Legal Review & Commentary
Hypodermic needle in towel pricks woman's palm, $25,000 verdict awarded
By Jon T. Gatto, Esq., Blake J. Delaney, Esq., Buchanan Ingersoll & Rooney, Tampa, FL
News: A woman admitted to the hospital put her hand on a metal railing by her bed in her hospital room. The part of the metal rail that the woman grabbed had a towel draped over it, and a used hypodermic needle was in the towel. The woman's palm was pricked by the needle. The woman sued the hospital for negligence and claimed as her damages living for a year with the fear of having contracted HIV, the pain and suffering of the needle prick, and the inconvenience of undergoing treatment for hepatitis B. A jury awarded the plaintiff $25,000 in damages.
Background: A 56-year-old woman was admitted to the hospital with complaints of respiratory distress. In her hospital room that night, the woman put her hand on a metal railing by her bed to stabilize herself. The part of the metal rail that the woman grabbed had a towel draped over it and, unbeknownst to the woman, a used hypodermic needle was in the towel. The woman's palm was pricked by the needle, and she called for help from the nursing staff, who cleaned the wound and disposed of the needle.
Over the course of the next year, the patient underwent a preventative regimen of medicines for hepatitis B and a series of HIV tests. After a year, doctors determined that she had not contracted any disease. The woman sued the hospital for negligently failing to dispose of the used needle, and she claimed as her damages living for a year with the fear of having contracted HIV, the pain and suffering of the needle prick, and the inconvenience of undergoing treatment for hepatitis B. The hospital disputed liability and questioned whether the incident even occurred as the plaintiff maintained and, if it did, faulting the woman's own negligence for placing her hand in the towel. After a trial, a jury returned a verdict in favor of the plaintiff for $25,000.
What this means to you: "Accepting the facts as presented, this is a case that should have been settled," says Ellen L. Barton, JD, CPCU, a risk management consultant based in Phoenix, MD. "The fact that it went to trial indicates that the hospital believed that there was a serious issue with the plaintiff's integrity."
According to Barton, given that the hospital obviously was not able to discredit the plaintiff's version of the event, it was unproductive to argue that the plaintiff was negligent in placing her hand in the towel. The towel could have been placed on the bedrail to provide some cushioning for the patient's hand or to provide some leverage for the patient to pull herself up. Thus, unless there was a prohibition of having towels on bed rails, it would appear that the patient bears no responsibility for the action that led to her injury. It is not reasonable to argue that the patient should have expected anything dangerous to be in a towel lying near her bed.
The situation as presented indicates a breakdown in the protocol around disposal of "used needles." It would have been helpful to conduct a root cause analysis to determine who last had control of the needle, when and why it was placed in the towel, when and why the towel was draped on the patient's metal bed-rail, and how such an incident could have occurred. Learning where the protocol failed is the best way to develop a procedure to avoid such failures in the future.
The hospital leaders genuinely may have believed that the facility was not responsible for placing the used needle in the towel and draping it over the bedrail. However, the situation should be viewed as an opportunity to review protocols and establish standards that would allow for periodic checks of such hazards, e.g., visual checks of bed/rails and the immediate environment to ensure they are hazard-free.
More than 600,000 medical sharps injuries occur each year in health care facilities in the United States. All health care workers and patients are at risk, but particularly those who handle sharp devices or equipment such as lancets, suture needles, scalpels, or hypodermic needles. Being injured by a "sharp" opens the door to the possibility of contracting human immunodeficiency virus (HIV) or hepatitis B or C virus. Hollow-bore needles, such as the needle at issue here, cause the most sharps injuries, as well as the greatest risk to bloodborne pathogens.
Sharps injuries have long been a focus of accrediting bodies as well as government entities. The Needlestick Safety and Prevention Act of 2000 and the revised 2001 Bloodborne Pathogens Standard require facilities to keep a log detailing sharps injuries. The Occupational Safety and Health Administration (OSHA) has cracked down on facilities that fail to comply with sharps-safety regulations. For example, in July 2003, OSHA fined a Pennsylvania rehabilitation center $92,500 for violations of the Bloodborne Pathogens Standard.
Providers and manufacturers have made great strides in terms of creating less dangerous sharps, and eliminating sharps where they are not necessary. However, the key to sharps safety still lies with the medical providers using the sharps.
Importantly, the Center for Disease Control has published a Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. The Workbook provides details on how to evaluate risk of injury associated with sharps and how to implement a program that will maximally reduce the risk of injury. The Workbook is available online at www.cdc.gov/sharpssafety/appendixA.html.
Some providers have gone as far as to create a committee dedicated to sharps safety. Such a committee should include frontline health care workers as well as members of administration. The committee should be given sufficient authority and resources to make a serious impact on the provider's commitment to sharps safety.
Lapses in sharps safety often are associated with anger, distractions, multiple attempts, and providers trying to rush procedures. Low staffing levels can lead to any or all of these root causes of sharps injuries. Building a culture of general safety awareness, and particularly sharps safety awareness, can make an enormous difference in terms of patient safety. It not only is increased training that improves sharps safety, but a general safety-first attitude. As the American College of Surgeons stated in its Statement on Sharps Safety: "A team approach to sharps safety is critical to reduce the risk of bloodborne infections resulting from sharps injuries in the operating room. Hospitals and health care facilities should make sharps injury-reduction techniques and instruments available for surgeons and OR personnel."
There are many simple measures that providers can take to prevent injuries relating to sharps:
- Once used, all sharps should be placed in sharps containers, which should be placed near areas where sharps are utilized.
- Sharps containers should be inspected weekly and discarded when three-quarters full.
- Staff should assume that all contaminated sharps are infectious and treat the sharps as such.
- Every sharp must be discarded immediately after use into a sharps container.
- Staff should not force a sharp into the container or attempt to retrieve a sharp from the container.
- Staff should never bend, break, shear, or remove needles from syringes.
- Staff should not recap needles or syringes by hand.
- Staff should work with only one uncapped needle at a time and should keep other sharps in plain view.
- Most applicable to this case, sharps never should be left unattended.
It is clearly an accepted corporate responsibility that the hospital will maintain an environment that is safe. In the case of "sharps," the stakes are particularly high due to the risk of transmittal of blood-borne pathogens. In this case, it appears clear that the hospital did not meet the standard of care.
Reference
- Kentucky Superior Court, Boone County, Case No. 03-0617.
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