The patient came to the emergency department complaining of knee pain.  The physician diagnosed a knee strain and ordered 60 mg of Toradol IM.  The patient received an IM injection from the emergency department nurse in the left deltoid of 60 mg of Toradol in 2 ml of fluid.  Immediately afterward the patient felt pain radiating up and down the arm.  The next day there was pain, swelling, tingling, spasms and weakness in the arm.  An orthopedist eventually diagnosed complex regional pain syndrome post Toradol injection.

  The Court of Appeals of Texas accepted the patient's nursing expert's opinion that the hospital's protocol for intramuscular injections violated the legal standard of care, in that the protocol was based on an outdated nursing text.  The Court threw out the local county judicial court's ruling which erroneously granted a summary judgment of no liability in favor of the hospital.  However, before the patient will be entitled to an award of damages from the hospital the patient's attorneys will have to convince a jury to accept her expert physician's opinion that her symptoms after the incident were in fact caused by the Toradol injection and not some other factor. Bowser v. Craig, 2015 WL 3946371 (Tex. App., June 29, 2015).

  The patient's laminectomy and spinal fusion procedure went ahead without a hitch.  Then at 2:00 a.m. the next morning a lab technician found the patient cyanotic and unresponsive in his med/surg hospital room.  He died two days later from anoxic brain injury due to respiratory arrest.  In the post-anesthesia care unit (PACU) two resident physicians had written duplicate orders for narcotics which were both given by a PACU nurse.  The patient was also medicated in the PACU with patient-controlled anesthesia (PCA).  The PACU nurse added PCA dosing to the patient's own on orders from the anesthesiologist.  On leaving the PACU for a med/surg floor the patient was handed a take-home dose of an oral narcotic.   On the med/surg floor the nurses gave him more pain medication and a sleeping pill before he was found unresponsive.

  The patient, only twenty-four years old, was on hospice care due to an uncorrected congenital heart defect that had plagued her with pulmonary hypertension.  She was admitted to the hospital for a palliative paracentesis procedure to drain fluid accumulation from her abdomen.  The medication reconciliation form completed by the admitting nurse indicated a twice-daily 2.5 mg Vasotec dose.  In fact, the primary care physician had reduced the Vasotec dose to 1.25 mg twice daily.   She was given the 2.5 mg dose over a complicated hospital course and died.

  The Court of Appeals of Kansas affirmed the jury's verdict that the admitting nurse and the patient's hospitalist physicians were not responsible for her death. The admitting nurse's and the patient's mother's testimony were at odds over whether the mother brought in the patient's current pill bottles.  The nurse testified she would have charted those current medications if the mother had done so. The nurse acknowledged she relied on five-month-old hospitalization records for the Vasotec dosage and did not look for records or contact the primary care physician's office, which would have revealed the fact the dosage had been lowered. Nevertheless, the jury declined to find fault. Dickerson v. Hospital, __ P. 3d __, 2015 WL 1510679 (Kan. App., April 3, 2015).

  An LPN was let go from her position in a nursing home just three days after she fell at work and broke several ribs and pinched a nerve in her elbow.  She missed no work before being fired but basically sat around for a few days doing sedentary tasks and did not work directly with patients or pass medications.  The LPN sued for disability discrimination.

  The US District Court for the District of Oregon let her case go forward.  The LPN was ostensibly fired for medication documentation errors discovered in a look-back review of her charting done right after she was injured.  The Court was suspicious of the timing of her firing, three days after her injury, before she saw her doctor and before a physician's opinion could be obtained as to her physical capacities so an interactive process could be started to determine if a reasonable accommodation was possible.  The LPN was also able to prove that other nurses with the same numbers of documentation errors, who were not disabled, were offered counseling and were not fired. McDonald v. Care Center, 2014 WL 3892969 (D. Ore., August 7, 2014).

  The jury awarded the family $1,250,000 as punitive damages, $400,000 for her pain and suffering and $554,000 attorney fees and costs.  The US Court of Appeals for the Sixth Circuit (Ohio) upheld the verdict.

  Two former employees of the nursing home described disturbing conditions at the facility, including disorganized medication carts, pre-pouring of medications and falsification of medical records.  There were only two LPNs assigned for the care of eighty residents. The LPNs were often rushed and as a result of their haste regularly engaged in the practice of pre-pouring medications.  The medication cart was "a mess" most of the time.  The wrong pills were in the medication trays.  The nurses would borrow medication from one resident and give it to another.  At the time of her death more than fifty of this resident's pills were found to be missing.  A supervisor altered records to cover up a medication error.  Staff and supervisors routinely filled in "holes" in residents' medication administration records retroactively at the end of the month.  In the Court's judgment, the whole situation went beyond simple negligence and justified the jury's decision to award punitive damages for conscious and malicious disregard of the resident's well established legal right to a safe environment free from significant medication errors. Freudeman v. Landing, __ F. 3d __, 2012 WL 6600356 (6th Cir., December 19, 2012).

  The facility's policy is for employees to document medications as the medications are administered.  The aide had been told and she knew what the policy was, yet she waited until the end of her shift to document her medications in the medication administration record. The aide was guilty of misconduct and her termination was justified.  COURT OF APPEALS OF MINNESOTA September 17, 2012

  A home health aide worked in a group home for residents with traumatic brain injuries.  Her job included administering medications to residents and documenting the medications in the medication administration record.  For medication errors the group home's policy was to counsel and warn an employee for the first four incidents and then to terminate the employee after a fifth.  The aide was terminated after her fifth medication error, having been counseled and warned after each of four previously.  

  An LPN was fired from her position in a nursing home after she transcribed via the facility's computer system a telephone order into a resident's chart from the resident's physician for 5 mg of sublingual Roxanol q 4-6 hours prn for pain as 5 ml instead of 5 mg.

  The Court of Appeals of Ohio ruled the nursing home had legal grounds to terminate the LPN for cause, that is, the LPN was not entitled to unemployment benefits.  The Court said it was not a factor in the LPN's favor that her charting error was discovered through the facility's own internal system of checks and balances before any actual harm occurred to a patient.  The LPN was not entitled to progressive discipline, that is, a write-up and plan of correction before being fired, as her error was so severe that it amounted to a violation of the law.   By law all medications must be administered according to the physician's directions and, by law, an LPN is required to have at least baseline competence in the administration of medications.

  After this incident Federal inspectors found that the hospital had no methodology in place to identify patterns of repeated medication errors by specific staff members, had not discussed trends for medication errors at quarterly quality assurance meetings and thereby failed to insure that its patients were free of significant medication errors as required by state and Federal regulations.  

  A medical facility's failure to provide appropriate safety precautions and staff training may constitute a basis for awarding a patient punitive damages if it is shown to amount to conscious disregard for patient safety.  Punitive damages are added to ordinary compensatory damages and in many cases far exceed the amount of the compensatory damages awarded. NEW YORK SUPREME COURT APPELLATE DIVISION January 12, 2012

  Willful failure to disclose pertinent medical information which a patient or patient's representative has the right to receive can be grounds for punitive damages, the Court went on to say.  The Court also found it problematic that the physician did not come to the hospital to see the patient and the Court felt the physician erred by ordering the glucose testing discontinued during the night until the next morning. Marsh v. Med. Ctr., __ N.Y.S. 2d __, 2012 WL 87957 (N.Y. App., January 12, 2012).

  The hospital used Children's Tylenol exclusively, which is three times less concentrated than the Infants' Tylenol the parents had been giving the child.  The nurse simply told the parents how often to give a full teaspoon, which was a major overdose since the parents were using a more concentrated product.  The nurse did not give the parents the manufacturer's printed dosage sheet with correct doses for different Tylenol products, a violation of hospital policy. COURT OF APPEAL OF LOUISIANA December 7, 2011

  The Court of Appeal of Louisiana approved a verdict finding the hospital 70% at fault and the parents 7% at fault.  The manufacturer of Tylenol appealed it's 23% allocation of fault unsuccessfully.   Most of the Court's lengthy opinion dealt with products-liability law.  The manufacturer's financial exposure for a fractional share of the multimillion dollar jury verdict is not limited like the hospital's by Louisiana's cap on medical malpractice damages. Hutto v. McNeil, __ So. 3d __, 2011 WL 6058038 (La. App., December 7, 2011).

  The nurse cannot raise the issue of discrimination as a defense to his termination.  The facility is correct that the nurse in question failed to prove that he was performing his duties at a level that met the facility's legitimate expectations at the time of his termination.  The facility had legitimate, non-discriminatory reasons for firing him, despite the fact he was a minority.

  Other nurses were counseled for their documentation issues rather than terminated.  However, their situations were not the same. One, unlike him, was basically still in training.  Another nurse violated any given rule only once before accepting correction. UNITED STATES DISTRICT COURT MARYLAND October 5, 2011

  A male nurse of Russian ancestry was terminated from his position in the ICU after a series of errors in the administration and documentation of narcotics.  One of the incidents involved IV bags hung during the night containing fentanyl which emptied much more rapidly than the ordered drip rate, without evidence of leakage or patient overdose, leading to suspicion the nurse injected himself.  The rest were basically failures to adhere strictly to rules for correct documentation.

  Even if an employee has been proven guilty of misconduct that justifies termination or other severe disciplinary measures, the employee can still sue for discrimination if other non-minority employees were not disciplined as severely for basically the same offense or offenses.  Another nurse was verbally warned, not fired, for a series of medication errors, but she had not yet completed her competency training like the nurse in this case had.  Still another nurse was also counseled rather than fired, but he violated several different facility policies only once each before accepting correction, not the same rules over and over again like the nurse in this case. Volochayev v. Sebelius, 2011 WL 4747898 (D.Md., October 5, 2011).

  A former employee cannot sue a former employer for defamation over a derogatory statement in a personnel file if the statement was put in the file with a good-faith belief as to its truth.  Employers have a legitimate legal interest in communicating candidly regarding an employee's or former employee's job performance.   As long as an unsatisfactory impression of an employee's competence is supported by proven factual evidence, the employer can communicate that impression to potential future employers.  An em-ployee must prove lack of good faith or actual malice to sue for defamation. Hatton v. Interim Healthcare, 2007 WL 902176 (Ohio App., March 27, 2007).

  The Court of Appeal of Louisiana, in approving the jury's limited verdict, pointed to the fact he had been on anticoagulants for some years, was having bouts of confusion which could have been caused by cerebral vascular insufficiency, and had to have plaque removed from his carotid arteries before the doctors would be willing to go ahead with the colon cancer surgery.  With such a complex pre-existing history there is no presumption that an accident produced an injury which showed up after the fact, the court said. Desselle v. Hospital, __ So. 2d __, 2004 WL 2291554 (La. App., October 12, 2004).