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Staph Infection Post-Operative: Nursing Care Was Not The Cause, Lawsuit Thrown Out
Legal Eagle Eye Newsletter for the Nursing Profession
Quick Summary: Post-operative wound infection is a known complication of surgery.
In this case there was not enough scientific proof for a civil judgment against a nurse for post-operative wound infection based on the nurse’s failure to give a Hibiclens shower pre-op and precisely-timed doses of antibiotic post-op.
True, it is a departure from the standard of care for nursing practice for a nurse to disregard a physician’s orders for the patient’s pre- or post-operative care.
However, for a patient to succeed with a professional malpractice claim based on a nurse’s departure from the standard of care for nursing practice, the patient is required to prove that the nurse’s conduct was the factor that caused harm to the patient.
A nurse may have the qualifications to testify as to standards of nursing practice in the pre-op and post-op care of cardiac surgery patients.
However, a nurse does not have the qualifications to give a medical opinion on the cause of a post-operative wound infection.
COURT OF APPEALS OF INDIANA, 1998.Many court cases of healthcare malpractice involve questionable conduct by a healthcare professional, and serious harm to a patient. But when the case comes to court the facts of the case fail to produce a verdict in favor of the patient. This often happens because the patient is unable to present strong scientific proof to the court of a cause-and-effect relationship between the healthcare professional’s misconduct and the harm which befell the patient. A recent case from the Court of Appeals of Indiana provides an illustration of this common scenario.
The patient came into the hospital for open heart surgery. Her surgeon ordered a pre-operative Hibiclens shower as a precaution against post-operative wound infection. The nursing staff did not see that she got the shower as ordered by the surgeon. The court did not say why this happened.
The surgeon also ordered post-operative cefamandole on a strict q 6 hour schedule until a total of nine doses had been given. According to the court record, the nurse administered the first three doses as scheduled, but the remaining six doses were given "sporadically." The court did not say why this happened either.
The patient went home. Soon she was having pain at the surgical wound site that brought her to the emergency room at another hospital. The emergency room physician diagnosed a staph infection at the wound site, and transferred her back to the first hospital. There she had to have her sternum removed, and had two additional surgeries to clean out her chest cavity and to create a chest wall. She was in critical care for four months before being discharged. She lived four more years, in continuous pain, according to the court.
Her claim against the hospital, her physician and a nurse was disallowed by a medical review panel. She filed a lawsuit in court anyway, and the court dismissed her case.
The basis for the dismissal was a lack of solid scientific proof of a cause-and-effect relationship between the patient’s post-operative wound infection and the nurse’s failure to give the Hibiclens shower pre-operatively and the nurse’s failure to follow the precisely-timed antibiotic schedule post-operatively.
The court accepted testimony from an experienced cardiac-care nurse brought in by the patient’s attorneys as an expert witness, that it is a departure from the standards of the nursing profession to disregard a physician’s orders. However, the court did not accept the nurse’s testimony as an expert on the issue of medical causation.
Instead, the court accepted medical testimony from a board-certified internist brought in as an expert witness on behalf of the hospital. The internist testified that the medical literature is unclear whether whole body disinfection with chlorhexidine prior to surgery has a significant effect on reducing the incidence of post-operative wound infection. The internist also stated references in the literature indicate that post-operative antibiotics are not considered a proven method of reducing the incidence of post-operative wound infection.
A court does not look at the medical literature itself. The court in this case refused to look at authorities cited by the patient’s attorneys to contradict the authorities the hospital’s expert witness had considered. A civil trial is a battle of the expert witnesses, in this court’s view to be decided on the basis of the credentials that stand behind the expert’s opinions.
According to the court, only a physician has the credentials to testify in court on the scientific issue of medical causation or lack of causation. Even though a nurse can testify the nursing care a patient received was deficient by nursing standards, only a physician can testify in court whether the deficient nursing care was the causative factor that harmed the patient. Long v. Hospital, 699 N.E. 2d 1164 (Ind. App., 1998).
More references from nursinglaw.com
http://www.nursinglaw.com/post-operative-care.htm
http://www.nursinglaw.com/post-surgical-care-nurse-patient.pdf
http://www.nursinglaw.com/post-surgical-infection.pdf
http://www.nursinglaw.com/complications-postoperative-nursing-negligence.htm
http://www.nursinglaw.com/post-operative-care-nurses-advocate-patient.pdf