Legal Eagle Eye Newsletter for the Nursing Profession (6)11 Nov 98

   The physician had ordered the patient’s activity increased, but only as tolerated.  APPELLATE COURT OF ILLINOIS, 1998.

   The patient had back surgery. Her physician ordered strict bed rest for two days. On the second day the physician changed the order to increase the patient’s activity. The patient was to be up and out of bed, with assistance, as tolerated.

   On the second day the patient’s nurse, without any physician’s orders, reduced the medication available through the patient-controlled analgesia to one-tenth of what was prescribed. As a result, the patient barely slept during the night between the second and third days after surgery. The patient was unable to fall asleep until 6:00 a.m.

   At 11:00 a.m. on the third day the same nurse who had cut back the patient’s PCA woke the patient. She told the patient she was supposed to get up out of bed so that the nurse could make her bed. The patient said she was in a lot of pain and did not want to get up.

   According to the Appellate Court of Illinois, the nurse started tugging at the patient’s arm. The patient told the nurse that was hurting her. Then the nurse moved both the patient's feet so her feet were hanging off the bed.

   The patient’s pain became excruciating. She pleaded with the nurse to leave her alone. The nurse forced the patient to a standing position and then shoved her into a straight-back chair. When the patient said she felt faint, the nurse pushed the patient’s head down between her legs. Then the nurse took a sheet off the bed and tied the patient to the chair. The nurse moved the call button out of the patient’s reach and left the room for ten minutes. She came back with some linens and another individual to help her make the bed. They made the bed and put the patient back to bed.

   The court ruled this nurse’s conduct was not just ordinary negligence, it was gross negligence. The legal significance of the gross negligence ruling was that the patient did not have to have testimony from an expert witness on standards of professional nursing practice to succeed with a lawsuit against the hospital which employed this nurse. When a patient is crying out in pain, according to the court, any lay person can tell the patient is not tolerating the activity and that the activity must be discontinued for the patient’s sake.

   The court noted that in some cases the assessment of a patient’s tolerance is a professional nursing judgment, such as when serial vital signs must be taken and evaluated during an activity. Prairie v. University of Chicago Hospital, 698 N.E. 2d 611 (Ill. App., 1998).