By Damian D. Capozzola, Esq., and Jamie Terrence, RN
News: A judge in Arkansas awarded a patient more than $2 million after a series of failures led to a missed diagnosis of sepsis and delayed treatment of a severe infection. The court found both the nursing staff and the attending physician negligent after a nurse initially failed to code the patient’s symptoms properly as a Code Sepsis. This case is a reminder to screen patients properly from the outset to avoid additional negligence risks that can compound the initial failed screening.
Background: The patient sought medical care at a hospital for respiratory problems and cough. After undergoing various tests, including a bronchoscopy, he was diagnosed with histoplasmosis and instructed to return for a follow-up CT scan in six months. Days later, the patient visited the ED, reporting fever, chills, cough, and fatigue. However, the nursing staff failed to properly note his fever of 100.3° F, which would have triggered a Code Sepsis and a different course of treatment. After the missed Code Sepsis, the attending physician failed to obtain a complete history, failed to review nursing notes, and diagnosed the patient with acute bronchitis based on incomplete information. The physician discharged him without conducting a thorough examination or ordering further tests.
Two days later, the patient returned to the ED with worsening symptoms, including difficulty breathing and vomiting. He was diagnosed with pneumonia, and a CT scan revealed lung and retropharyngeal fluid, mediastinum inflammation, and emphysema. Necrotizing fasciitis was discovered during surgery. Subsequent procedures were required to remove the infection.
The patient filed a claim of medical malpractice, alleging negligence from the nursing staff and attending physician. The court determined the nursing staff breached the standard of care by failing to properly screen the patient for sepsis, communicate relevant information, and repeat abnormal vital signs. The physician was found to have breached the standard of care by neglecting to obtain a complete history, review nursing notes, conduct a thorough examination, and order appropriate tests. The court concluded if the patient had been admitted to the hospital and received proper treatment, his condition would have been identified earlier, leading to timely administration of antibiotics and a better outcome. The patient was awarded more than $2 million in damages, covering past and future medical expenses, permanent injuries, disfigurement, and pain and suffering.
What this means for you: This case highlights the importance of screening patients properly and the compounding risks for nurses, physicians, and hospitals that can result when staff miss a screening. The patient sought medical care for respiratory problems, but due to failures in screening, diagnosis, and treatment, his condition worsened, leading to severe complications. The court found both the nursing staff and attending physician negligent, resulting in significant damages awarded to the patient. This case serves as a crucial reminder for physicians regarding the importance of thorough screening, accurate diagnosis, comprehensive patient history review, and appropriate treatment decisions, detailed below.
• Importance of proper screening: In this case, the nursing staff failed to screen the patient for sepsis, overlooking critical symptoms and neglecting to initiate necessary tests. For physicians, this highlights the crucial role of meticulous screening protocols. It is imperative for healthcare professionals to be vigilant and identify potential red flags indicating severe conditions such as sepsis. Timely recognition and appropriate action can significantly affect patient outcomes.
• Comprehensive patient history review: The attending physician’s failure to obtain a complete history and review nursing notes is a critical aspect that led to the misdiagnosis. Physicians must recognize the significance of gathering comprehensive patient information, including medical conditions, previous test results, and relevant nursing observations. Neglecting this step can hinder accurate diagnoses and impede the delivery of appropriate care.
• Thorough examination and diagnostic testing: The attending physician diagnosed the patient with acute bronchitis without conducting a thorough examination or ordering further tests. Physicians must not solely rely on initial impressions or incomplete information when making critical medical decisions. A thorough evaluation and use of diagnostic tools are vital for accurate diagnoses and effective treatment planning.
• Timely administration of treatment: The court concluded the patient’s condition would have been identified earlier if he had been admitted to the hospital and received proper treatment. This underscores the significance of prompt and timely intervention in managing medical conditions effectively. Physicians should prioritize early diagnosis and timely administration of appropriate treatments to enhance patient outcomes and minimize potential complications.
• Lessons on communication and collaboration: Effective communication among healthcare professionals is essential to ensure comprehensive patient care. In this case, the nursing staff’s failure to communicate relevant information to the attending physician hindered the overall assessment and subsequent treatment decisions. Providers must foster a collaborative environment, promoting open lines of communication and emphasizing the importance of sharing critical patient information across the healthcare team.
This case also shows it is critical for a physician reviewing the assessment of another healthcare provider, such as a nurse, therapist, or even another physician, to note not only what information is present, but what is not present. The data gathered are part of a total picture that is needed to formulate a diagnosis. If pieces of the picture are missing, moving forward with a diagnosis is extremely risky for the patient and all involved with providing care. This patient’s presenting symptoms were classic for possible sepsis. The first measurement required is core body temperature. The body responds to bacterial or viral infections by elevating its core temperature to create an environment harmful to invading microorganisms, thus reducing their ability to grow and spread into surrounding tissue and the blood. Untreated infections of all kinds can lead to severe sepsis, metabolic acidosis, and death within hours and days, depending on factors such as pre-existing conditions. A failure of the triaging or admitting nurse to measure the patient’s temperature or to measure but fail to record it would be a breach in the standard of nursing practice.
Another critical response to infection is the production of more white blood cells. These cells attack invading microorganisms and provide another means of protecting the body from sepsis. A routine blood test will reveal the presence of this response. All these measurements combined with the patient’s subjective comments, medical history, recent travels, exposures to others who may be ill, medications, immunosuppressive treatments given, and more form the picture. The attending or treating physician must assure all data are in the record. If a piece is missing, the physician seeks it out. A prudent nurse not only documents data accurately and completely — he or she also calls the patient’s physician to report values that are in a critical range. This extra step saves lives since some physicians are less than meticulous about reviewing nurses’ notes.
The COVID-19 pandemic is changing how medicine is practiced. Despite the cooling of restrictions, many hands-off habits and shortcuts remain. Extra vigilance is required by all.
This case serves to remind providers how their actions can significantly affect patient outcomes. Thorough screening, comprehensive patient history review, diligent examination, and appropriate treatment decisions are vital components of providing quality healthcare. By learning from this case and emphasizing these aspects in their practice, providers can enhance patient safety, lower the risk of medical errors, and ultimately provide optimal care to their patients. Continuous professional development, staying updated with current medical guidelines, and prioritizing patient-centered care are essential for providers to prevent similar incidents and improve the overall quality of healthcare.
REFERENCE
• Decided May 4, 2023, in the United States Federal Court for the Eastern District of Arkansas, Case No. 4: 21-CV-00416.
This case highlights the importance of screening patients properly and the compounding risks for nurses, physicians, and hospitals that can result when staff miss a screening.
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