Medical Law and Bioethics Unit 5

4 D’s Duty Dereliction of duty Direct or proximate cause Damages

Duty Takes place when a physician and client relationship is established

Dereliction of duty The physician or healthcare provider failed to provide a correct standard of care to the patient

Direct or proximate cause The dereliction or breach of duty was the direct cause of the patient’s injury

Damages Injuries caused by the defendant for which compensation (financial or otherwise) is due

Case 1 After Victor’s birth, his condition deteriorated rapidly and he developed breathing problems so how did the medical staff respond

Case 1 Suctioned baby and administered oxygen Physician inserted ET tube but could not suction through it because the nurse did not supply the Dr. with the correct tubing Dr. inserted a 2 nd ET tube but was unable to use the ambu bag provided because it had a mask attached to it. Dr. performed rescue breathing until appropriate equipment arrived

Case 1 Outcome: Baby survived but suffered many injuries including cerebral palsy Suit was filed against Dr. and hospital for professional negligence

Case 1 Nurse testified that she was unfamiliar with the equipment that was used Two experts testified that the hospital failed to provide appropriate equipment and training for the nurse Dr. testified that the nurse’s actions led to the injuries sustained by the infant

Let’s look at this case using the 4 D’s  Physician  Hospital

Let’s first determine if the physician was negligent by reviewing the 4 D’s as they relate to the PHYSICIAN ONLY We will thoroughly look at each D as it relates to the physician so please try not to jump ahead

Now let’s determine if the hospital was negligent by reviewing the 4 D’s as they relate to the HOSPITAL ONLY We will thoroughly look at each D as it relates to the hospital so please try not to jump ahead

Mather v. Griffin Hospital In the actual case: The physician was not found to be negligent The hospital was found to be negligent Why was the hospital found negligent and not the nurse?

Respondeat superior

Case 2 Mr. Kuna underwent successful surgery at the hospital. After he regained consciousness he felt a terrible pain in his foot. His wife helped remove his TED hose and found his small toe dark in color and covered with blood.

Case 2 The Dr. prescribed pain medicine when it was discovered Nurse later cleansed the toe and applied salve

Case 2 Outcome After two weeks of care, the toe gets gangrene and is partially amputated Patient files suit against the hospital stating that the nursing staff was negligent for failing to remove his stockings and bathing his feet daily

Case 2 Wife testifies that she never witnessed a nurse removing the TED hose for 9 days following surgery Chart documented a complete bath daily and that pedal pulses were checked daily No expert testimony

Let’s look at this case using the 4 D’s

Kuna v Lifemark Hospitals of Texas Evidence suggests that improper positioning of the foot in the stocking and then failure to remove it and check it routinely led to the development of the sore. No expert testimony or evidence to suggest that the sore led to the gangrene and partial removal of the toe. Court ruled in favor of the defendant