Nurse As Patient Advocate: Information Makes The Case.

Nurse As Patient Advocate: Information Makes The Case.

Legal Eagle Eye Newsletter for the Nursing Profession

July 2017

Nurses are not expected simply to express disagreement with the patient’s physician without facts to make their case.

To advocate effectively for a patient a nurse is expected to convey relevant information to the physician about the patient’s condition that will persuade the physician to take a course of action more appropriate to the patient’s needs.

In this case the patient’s family’s nursing expert needs to explain more fully her allegations that the hospital’s nurses failed to advocate for the patient. To make out a case against the hospital the family’s nursing expert must show there was information about the patient about which the physician was unaware about which the nurses were aware which the nurses neglected to bring to the physician’s attention.

It is not sufficient for the expert simply to say after the fact that the nurses should have advocated for more tests and protested against transferring the patient. That would amount to trying to reason backward from the bad result to a conclusion that negligence was committed. SUPREME COURT OF TEXAS June 9, 2017

The thirty-six year-old mother arrived at the hospital by ambulance in the middle of the third trimester of her third pregnancy. She had been vomiting and experiencing fever and abdominal pain and was having mild contractions.

The emergency physician ordered various tests. The sonogram was normal. The MRI showed placenta accreta but no placental abruption. The physician deemed the mother’s condition serious but he did not see it as an emergency. He believed the mother and child would benefit from a higher level of care than the hospital could offer. After contacting a physician at another hospital 159 miles away who concurred with the transfer and agreed to accept the patient the emergency physician ordered her transferred by ambulance.

Unfortunately the mother’s condition bottomed out while the ambulance was stuck in a massive traffic jam very close to the destination hospital. By the time they finally got to the hospital the mother was in full cardiac arrest with a placental abruption. The mother died at the hospital and the baby was delivered stillborn by cesarean.

The Supreme Court of Texas ruled that the patient’s family’s lawsuit as it stands now does not have sufficient proof the nurses at the first hospital could and should have advocated effectively against the patient’s transfer to the second hospital. However, the Court did not dismiss the case. The family’s nursing expert was given time to supplement her opinion if she can find any information the nurses knew about and should have brought to the physician’s attention that would have convinced him keep the patient at the hospital. It was not sufficient for the family’s nursing expert simply to say that the nurses should have advocated for further testing and evaluation and for keeping the patient at the hospital. The Court saw no reason for the physician to have listened to the nurses unless they were armed with relevant information to make their case. Hospital v. Zamarripa, __ S.W.3d __, 2017 WL 2492003 (Tex., June 9, 2017).