CO 506 Assignment 4

506 Response from student # 1

Mrs. Smith a patient who after surgery contracted a deadly staph infection as well as an autoimmune disease following complications from the infection is filing a negligence suit against Bright Road Health System.  “Duty of care is defined as a legal obligation of care, performance, or observance imposed on one to safeguard the rights of others” (Pozgar, 2016).  Mrs. Smith was in the care of Dr. George Paltrow following the surgery as he was conduction routine post operation exams.  The attending physician and nurses were responsible for the care of Mrs. Smith as well as the other patients in the exam room during the time of evaluation.  In this case duty of care was established; however, I believe that it was breached.  The nurse and Mrs. Smith pointed out that the attending physician did not change gloves in between the examination of the patients.  The physician and nurses are responsible for duty set by hospital policies and procedures.  The physician stated that policies requiring hand washing and a new pair of gloves are set by the hospital.  It is a requirement to wash hands prior to treating patients as well as changing gloves in between patients. 

According to Pozgar, breach of duty is defined as failure to conform to the required duty of care (2016). “Breach of duty of care may be established by the Court if there is a difference between what actually happened and what should have happened” (Todd, 2011, pg 64). In the case of Mrs. Smith there was a breach of duty by both the physician and the attending nurses.  As a physician Dr. Paltrow should have changed gloves before treating Mrs. Smith as well as performed necessary handwashing techniques.  Also, the attending nurses or physician should have reported the onset of Mrs. Smith symptoms of infection following her surgery.  Several witnesses said that Mrs. Smith had a high fever a symptom of a staph infection. However, the diagnosis of her infection was delayed because the attending physician was not notified of the infection.

The patient’s injury was confirmed as well as the other patients in the room also contracted a staph infection.  Not only did Mrs. Smith contract a deadly staph infection she now has an autoimmune disease as a result.  Because the staff did not report the staph infection in a timely manner there were more severe consequences.   This shows negligence on the staff’s part because all infections should be reported to the physician in a timely manner.

Causation refers to the connection between the negligent act and the injury (Mendelson, 2017).  Causation is often a matter of the court to decide whether or not there was a breach of duty and in fact this breach caused the patient’s injury.  In this case the hospital’s policies were not up to par.  Witnesses attested to a lack of training and signage, and inadequate supply of gloves, and inconvenient washing stations.  All hospital staff should be trained on the proper handwashing techniques as well as necessary steps to follow upon the identification of an infection.  The nurses and physicians should also be aware of the seriousness and consequences of a deadly staph infection.  No matter the location of the gloves each attending staff member should be changing gloves upon the examination of each patient.  These policies are a part of the standard of care of both the physician and the nurse.  There should also be an adequate supply of gloves in glove boxes in each and every exam room.  The likelihood of this injury would decrease with proper training. The prevention of staph infections includes but are not limited to the following (Nurse DA, 2015):

· Washing their hands before and after they touch every patient

· Wearing gloves and other protective clothing when they treat wounds, touch IVs and catheters, and when they handle bodily fluids

· Using the proper sterile techniques

· Promptly cleaning up after dressing (bandage) changes, procedures, surgeries, and spills

· Always using sterile equipment and sterile techniques when taking care of patients and equipment

· Checking for and promptly reporting any sign of wound infections

Therefore, policies must be in place as well as signage that include the following information.  Lack of hygiene is a number one cause of staph infections.  During my interviews, everyone seemed aware of the severity of staph infections and how important it was to follow procedure.  Therefore, I believe that with the adequate policies and the correct supervision of the staff this incident could have been prevented.  No matter the circumstance it is important for every employee to follow procedure and to also evaluate procedures on a regular basis to ensure up to date information is provided to the employees.  Not only in this case but in every routine exam clean gloves and proper hand washing techniques should be enforced.  There is always a risk of infection following surgery however it is the responsibility of the hospital staff to limit the risk by enforcing proper policies and procedures.  Infection prevention programs are a necessity of a hospital in order to not only prevent but to educate staff on how to respond in the likelihood a patient does contract an infection.  From a biblical perspective, it is important to care for those who are sick and those who trust us to care for them. 

References

Mendelson, D. (2017). Causation in law and medicine. Routledge.

Response from student # 2

Bright Road Health System exists to provide healthcare services to constituents who present for care.   In this capacity, they employ physicians, nurses, and ancillary personnel dedicated to this task.  To complete this task in an ethical manner, it is necessary to address the ethical position that Bright Road holds in delivery of healthcare.  Bright Road ascribes to a duty based approach.  Their view is based upon an obligation to ‘do right’ and provide the best possible care to its constituents (Pozcar 2016, p. 39).  Using a duty based ethical framework, the patients have the right to expect the health system to deliver the highest possible level of care currently available.  This also means that Bright Road Health System and its employees, have a duty to care or a legal obligation of care to safeguard the rights of others (Pozcar, 2016).   We as Christians hold this world view as well.  We hold justice and fairness as positive aspects of our faith.  1Kings 3:28, “When all Israel heard the verdict the king had given, they held the king in awe, because they saw that he had wisdom from God to administer justice “(New International Version, 1997).

     Mrs. Smith presented to Bright Road Health System for a surgical procedure provided by her surgeon, Dr. George Paltrow.   Mrs. Smith developed a life-threatening staphylococcus wound infection on day two of her recovery.    The empyema she subsequently developed required drainage which was treated by Dr. Holly Brigham.  Treated aggressively with antibiotics, Mrs. Smith subsequently recovered requiring a thirty-day hospital stay instead of the planned five-day recovery period.   She maintains that the development of this infection contributed to the development of a permanent autoimmune disease that she now suffers with.  Mr. and Mrs. Smith are maintaining that Bright Road Health System and its employees failed to deliver the standard of care established through policy, procedure and hospital regulations.  Deviation from the standard of care resulting in damages caused by the breach of one’s duty to care constitutes negligence (Pozcar, 2016, p. 68). 

     Mrs. Smith was examined on post-operative day 1 by her doctor accompanied by his surgical residents.  Witness to this examination was nurse Jenifer Brainard, who observed Dr. Paltrow examine Mrs. Smith without proper handwashing and universal glove precautions.    This is in clear violation of hospital policies and procedures for patient contact.   Hospitals are subject to internal review when considering infections rates, they also must adhere to national scrutiny.   In addition, Mrs. Smith, a fresh postoperative surgical patient was placed close to a known staph infected patient further jeopardizing her recovery.  Floor nursing staff, which was admittedly understaffed neglected to protect Mrs. Smith by placing her next to a patient who required contact precautions.

        Besides breach of duty, causation must also be established.    Mrs. Smith’s surgical recovery, was complicated by high fever and difficulty breathing necessitating an additional procedure and longer hospital stay.   This was witnessed by her husband, Mr. Smith who was present at her side throughout the course of her hospital stay.    Proximate cause refers to the relationship between a breach of duty and resulting injury (Pozcar, 2016, p. 73).  A departure from standard procedure is not, in and of itself, sufficient to warrant damages in a negligence case (Pozcar, 2016) The patient must show that they have been harmed.   Disregard for proper handwashing and universal precautions and its subsequent outcome is foreseeable.  A direct link has been established between the staph infected patient and Mrs. Smith’s wound infection.  Bright Road Healthcare System is liable for negligence and accompanying damages.

      Causation regarding Mrs. Smith claim that she developed an autoimmune disease resulting from her infection has not been established.  As noted previously, causation must be proximal.  There has been scientific study in this area.  A National Institutes of Health article, describes that ‘bystander activation [ can occur and] describes an indirect or non-specific activation of autoimmune cells caused by the inflammatory environment present during infection’ (Ercolini and Miller, 2008, p. 1-15).  The evidence remains weak and requires further study using animal models (Ercolini and Miller, 2008).  Mrs. Smith’s claim that she suffers from the development of an autoimmune disease as the result of her infection is unsubstantiated.

     Indemnification refers to a contractual right whereby one party agrees to cover the losses of another party in certain circumstances (Webster, 2016).   It has been established that Mrs. Smith has shown cause for her claim of negligence resulting from her care by employees of the Bright Road Health System.   In addition, the healthcare system has not fully supported those employees in the education and the return demonstration of knowledge of handwashing, gloving and overall contact precautions.  They have not been actively promoting infection control and considered modification of the physical environment promoting placement of sinks for handwashing or stations for hand sanitizer use.  This was admitted by the named physician and substantiated by the nurse who witnessed the poor infection control technique.  The policy that placed Mrs. Smith in a ward close to known infected patients also requires revision.  Mrs. Smith need only show that the evidence outweighs the hospital’s claims to prove fault (Pozcar, 2016).   Both nurses and physicians who adhere to peer review professional constraints would be unable to positively support their standard of care for Mrs. Smith.   Would a healthcare provider of similar qualifications do the same in similar circumstances (Habibzadeh, 2011, p. 57)?  It is not likely.

Bright Road Health System is, in this case, Respondeat Superior and should answer for all breeches of standard patient care by the organization and its employees.

References