Legal Eagle Eye Newsletter for the Nursing Profession(4)1 Oct 95 

   Quick Summary: The most likely cause of the ulnar nerve injury was that the arms on armboards were not extended more than forty-five degrees, which increased the likelihood the surgeon would inadvertently lean on the arm near his work area while carrying out the surgical procedure. The standard of care requires that the arms be positioned so that the surgeon will not come in contact or lean on them during the procedure.

   The jury in this case assigned fault on the following basis: 70% to the anesthesiologist, 20% to the surgeon and 10% to the hospital as the employer of the circulating nurse. The Court of Appeals of Louisiana upheld the jury’s ruling.

   The patient underwent abdominal surgery to repair a hiatal hernia. He was positioned on the operating table with both his arms extending outward from each side of the operating table on arm boards. The surgeon stood at his right side throughout the procedure, which lasted one hour and twenty minutes, according to the court record.

   When the patient got to his room afterward, he reported numbness and tingling in his right hand. This persisted well past his discharge from the hospital. The patient later underwent outpatient nerve conduction studies which revealed an ulnar nerve injury, which did not respond to physical therapy. Tests ruled out other causes for the condition besides injury in the operating room. There was a procedure done to reposition the ulnar nerve, which was only partially successful in relieving the numbness and tingling and in restoring function to the injured arm.

   The expert testimony at trial was that the standard of care required the patient, when arm boards are used, to have his arms positioned with palms up, with plenty of padding under them. The arms should be extended at ninety degrees. There must be a special elbow protector placed under the elbows.  Robertson vs. Hospital Corp. of America, 653 So. 2d 1265 (La. App., 1995).

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