Assignment task:
Is Nurse Greene liable for malpractice? How did she violate standards of care from a legal perspective? Did she fulfill the role of patient advocate? Would an expert nurse witness need to testify at this trial and why? What, it any, types of damages should be awarded?
Marion M. Burgess, the plaintiff's husband, brought a lawsuit against Kent Hospital, the admitting physician (Dr. Bishop), the gastroenterologist (Dr. Regal) and Nurse Greene. The patient was admitted to the cardiac care unit at 10:30 AM Saturday morning directly from her cardiologist's (Dr. Joseph Bishop) office, to be monitored and treated for new onset a trial fibrillation. Her condition and vital signs were stable throughout the morning, but she complained to Nurse Greene at 2:15 PM that she was having abdominal pain (#5 on a scale from 0-10) and nausea. The nurse examined her abdomen and determined that it appeared normal. despite the patient's complaints of pain. Nurse Greene notified Dr. Bishop at 2:30 of the pain and nausea. He ordered Tylenol (acetaminophen) and Phenergan (promethazine), which Nurse Greene gave at 2:55 PM. Her "focus note" for 3:55 p.m. indicated that the patient was still having abdominal pain- "the worst she had ever had" (#10 on a scale from 0-10), and nausea, and at the same time her blood pressure and heart rate had increased significantly. The nurse called the physician's answering service and again reported the patient still had abdominal pain, was nauseous, and other symptoms related to her cardiac condition. The answering service did not perceive the call to be any type of emergency. The physician then ordered some cardiac medications. At 5:00 PM the patient continued to have the pain and nausea, and the pain was "worse than usual". The husband requested that a doctor examine the patient (the second such request according to the family), so Nurse Greene again called the answering service to report her symptoms, but again did not indicate any emergency. The family claimed that the patient had been "doubled over" and was "screaming in pain".
The admitting physician saw the patient at 6:50 PM and consulted a gastroenterologist. The gastroenterologist (Dr. Regal) saw the patient at 8:30 PM and noted tenderness in the abdomen, normal bowel sounds, and noted that the patient's complaints of pain (#10 on a scale from 0-10) to be out of proportion with his physical findings. On Sunday morning, Nurse Greene returned for another shift and found the patient "moaning" and with her abdomen hard and distended at 7:25 AM. She notified both Dr. Bishop and Dr. Regal and the patient was transferred to the intensive care unit. After the intensivist examined the patient, it was determined she needed emergency surgery. The surgery revealed the patient's large intestine was necrotic and infected, the necrosis being caused by a mesenteric blood clot. The patient died the next day. In the lawsuit, the husband claimed, among other allegations, that the nurses were negligent in administering pain medication before knowing the cause of her acute abdominal pain and that they failed to act on a significant decline/change in the patient on Saturday.