Legal Review & Commentary
Acid mix-up burns patient, results in $500,000 verdict
News: A young female patient was burned and suffered nerve damage after trichloroacetic acid was improperly used instead of acetic acid during her colposcopy. She sued for damages and was awarded $500,000 for pain and suffering.
Background: A 24-year-old female patient was seen by her obstetrician/gynecologist for a scheduled, routine checkup colposcopy. During the procedure, that plaintiff felt a severe burning sensation and began writhing in pain. The procedure was discontinued, and the OB/GYN discovered that instead of acetic acid being used to swab the plaintiff's cervix, trichloroacetic acid (TCA) had been used.
The patient claimed that the medical assistant who was an employee of the clinic where the procedure was performed negligently handed the wrong acid to the treating physician. Furthermore, she claimed that the physician was negligent for not double-checking the material being handed to him prior to its application. She claimed that she suffered severe vaginal burns and sloughing of her vaginal walls, causing permanent damage to the nerves inside the vaginal wall and chronic painful vaginal spasms during intercourse due to the practitioner's errors.
The OB/GYN successfully argued that he properly relied upon the medical assistant to have the appropriate materials for the procedure. The medical assistant averred that the patient's injuries were not caused by the application of the wrong chemical but were related to infections and other problems the patient experienced prior to the incident.
The jury returned a verdict in favor of the physician but against the medical assistant and her employer. The patient received $500,000 in pain and suffering damages.
What this means to you: "Care providers must understand that acids used topically are medications that pose the same risks as those administered orally or intravenously. Thus, the same care must be given to ensure that the correct acid in the prescribed concentration is used to prevent injury. In this case, using TCA instead of acetic acid was found to cause severe vaginal burns with long-term consequences to the patient," notes Cheryl Whiteman, RN, MSN, HCRM, clinical risk manager for Baycare Health System in Clearwater, FL.
"While the incident took place in physician's office rather than a more regulated outpatient or inpatient facility, someone should be charged to investigate the occurrence and determine if there are ways to avoid such instances in the future. To investigate this event, the risk manager or other staff member should determine how solutions are and should be stored. Safeguards should be implemented to prevent inappropriate use of potentially caustic solutions. This would include using warning labels and tall man lettering, where appropriate, to help differentiate between solutions that may have look-alike and/or sound-alike names. Certainly acids or solutions that are not appropriate for direct application to the patient should be removed from the patient care area. Sometimes it can be as simple as making a decision to store and/or label materials differently," observes Whiteman.
"Just as should be with prescriptions for and administration of medications, physician orders for acids and topical solutions should be clear, including the proper use of decimals and appropriate use of zeroes. Pharmacists should mix any nonstandard solutions to ensure that the concentrations are appropriate and calculated and mixed accurately," adds Whiteman.
"As we saw in the last case, TCA may be used in various topical applications," she says.
"In higher concentrations, such as 35%, TCA regularly is used as a chemical peel. In lower 1% to 5% solutions, TCA may be used an astringent antiseptic or as an escharotics for venereal or other warts, and it is also used widely as protein precipitant. This is probably why the solution was handy in the OB/GYN's office; however, when treating genital warts, it is important to treat only the wart to avoid irritation to the surrounding normal tissue, for it is difficult to control how deeply the acid penetrates the skin."
"While we are not told how strong the TCA was, given the severity of the burns and fact that it was stated by the defense that the wrong solution was used, we can only assume that the concentration was high enough to cause damage. As always, you take the patient how they are, and so underlying ‘infections and other problems' the patient may have been experiencing is no excuse for poor care, and neither is a particular patient's hypersensitivity," adds Whiteman.
"It is essential that those involved in the use of acids and solutions understand their role in administration. Policies and procedures should be established that clearly define who is responsible for verifying the solution; all involved, including physicians, nurses, assistants, and technicians, should be educated in regard to the policies so that they understand their responsibilities. This should help in establishing accountability and prevent the finger-pointing elicited by the physician and the medical assistant in defending their positions. Medication safety is a team effort," she concludes.
Reference
• Cobb County (GA) State Court, Case No. 99A4764-5.
News: A young female patient was burned and suffered nerve damage after trichloroacetic acid was improperly used instead of acetic acid during her colposcopy. She sued for damages and was awarded $500,000 for pain and suffering.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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