Forensic Issues Essay Paper
Order Instructions:
Forensic Issues.
Assume that you are called upon to testify in one of the two case scenarios below on behalf of the nurse-defendant. Outline what evidence is important to preserve – how? Why?
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 Facts: 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 Jeffrey 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 forty-five 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 dislodged for 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 6 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 Manger is Susan Post, J.D. who works in collaboration with the Quality Assurance director Amy Green. Amy had noted when doing chart reviews over the last three 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.
Case Study 2:
Wrongful Death by Howard Carpenter on Behalf of Wilma Carpenter,
Deceased People Involved in Case:
Mrs. Wilma Carpenter-patient-deceased
Mr. Howard Carpenter-husband and plaintiff in wrongful death suit
Mrs. Scale, RN, MS-nursing supervisor
Elizabeth Adelman, RN, recovery room nurse
Richard Washington, M.D.-orthopedic surgeon
Judy Gouda, RN, NP
Joseph Alsoff, LPN-post surgical unit nurse
Kelly Wheeler, RN-post surgical unit nurse
David Casler, LRT
Susan Post, JD-Risk Manager Amy Green-Quality Assurance Michael Parks, RN, MS, CNS-education coordinator Caring Memorial Hospital Facts: The plaintiff, Mrs. Carpenter was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, M.D. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN witnessed the consent, Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, R.N. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS. The patient had an epidural catheter for a post-operative pain management, following an episode of hypotension in the Recovery Room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the Recovery Room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse’s assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient. Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was and was stable. She then left to care for other patients. The licensed practical nurse, Joseph Alcoff, had been working on the unit for several years. It had been rumored that Joseph was an alcoholic. There was no evidence that he had been drinking on the unit. Approximately an hour after the patient arrived on the unit, she was unable to tolerate respiratory therapy that was ordered, and she became nauseated and vomited. David Casler administered the respiratory therapy. According to Kelly, the registered nurse, ten minutes after the vomiting episode, Joseph Alcoff, the LPN, found the patient blue and unresponsive and called a code. Joseph is the only person other than the physician that carries his own liability insurance. The hospital also has malpractice insurance. The code team responded, along with Kelly, the registered nurse. Mrs. Carpenter was intubated and cardiac resuscitation was initiated. The patient responded to resuscitative efforts and she was transferred to the intensive care unit. Subsequently, Mrs. Carpenter did not do well, was unresponsive, and declared brain dead and taken off the respirator. She did not have a DNR in place. There is a conflict in testimony between Joseph the LPN and Kelly the RN. Joseph indicated that Kelly found the plaintiff to be unresponsive after the vomiting episode and called the code. The time elapsed between the vomiting episode and finding the patient is in dispute. The final diagnosis was anoxia encephalopathy due to the time lapse between CPR being initiated. The patient was eventually extubated, breathed independently for a period of time, and then subsequently expired. The vital signs ordered by the physician were hourly. The hypotensive episode in the recovery room had not been reported to the registered nurse. The Risk Manger is Susan Post, J.D. who works in collaboration with the Quality Assurance director Amy Green. Amy had noted when doing chart reviews over the last three months prior to this incident that the vital signs taken in the recovery room were not charted, not done, or not reported to the units. 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 postoperative 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 these units and what types of resources and training was needed.
SAMPLE ANSWER
Forensic Issues
There are certain evidences I should preserve if I am called upon to testify on behalf of a nurse-defendant in the case of Yolanda Pinnelas. One of the evidence I would protect is the one indicating that the pharmacy delayed in delivering the drug on time. This evidence will be altered with by indicating that the drug was actually delivered on time. The reason why this evidence ought to be protected is that it is against the law to delay to deliver drugs to a patient in un-stabilized condition (Maschi, Bradley & Ward, 2009). This provision is provided in the Patient Care Act which indicates that license of RNs could be revoked if proves that a patient was actually neglected.
Evidence that also requires to be preserved is the evidence that Jeffrey had neglected Yolanda prior to his assignation. This is very critical in court of law as it suggest that there was no close monitoring of Yolanda’s improvement during the treatment. This is against the competency standards of any Registered Nurse (RN). This evidence can be preserved by indicating that, the hospital being understaffed, made Jeffrey to check on other patients who were undergoing the same treatment (Furuse, 2001). This statement will convince the judges that Jeffrey was universal in trying to give all the patients quality services accorded to them.
Delicate evidence that need to be preserved too is the evidence that Betty, the supervisory nurse, did not note the name of the SAFE-INFUSE or its serial number. The problem here is that the pump was neither isolated nor sent for maintenance. If this evidence is presented in the court of law, Betty can be sued due to incompetency. Any medical practitioner is expected to demonstrate competency levels when dealing with patients. To preserve this evidence, it should be indicated that the reason behind using the pump is because the other six infusion pumps were already being used, and there was an urgent need to give Yolanda the intended services.
Doctor William Brady, if evidence is presented in court, can be fired or his license gets revoked. This is because he used dermatome that resulted in uneven harvesting of tissue and further scaring in Yolanda’s thigh area where the skin was harvested. This is against competency standards that indicate that William ignore to verify whether mitomycin had actually entered Yolanda’s body tissue and went ahead with skin grafting (Carroll & Buddenbaum, 2007). This evidence can be preserved by indicating that Dr. William was working guided by the documentation in the medical record that indicated that only infiltration to the IV had happened.
Amy Green, on the other hand, can be sued in court if the evidence attributed to him is presented. The evidence is that she had opted to use floating nurses to counteract the rising nurse-shortage shortage in the facility (Baker, 2005). I will defend Mrs. Green by providing that the use of floating nurses is due to neglect the state government to supply hospitals with more nurses. Therefore, Mrs. Green used floating nurses to reduce the increasing burden attributed to the reduced number of nurses.
Having malpractice insurances can convince the judges that the negligence of the medical officers used in treating Yolanda was because their mistakes were insured. This evidence requires to be protected by indicating that malpractice insurance is only geared to ensure that medical officers work professionally despite being insured. In the concerned hospital, only Betty and William are insured (Furuse, 2001). This evidenced can be preserved by arguing that the malpractice insurance attributed to Betty and William is because they hold very delicate position that is frequented with unavoidable mistakes.
References
Baker, T. (2005). Reconsidering the Harvard Medical Practice Study conclusions about the validity of medical malpractice claims. J Law Med Ethics.
Carroll, A.E., & Buddenbaum, J.L. (2007). Malpractice claims involving paediatricians: epidemiology and aetiology. Paediatrics.
Furuse, A. (2001). What we must learn from recent medical accidents—experiences at the investigation committee. Gan To Kagaku Ryoho
Kohn, L.T., Corrigan, J.M., & Donaldson, M..S. (2000). To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press.
Maschi, T., Bradley, C., & Ward, K. (2009). Forensic social work: Psychosocial and legal issues in diverse practice settings. New York, NY: Springer Pub.
Ubelaker, D. H. (2013). Forensic science: Current issues, future directions. Chichester, West Sussex: Wiley-Blackwell.
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