The Case of Yolanda Pinnelas
Instructions: The group will write a10–15-page APA formatted paper (title page and references list do not count towards the 10–15 pages). Support the paper with peer reviewed articles and case law where applicable. You must have minimum of eight references. You may have an appendix that has samples of documents that support your positions or expands on the facts of the case.
1. Liability issues
2. Parties involved and who should be sued
3. Defenses of the parties
4. Documents that the Plaintiff’s side will ask for and how they will be used
5. Standards of care
6. Duty, breach, damages and proximate cause
7. Insurance issues
8. Risk management issues before and after the incident
9. Documentation and mandatory reporting
10. Who should write the incident report and what should it say?
11. The doctrine of Respondent Superior and how it would apply
12. The issues surrounding informed consent
13. Preparation for court of the parties
Case Study 1: Malpractice Action Brought by Yolanda Pinnelas
People involved in case:
Yolanda Pinnelas — patient
Betty DePalma, RN, MS — nursing supervisor
Elizabeth Adelman, RN — recovery room nurse
William Brady, M.D. — plastic surgeon
Mary Jones, RN — IV insertion
Carol Price, LPN
Jeffery Chambers, RN — staff nurse
Patricia Peters, PharmD — pharmacy
Diana Smith, RN
Susan Post, JD — risk manager
Amy Green — quality assurance
Michael Parks, RN, MS, CNS — education coordinator
SAFE-INFUSE — pump
Brand X infusion — pump
Caring Memorial Hospital
The patient, Yolanda Pinellas, is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy. Caring Memorial is a hospital in upstate New York. Yolanda was a student at Ithaca College and studying to be a music conductor.
Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. Mary Jones, RN, inserted the IV on the day shift around 1300, and the patient, Yolanda, was to have Mitomycin administered through the IV. An infusion machine was used for the delivery. The Mitomycin was hung by Jeffery Chambers, RN, and he was assigned to Yolanda. The unit had several very sick patients and was short staffed. Jeffery had worked a double shift the day before and had to double back to cover the evening shift. He was able to go home between shifts and had about 6 hours of sleep before returning. The pharmacy was late in delivering the drug so it was not hung until the evening shift. Patricia Peters, PharmD, brought the chemotherapy to the unit.
On the evening shift, Carol Price, LPN, heard the infusion pump beep several times. She had ignored it as she thought someone else was caring for the patient. Diana Smith, RN, was also working the shift and had heard the pump beep several times. She mentioned it to Jeffery. She did not go into the room until about 45 minutes later. The patient testified that a nurse came in and pressed some buttons and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done.
Diana Smith responded to the patient’s call bell and found the IV had been dislodged from the patient’s vein. There was no evidence that the Mitomycin had gone into the patient’s tissue. Diana immediately stopped the IV, notified the physician, and provided care to the hand. The documentation in the medical record indicates that there was an infiltration to the IV.
The hospital was testing a new IV infusion pump called SAFE-INFUSE. The supervisory nurse was Betty DePalma, RN. Betty took the pump off the unit. No one made note of the pump’s serial number as there were six in the hospital being used. There was also another brand of pumps being used in the hospital. It was called Brand X infusion pump. Betty did not note the name of the pump or serial number. The pump was not isolated or sent to maintenance and eventually the hospital decided not to use SAFE-INFUSE so the loaners were sent back to the company.
Betty and Dr. William Brady are the only ones that carry malpractice insurance. The hospital also has malpractice insurance.
Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The claimant is alleging that, because of this, she is no longer able to perform as a conductor, for which she was studying.
During the procedure for the skin grafting, the plastic surgeon, Dr. William Brady, used a dermatome that resulted in uneven harvesting of tissue and further scarring in the patient’s thigh area where the skin was harvested.
The risk manager is Susan Post, JD, who works in collaboration with the quality assurance director Amy Green. Amy had noted when doing chart reviews over the last 3 months prior to this incident that there were issues of short staffing and that many nurses were working double shifts, evenings, and nights then coming back and working the evening shift. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several units. Prior to this incident, the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on this unit and what types of resources and training was needed.
The Case of Yolanda Pinnelas
Defenses of the parties
The nurses will be accused for standard negligence and improper care for the patient. Jeffery Chambers, the staff nurse did not provide proper care for the patient. The infusion machine beeped severally but Jeffery did not respond. This is taken as a form of negligence but the defendant may argue that the treatment and care he gave the patient was in order with the medical standards (Suszek, 2015). The staff nurse may also argue that the damages on the patient’s hand were not as a result of his negligence.
The plaintiff‘s expert may also accuse the nursing supervisor, Betty Depalma for the use of infusion pump that was not in good working condition on the patient as it caused necrosis of the patient’s hand. The malpractice insurance lawyer may defend the nurse using the Respectable minority principle since they were trying to use a new method of treatment that utilizes the infusion machines (Suszek, 2015). However, Jeffery Chambers, the nurse that was assigned to Yolanda, was supposed to inform the patient about the possible results of the use of the pumps; the patient’s expert may accuse the nurse for the lack of informed consent. The defendant may decide to focus his attention on the harm that was caused to the patient and not on the mistakes that he made. In this case the nurse will choose to lose the case and pay for the harm caused to the patient (Suszek, 2015).
The hospital malpractice lawyer can also defend the nurses by arguing that the plaintiff’s opinions are not scientific hence are not well founded. The judge will be forced to stop the plaintiff’s expert from giving more opinions. This may block the complainant from providing the case.
Duties, Breach, Damages, Proximate cause
There are certain duties that nurses should perform to their patients without breaching. These include duty to provide care for the patient, duty to decide on the form of treatment to give the patient, the duty of a doctor to seek the informed consent of his or her patient before diagnosing and treating them and the duty to administer the treatment to the patient (Goguen, 2015). A breach of the duties is legally wrong and the patient has a right to seek judicial intervention.
The nurses at Caring Memorial Hospital breached some of the duties; Jeffery Chambers, the staff nurse, did not give proper care to the patient. The infusion pump was heard beeping several times but he was not there to attend to the patient. A nurse that was not identified switched off the infusion pump to stop it from beeping without attending to the patient. Jeffery Chambers failed to seek the informed consent of the patient before treatment using the infusion pumps and this is a standard negligence. Yolanda has to prove to the court how these duties were breached. The damages caused were the hand necrosis due to the dislodged IV and the scarred thigh due to use of dermatome to harvest tissue. The proximate cause is medical negligence by the nurses.
Preparation for Court by the Parties
In preparation for court, the nurses will have to seek lawyers who will defend them in court. Betty DePalma carries malpractice insurance and therefore she will be represented by the malpractice lawyer from the insurance company. Jeffery Chambers, the stuff nurse will look for an attorney to represent him. The nurses will go through a deposition process whereby they will provide their testimonies under oath. Yolanda’s attorney will ask the nurses some questions in relation to the treatment they gave his client in a process called direct examination process. The nurses must provide honest answers to the questions since the information will be used for trial. The defendants’ attorneys will then asking their respective clients questions to obtain more information in a process called cross-examination. A re-direct follows where the plaintiff’s attorney will ask the defendants some more questions. A re-cross examination of the defendants is then done again. The plaintiff will also undergo the deposition process. (Goguen, 2015).
During the direct examination and the
re-direct, the nurses’ representatives have the freedom of objecting to
questions asked by the complainant’s attorney (Goguen, 2015). In case of
harassment of either party, the attorney may ask for approval of a judge to
terminate the deposition. The nurses however, should remain calm and confident
since they are preparing for court where they will need to convince a jury.
Goguen, D. (2015). Injury lawsuits against hospitals & doctors: Medical Malpractice overview – AllLaw.com. Retrieved 28 October 2016, from http://www.alllaw.com/articles/nolo/medical-malpractice/injury-lawsuits-against- hospitals-doctors.html
Suszek, A. (2015). Defending a medical malpractice claim. AllLaw.com. Retrieved 28 October 2016, from http://www.alllaw.com/articles/nolo/medical-malpractice/defense-1.html