Need health and medical help with 506 Unit 4 Topic 2

Topic 2: Defenses to Malpractice and Risk Management

Take the malpractice case assigned to your group and discuss the defenses that may be raised in that case. Discuss how the incident could have been prevented. What risk management techniques could have been used before and after the adverse patient occurrence?

At least 250 words with 2 references/citations

***Case study

Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma Carpenter, Deceased

People Involved in Case:

Mrs. Wilma Carpenter — patient, deceased

Mr. Howard Carpenter — husband and plaintiff in wrongful death suit

Mrs. Scale, RN, MS — nursing supervisor

Elizabeth Adelman, RN — recovery room nurse

Richard Washington, MD — orthopedic surgeon

Judy Gouda, RN, NP

Joseph Alsoff, LPN — post-surgical unit nurse

Kelly Wheeler, RN — post-surgical unit nurse

David Casler, LRT

Susan Post, JD — risk manager

Amy Green — quality assurance

Michael Parks, RN, MS, CNS — education coordinator

Caring Memorial Hospital

Facts:

The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.

The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse’s assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.

Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.

The licensed practical nurse, Joseph Alcoff, had been working on the unit for several years. It had been rumored that Joseph was an alcoholic. There was no evidence that he had been drinking on the unit. Approximately an hour after the patient arrived on the unit, she was unable to tolerate respiratory therapy that was ordered and she became nauseated and vomited. David Casler administered the respiratory therapy. According to Kelly, the registered nurse, 10 minutes after the vomiting episode, Joseph Alcoff, the LPN, found the patient blue and unresponsive and called a code. Joseph is the only person other than the physician that carries his own liability insurance. The hospital also has malpractice insurance.

The code team responded, along with Kelly, the registered nurse. Mrs. Carpenter was intubated and cardiac resuscitation was initiated. The patient responded to resuscitative efforts and she was transferred to the intensive care unit. Subsequently, Mrs. Carpenter did not do well, was unresponsive, and declared brain dead and taken off the respirator. She did not have a DNR in place.

There is a conflict in testimony between Joseph the LPN and Kelly the RN. Joseph indicated that Kelly found the plaintiff to be unresponsive after the vomiting episode and called the code. The record is not clear as to when the vital signs and epidural site were assessed. Kelly said she did a motor and sensory level assessment and they were fine — it is not charted though. The time elapsed between the vomiting episode and finding the patient is in dispute. The final diagnosis was anoxia encephalopathy due to the time lapse between CPR being initiated. The patient was eventually extubated, breathed independently for a period of time, and then subsequently expired.

The vital signs ordered by the physician were hourly. The hypotensive episode in the recovery room had not been reported to the registered nurse.

The risk manager is Susan Post, JD, who works in collaboration with the quality assurance director Amy Green. Amy had noted when doing chart reviews over the last 3 months prior to this incident that the vital signs taken in the recovery room were not charted, not done, or not reported to the units. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several postoperative units. Prior to this incident, the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on these units and what types of resources and training was needed.

Expert Solution Preview

Introduction:
The malpractice case assigned involves a patient who underwent a total hip replacement at Caring Memorial Hospital and later died. The case involves multiple healthcare professionals, including the physician, nurses, and respiratory therapist. In this answer, we will discuss the defenses that may be raised in the case, how the incident could have been prevented, and the risk management techniques that could have been used.

Answer:
Defenses that may be raised in the case include failure to prove negligence, contributory negligence, and assumption of risk. For example, the defense may argue that the healthcare professionals acted in accordance with the standard of care and that the patient’s death was not a result of their actions or inactions. The defense may also argue that the patient or her family contributed to her death by failing to disclose pertinent health information or not following post-operative instructions.

The incident could have been prevented by implementing adequate risk management techniques before and after the adverse patient occurrence. These techniques include improving staff education and training, ensuring proper documentation of vital signs, and reducing workload on nurses to prevent burnout and fatigue. The hospital could also have implemented better communication channels between different healthcare professionals to ensure that crucial information is relayed in a timely manner.

After the adverse patient occurrence, the hospital could have employed a proactive risk management approach, such as conducting a root cause analysis to identify the underlying problems that led to the patient’s death. Additionally, the hospital could have implemented corrective actions to prevent similar incidents from occurring in the future.

In conclusion, the defenses that may be raised in the malpractice case involve failure to prove negligence, contributory negligence, and assumption of risk. The incident could have been prevented by implementing adequate risk management techniques before and after the occurrence, such as improving staff education and training, ensuring proper documentation of vital signs, and reducing workload on nurses. The hospital could have also employed a proactive risk management approach after the occurrence by conducting a root cause analysis and implementing corrective actions.

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