The Court of Appeals of Texas upheld his lawsuit against the hospital.  The Court endorsed the patients experts opinions that linked the amputation to negligence by the nurse who cared for him his second through fourth days in the hospital and failure by the nurses charge nurse on the orthopedic unit to advocate for the patient by initiating the nursing chain of command.  

  On his second day on the hospitals orthopedic unit the patient told his nurse he was losing sensation in his injured leg.  The nurse checked the leg and found the pulse was weak.  Both of those changes, diminished sensation and weakening pulse, pointed to compartment syndrome starting to develop in his injured extremity.   According to the Court, these were changes his nurse should have reported to the orthopedist or the hospitalist under a nurses general legal duty to report any and all significant changes in a patients health status to the physician.

  The next day the same nurse cared for the patient. She found and noted pitting edema the nurse rated as 3+ and the patient reported pain in the leg 8/10.  These new and significant changes in the patients health status were not reported to a physician.

  When one of the physicians saw the patient on his third day the physician himself found that the posterior tibial pulse was weak or absent.  The physician tried but was unable to obtain a dorsalis pedis pulse with the Doppler.  However, when the physician took no further action in the face of these developments the nurse was required to go her charge nurse.

  On the fourth hospital day the same nurse was caring for the patient.  She finally paged a physicians assistant when the patient’s labs came back with an alarmingly high CK value she recognized as a sign of tissue death.  Despite the fact the situation called for the immediate attention of a vascular surgeon the nurse waited four hours for a return call from the physicians assistant before she went to her charge nurse with the ominous lab value and the fact the physicians assistant was not responding to her page.  The charge nurse did not try to contact the physicians assistants supervising physician and tried only unsuccessfully to contact the patient’s orthopedist, the hospitalist, a vascular surgeon and the emergency department physician.

  At this point the charge nurse had the responsibility to advocate for the patient by going directly to the medical administration of the hospital to get something done.  The patient’s experts agreed that appropriate advocacy by the nurses more probably than not would have prevented the catastrophic outcome.

  The hospitals attorneys argued in the hospitals defense that the physicians were to blame for not being more attentive to the patient.  Several times during the patients course before his amputation the physicians themselves found signs of developing compartment syndrome and took no appropriate action.  One physician reportedly ordered anticoagulants for the patient which were wholly inappropriate.