hawk. They're very devious.

You should discuss what options, you as a aide have in charting to protect yourself with either your manager or someone in staff development. Aside from that, an incident report should have been made that includes all the statements this lady made to you, including everything you did to prevent her from being injured when she went down. I don't know what your hospital does, but when I was a manager my hospital allowed us to attach the personal statements of any staff involved in incidents to the incident reports to help clarify what happened. Ideally, however, entries in the patient's chart should tell the story.

The woman has a screw loose. These kind of people show up from time to time. You can't run away from them. You protect yourself by doing everything possible to make sure they don't get injured. We have had patients where we insisted that staff attend them in pairs and never alone because of false things the patients have claimed. This way you have a witness to their screwball behavior at all times. And, of course, you document all facts--thoroughly. This way if a case ever goes to court your charting will be your testimony.

[CritterLover, BSN, RN]

she has unsuccessfully sued your hosptial x2, and she thinks that the threat of a third lawsuit is going to have any effect???? sounds like she has a few screws loose, if she even thinks she is going to find a lawyer to even represent her. they have a reputation to uphold, too, you know.

just to echo everyone else, documentation is one of the keys to stopping these kinds of people early. the other key would be to treat her just like all of your other patients. adhere to your standards of care. don't go out of the way to give the "extra" treatment, but give them what everyone else gets: quality care. just make sure you document your efforts, her responses, and how you adjusted your care based off of her response. (everone deserves an individualized poc, and even if you have a care track for her diagnosis, that doesn't mean you can't modify it to fit her needs. but if she is not following the care track out of will rather than necessity/physical debility, then her behaviour, and the teaching, needs to be charted.)

[TrudyRN]

Document, as already stated. But as an aide, do you chart notes?

Do keep your own record and do an incident report and keep a copy. Even if they tell you you aren't allowed to keep a copy, you can still write down the pt's name, the date, her statements, etc., who told you to do what and then deserted you, it sounds like, didn't help you with this extremely large patient, did PT put her into a chair and leave her there in a safe way, was her call bell handy, were wheels locked, was the chair at the right height, and all details, lighting levels, any obstacles on the floor, etc. Be thorough.

And no, you can't avoid all mentally ill persons. This patient needs therapy, maybe medication, for depression and anger.

Be strong. Go back to clinicals. God bless you.

[caroladybelle, BSN, RN]

First, for a lawsuit to be successful, there must be some harm and there must be some deficit in care.

As there is no harm mentioned, there is nothing legit to sue on. And there does not seem to a deficit in care.

I have dealt with some highly dysfunctional people that deliberately fell, or were so noncompliant that they fell. You know the ones that can reach the call light to call and then ask you to hold their kleenex to blow their nose. Or the 240# lady that walked into the ER, but is too "tired" to get OOB to the chair. Then proceeds to try to injury the nurse by slipping while being transferred.