Problem
Greta, a 27-year-old woman, comes to the Emergency Department complaining of severe abdominal pain and vomiting. After being triaged, she speaks with Dr. Smith, an attending. Dr. Smith orders some tests and determines that she has gallstones and will have to have her gallbladder removed. Greta is admitted and the next morning, is brought into surgery for a laparoscopic procedure. During the surgery, Dr. Jones, a surgeon in his first year as an attending, becomes nervous when he realizes that there is a lot of inflammation and that he can't properly see the bile ducts. He thinks that a surgeon with more experience might be able to successfully complete the laparoscopic procedure, but that he doesn't want to take a chance. He decides that the laparoscopic procedure will have to be converted to a traditional open cholecystectomy (gallbladder removal). The surgical team quickly opens Greta up and Dr. Jones completes the procedure. The surgical nurses count the instruments and confirm everything is there, and Greta's incision is closed and brought to recovery. Dr. Jones orders the antibiotic Rocephin to prevent any post-surgical infection. Nurse Sarah puts in the order, but unknowingly and accidentally takes out the drug rocuronium, a paralytic often used for anesthesia. Nurse Sarah administers the rocuronium, and within moments, Greta goes into respiratory paralysis and experiences cardiopulmonary arrest. During the code, Nurse Sarah checks the medication and realized her mistake. She immediately tells the team what has happened, and Greta is resuscitated, but with suspected brain injury. Greta is moved to the ICU. A few weeks later, Greta, still in the ICU, begins experiencing a high fever and is found to have a high white blood count, indicating an infection. Over the next few days, Greta experiences sepsis, and, sadly, dies later that week. Although they know about the medication error, Greta's family thought that she had been improving, so they ask for an autopsy. The medical examiner finds a surgical sponge in her abdominal cavity, left there during the gallbladder surgery.
This hypothetical presents an extreme situation and is not based on any real-life case but provides a good opportunity for discussion of situations where health care workers may be negligent, or not.
I. Discuss and analyze the issues surrounding negligence of health care providers in this hypothetical scenario.
II. Reason through the elements of negligence (duty, breach, causation, and injury) as to each potentially negligent person or entity, and determine which health care professionals, if any, you would find negligent for Greta's injuries and eventual death.