negligence and malpractice
Prompt: Based on the information you gathered from the LearnScape video interviews, on your research, and on a biblical worldview, analyze this incident and write your recommendation to the Chief Counsel regarding negligence/malpractice liability. Directly address the 4 elements required to prove negligence: Duty to care, Breach of duty, Injury, Causation (specifically foreseeability).
Malpractice and liability are two words and concepts that need to be well understood by health care administrators, as well as health care providers and staff. This case study of Bright Roads Health System reviewed the reason why those two terms are important and how lack of understanding liability and malpractice can affect areas of care and legal obligation. Areas of duty to care, breach of duty, injury and causation are discussed and identified through employee interviews, and help to form a recommendation to the chief legal counsel of the health system as to how the hospital should proceed. Pozgar (2019) discusses how a small percentage of physicians end up being responsible for the large and growing number of malpractice dollars owed. Through this case, interviews and research on malpractice a recommendation can be provided.
Duty to Care
Duty to care in any medical setting is defined with a legal obligation to care and dedication to this principle can be seen through established best practice of care. Duty to care is also defined by an ethical and professional obligation to provide the best care possible for patient and to ensure their safety. (Water et al., 2017) There are many layers to who would be responsible for care overall during the patient’s time at the health care facility, however in this case duty to care was established when the patient was admitted as a surgical patient and also in the post-operative care unit. Documentation of duty to care can be seen in admission paperwork that is presented to the patient upon arrival. By the patient being admitted the hospital, Mrs. Smith was admitted to their care at Bright Roads and they have the legal obligation to provide the best care possible to her.
Breach of Duty
Physicians and nurses do not go into the field of medicine to breach duty of care; they have entered this field of work to help care for people. This case had many interviewees who made the statement that mistakes happen and that is true it is human nature. However, in this case there were several breaches in duty to care on multiple levels from policy to practice. All of the errors that occurred throughout Mrs. Smith’s stay were avoidable. Breach of duty to care is determined by if a "breach" to duty of care fails to reach the standard of care required by law. (Price, 2010) In this case, based on interviews, there are many ways to look at the reasons for why mistakes or errors happened. The first thing to establish is that breach of duty did occur. Mrs. Smith contracted a staph infection during her time at the hospital, which was followed by a poor plan of care and slow response time to treat the infection.
The cause of the staph infection was due to gloves not being changed between 4 post-operative patients, and one of them had a staph infection, which was then passed on to other patients, including Mrs. Smith who exhibited symptoms. Mrs. Smith then showed signs of the infection, including a temperature of 106 degrees and the physician was not notified by the nursing staff. The husband was so worried he contacted Bright Roads CEO, who then made sure the patient was helped. There was a long series of errors on multiple levels.
Staff on nursing and physician levels made statements that policy, procedures and supplies were not well enforces or provided to staff of Bright Roads. The concept of hand hygiene and glove changing is not a new practice and unfortunately mistakes from the lack of proper procedure are not new either. In research conducted containing behaviors for hand hygiene, a conclusion was determined that “knowledge, awareness, action control, and facilitation is not enough to change HH behavior.” (Huis, et al., 2012) This is evident in this case, however new behavior strategies and enforcement of hospital policy will be needed to avoid further cases. Signs regarding policy were added all over the hospital after this specific case.
Injury
The initial injury in this case caused by something in the hospital is the staph infection. After the CEO was involved an infectious disease specialist and a pulmonologist were called in to this case. Dr. George Paltrow, Chief of Surgery was also informed at this time of the outcome of his case. Based on interviews, my conclusion as to how the injury took place is due to Dr. George Paltrow not changing his gloves in between patients, therefore passing the infection from patient to patient.
Mrs. Smith not only contracted a staph infection, but she also has issues that happened after the staph infection was cleared by infection control and pulmonology. The complication from the staph infection included spread of the staph infection to her lungs, puss build up in the plural space of her lungs and the need to drain the puss. Pulmonologist Holly Brigham stated that the auto immune disorder that Mrs. Smith developed after the staph infection cannot be definitively linked to the pocket of fluid left in her plural space. The lasting injury would need further investigation as to the cause.
Causation
In interviews with two physicians and a nurse they all stated that the hospital lack in the area of protocol enforcement with infection control and hand hygiene. There were many other reasons that the employees thought could contribute to the infection and sickness such as black and green mold, air cleanliness and staff response time. Mr. and Mrs. Smith do have a case with the hospital for breach of duty; however causation of the gloves passing the infection from one patient to another cannot be determined because Dr. Paltrow could have changed his gloves before coming into the room. They can confirm that Dr. Paltrow did not wash his hand in the proper location, as he washed them right next to her in her patient room. The cause of the staph infection can be determined based on employee interviews or depositions if this case goes to court.
Recommendation
There will be proof against the hospital, not the doctor because the doctor is an employee of the hospital there for the concept of respondiant superior will come into play. The proof against the hospital includes lack of proper training and enforcement of hospital protocol, poor signage for protocols, poor glove supply, poor location and number of handwashing stations. The hospital should have enforced their policies and this situation could have been avoided. There is also a communication issue between physicians and nursing staff that needs to be addressed, as nurses should not be afraid to contact a physician, especially when it pertains to patient care, and in this case life or death. The recommendation I would make to the chief legal counsel for Bright Roads is that the hospital would be found liable for negligence for this infection, therefore they should try to settle this malpractice case through mediation and settle for damages to the patient. I would also recommend re-training for all staff on this policy and procedure regarding infection and infection control, and all staff involved including physicians should have something in their employee file regarding this case.
Biblical Worldview
A case like this might be one that a hospital could brush under the rug and move forward from without being scathed. The CEO getting involved and being abreast of the situation shows their commitment to the care that should be provided by the hospital. As a Christian health care administrator, it is integral that we keep our Biblical world view intact. We must love others and do what is right. There was a major error that almost costed a patient their life and the hospital in this case must live and learn from this instance. Galatians 6:9 reminds us, “And let us not grow weary of doing good, for in due season we will reap, if we do not give up. “ (Galatians 6:9, ESV) It is not always easy to do what is right in the eyes of God and is much easier to conform to the world. We must follow the law of the land and of the Bible. In this case admitting wrong is needed, and then it needs to be followed up by staff training and reviewing the strategy and policy of the company. Mrs. Smith’s case is not the first like it and will not be the last but by reviewing cases like this we can work towards compliance and prevention in the future, as well as prepare for malpractice cases that will come to our desks.