By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Los Angeles
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Los Angeles
David Vassalli, 2016 JD Candidate
Pepperdine University School of Law
Malibu, CA
News: In 2011, a man fell 16 feet from a scaffold and landed on a concrete slab. The man was airlifted to a local hospital with a broken left leg, left foot, and left elbow. The man’s wife met him at the hospital, and the two stayed at the hospital while the man was treated. According to court documents, the next day the man began complaining to his wife of increasing pain in his left arm. The complaints of pain led the man’s wife to inform a nurse at the hospital that her husband needed to be seen by a physician. The nurse informed one of the medical staff, a first-year resident, of the patient’s increasing pain.
The first-year resident finally saw the man nearly six hours after the nurse informed her of the man’s condition. The first-year resident prescribed morphine and examined the man again another six hours later. An hour after the first-year resident consulted with the patient the second time, the supervising surgeon examined the man before surgery and discovered that the man’s left hand was numb and the pressure in his arm needed to be alleviated. The man was rushed to the OR for surgery on his left arm to relieve the pressure, but the man already had permanently lost the use of his left hand due to compartment syndrome. Compartment syndrome occurs when pressure builds inside an enclosed space in the body and restricts blood flow, which causes tissue damage to the affected area.
The man filed a medical malpractice suit that alleged that the first-year resident was negligent for failure to diagnose his compartment syndrome and promptly respond to his condition, and that the hospital was negligent for the conduct of its staff and for failing to adequately supervise its first-year residents. The hospital denied its staff was negligent and that the first-year resident was negligently supervised.
The jury found that the first-year resident was negligent for failure to diagnose the man’s compartment syndrome, and the hospital negligently supervised its first-year resident. As such, the hospital was held liable for the $1.57 million jury award, which consisted of $1.3 million for pain and suffering, loss of income, and disfigurement; and $275,000 for his wife’s loss of consortium and household services damages.
Background: On Feb. 2, 2011, a 51-year-old man, working as a carpenter, fell from a scaffold that was 16 feet high onto a concrete slab. The man was airlifted to a local hospital with a broken left leg, left foot, and left elbow. The man was admitted into the hospital and met there by his wife later that night. On Feb. 3, according to court documents, the man began complaining of increasing pain in his left arm. At approximately 7:45 p.m., the man’s wife informed a nurse of his condition and requested that he be seen by a physician. The nurse quickly relayed the message to a first-year resident, who did not examine the man until the next morning at approximately 2:25 a.m. The first-year resident prescribed morphine and again examined the man about 6 a.m. During her two examinations, the first-year resident did not detect that the man was suffering from compartment syndrome.
Compartment syndrome occurs when an injury or other event leads to excessive pressure building up inside an enclosed space in the body. The high pressure in that compartment of the body restricts blood flow to an area and affects nearby tissues. If the pressure is not alleviated, typically through surgery, severe tissue damage, loss of body function, or death can result.
An hour after the first-year resident’s last examination, the supervising surgeon examined the man and discovered the man’s left hand was completely numb and that he required immediate surgery to alleviate the pressure in his left arm. At 9 a.m., the man underwent surgery, and fibrous tissue constricting blood flow to the injured area of his left arm was opened to alleviate the pressure and increase blood flow to his hand. By the time of the surgery, 12 hours after his initial complaint of increased pain in his arm and six hours since he was first examined by the first-year resident, the man had completely and permanently lost the use of his left hand.
The man filed a medical malpractice lawsuit alleging that the first-year resident failed to diagnose and timely treat his compartment syndrome and that the hospital failed to properly supervise its first-year residents. The lawsuit sought to hold the hospital liable for the conduct of the first-year resident who, as well as other first-year residents, allegedly was required to work longer than 24-hour shifts, provide overnight coverage, and be responsible for 20 to 60 patients at a time. The hospital argued that failure to diagnose the compartment syndrome was not negligent and maintained that their first-year resident’s workload was not a factor and within the permissible scope of first-year residents.
The jury agreed with the man and found the hospital was liable for the loss of use of his left hand. Particularly, the jury found that the first-year physician was negligent for not diagnosing the man’s compartment syndrome earlier and the hospital was negligent in its supervision of its first-year resident. The man was awarded $1.57 million for his injury, which included $1.3 million for pain and suffering, loss of income, and disfigurement; and $275,000 for his wife’s loss of consortium and loss of household service damages.
What this means to you: This case shows that failing to comply with practice standards regarding the supervision of residents can lead to liability for a hospital. While there are no federal laws limiting the number of hours a resident can work, the Accreditation Council for Graduate Medical Education (ACGME) establishes recognized requirements for medical residents. Among the requirements are that first-year residents are not to work an average of more than 80 hours per week or 16 consecutive hours.
The ACGME assigns different guidelines, depending on what year the resident is practicing, such as a first-year resident having a 16-hour work cap and second- and third-year residents having a 24-hour work cap. In addition to the ACGME, some states have statutes in place limiting the activity of medical residents’ workloads. In this case, the injured man was able to produce evidence that the first-year resident was working shifts of longer than 24 hours and responsible for caring for 20 to 60 patients at a time. As such, the hospital failed to comply with accepted standards and was held liable for the injuries arising from her medical treatment of the patient. A hospital using medical residents should be aware of, and strictly comply with, ACGME standards and the regulations in its state regarding the supervision of its residents, including the different requirements regulating residents based on their year in residency.
Another lesson offered from this case is the need to address serious injuries in a timely manner and have physicians possessing the ability to recognize symptoms indicating the development of a more severe injury. As the man’s complaint alleged, compartment syndrome is caused by the type of serious injuries he experienced, and complaints of increased pain and swelling are signs it is developing. Had the man been examined sooner by the first-year resident or sooner after his complaints of pain by the surgeon, the compartment syndrome could have been detected, the man’s left hand still could be functional, and the hospital could have avoided liability. Physicians using resident physicians need to be extra vigilant when assigning these “student” physicians to round on their patients. The acuity level of each patient, along with the respective diagnoses, must be evaluated before making assignments. A first-year resident is probably more suited to round on patients who are stable, ready for discharge, and have uncomplicated medical issues. That said, physicians still have supervisory duties to their residents, and their residents have a parallel responsibility to consult with their supervising physicians about their patient assessments before taking any actions. This statement is especially relevant for the newer first-year residents. As such, hospitals should ensure patients with serious injuries exhibiting symptoms of a worsening condition are seen in a timely manner and by physicians capable of detecting their maladies.
REFERENCE
Superior Court of Washington, King County, Case Number 13-2-25430-1 (Dec. 21, 2015).
In 2011, a man fell 16 feet from a scaffold and landed on a concrete slab. The man was airlifted to a local hospital with a broken left leg, left foot, and left elbow. The man’s wife met him at the hospital, and the two stayed at the hospital while the man was treated. According to court documents, the next day the man began complaining to his wife of increasing pain in his left arm.
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