Legal Review & Commentary
Chemical disfigurement: $93,000 verdict in Texas
News: A woman went to an emergency department (ED) with severe muscle contractions and was given calcium chloride intravenously. The caustic material was inappropriately administered and her hand was so disfigured that reconstructive surgery was required. The jury returned a $93,000 verdict in the patient’s favor.
Background: The 40-year-old patient had undergone surgery to remove her parathyroid gland because of cancer. Without the gland, she was required to take a daily calcium supplement. When she inadvertently ran out of calcium, she experienced severe muscle contractions, which prompted her to go to the ED. When she arrived, the contractions were causing her to be short of breath. The ED physician ordered calcium chloride, provided intravenously. During one of the injections into the top of her hand, the calcium chloride extravasated under the skin, causing a chemical burn. Plastic surgery was required to repair the damaged tissue.
The plaintiff reported she has discoloration in cold weather and scarring involving this hand. She alleged that the doctor should have used calcium gluconate instead of calcium chloride because it is less caustic. Further, the plaintiff claimed that the IV was given in the wrong area, that it should have been administered into her arm rather than her hand. The plaintiff claimed the hospital was negligent, that the nurses improperly placed the IV, and that too much calcium chloride was administered too quickly.
The defendants contended that calcium chloride was appropriate and within the standard of care. The defendants maintained that since the patient’s muscle contractions were extremely acute, the calcium chloride dosage was correct. Further, the defendants maintained that the site for the injection was appropriate and that the risk of IV infiltration is one that could not be completely eliminated.
What this means to you: "In addition to other risks, emergency medicine has an attendant risk of not knowing its patients. In this case, the use of the most appropriate substance and locating the most appropriate place to inject the substance was compounded by the risk of treating a patient in extreme, emergent discomfort," says Ellen L. Barton, JD, CPCU, risk management consultant, of Phoenix, MD. "However, emergency department health care practitioners take their patients as they find them and, in this case, had the injection been properly placed in a vein no extravasation would have occurred. Therefore in the emergency room setting, it is clearly important to have protocols that will provide the greatest protection to all patients, which means providing for the appropriate substance injected in the appropriate place.
"The training and education of staff become critically important in assuring that protocols are actually followed, particularly in emergency departments. Although it can be argued that infiltration is a known risk of injection [emergency or not] that cannot be completely eliminated, it is well-known that proper placement of a needle in a vein can be verified by checking blood flow. Thus, this risk argument can be easily countered by appropriate education and training to avoid or at least mitigate such mishaps," adds Barton.
"Undoubtedly, where there is fire, someone can get burned. And, as these cases illustrate, when the patient is burned, damages against the providers may be anticipated. Credentialing, education, and training are critical elements to employ so that providers don’t burn their patients and in turn themselves. When equipment and materials are potentially flammable and caustic, there is not enough that can be said about the need for sufficient training and education for staff and professionals regarding their use. And, this training and education must also extend to handling the what if something goes wrong’ untoward incidents," concludes Barton.
Reference
• Karen Ippolito v. Tomball Regional Hospital and Dr. An Duc Tran, Harris County (TX) District Court, Case No. 1999-13588.
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