Medical Malpractice or Negligence

Medical Malpractice or Negligence

Medical malpractice or negligence are serious compromises in quality during care provision that often harm the patients. In medical malpractice, the healthcare provider is aware of the consequences before indulging in the malpractice, but medical negligence is usually due to an honest mistake. Medical malpractice and negligence not only contravene the provisions of ethics and standards of practice but are also a contravention of civil law. Medical malpractice and negligence laws are not native to the United States legal system but were adopted from English law. Currently, medical malpractice law has been adopted in all states, with states differing on the nature of litigation they attract against providers who contravene these provisions (Michalak, 2021). This paper details an actual case of medical negligence and the organizational response to it.

Case Presentation and Organization Responses

In the Southern District Hospital in Minnesota, a case of negligent care was reported. A 67-year-old Caucasian female was admitted to the hospital with heart failure. On conducting a pressure ulcer risk assessment, the patient was at risk for pressure ulcers, as indicated by her limited mobility. Skin assessment results also suggested that the skin in the pressure area was vulnerable to pressure ulcers. On her first assessment post-admission, skin assessment revealed no skin damage on her buttocks. Redness was observed in her left buttock and the hip area. It was recorded that the patient was to be turned every two hours, and a barrier cream was to be applied to the affected parts. However, this failed to be recorded. Throughout her admission post-assessment, the patient was not turned, and the barrier lotion was not applied.

On the subsequent assessment, the patient was referred to a tissue viability nurse. The nurse documented that the patient had an infected pressure ulcer on the hip and left buttock regions. The patient was given an octenisan bath before being repositioned in bed. The patient was discharged from the hospital and transferred to a nursing care home, where the pressure ulcer sore was noted pre-admission. The chief nursing officer in the hospital launched a formal investigation into the matter to unearth the act of negligence. The patient’s caregivers also lodged a formal complaint and sought legal interventions.

Preliminary findings on the issue reported several counts of negligence on the nursing end. These include failure to record the recommendation of turning the patients, applying the barrier cream on the patient, and failure to turn the patient every 2 hours. According to Cheluvappa & Selvendran (2020), medical negligence arises when the patient is accorded substandard treatment or treatment that is not consistent with the standards of medical practice. Pressure ulcers are a common presentation among patients with limited mobility. Standard nursing management of pressure ulcers includes regularly changing the patient’s position and dressing and applying barrier cream(Boyko et al., 2018). Patients considered at risk for pressure ulcers should be closely monitored for the development of pressure sores to prevent infections that may complicate their health condition.

In the case presented, the treatment accorded to her was inconsistent with the standard nursing management of pressure sores. The hospital’s administration sought to pursue the matter internally by employing its investigative team. A preliminary investigation into the case established that the burden of proof lay on the two nurses who were in attendance during the initial assessment of the patient, the nurse in charge, and the nurse who handled the shift the following day. The first two nurses were held liable for failing to document the recommendations by the physician. While the lead physician stated that a barrier be applied and the patient be turned every two hours, that was not recorded and done. The nurses on shift the next day were also liable for similar claims. The nurse in charge failed to oversee the activities of the junior nurses in her unit.

Detailed investigations placed the burden of proof on the two nurses on shift during the first assessment. According to Minnesota’s statutes on malpractice, medical negligence becomes malpractice if the healthcare provider’s actions harm the patient by making their condition worse, resulting in unwanted or unreasonable complications, or necessitating an additional medical practice (Gjelten, 2022). The nurse’s actions in the case presented resulted in unwanted complications of pressure sores that warranted further treatment. Additionally, the condition warranted additional care intervention. The nurses’ actions thus surmounted medical malpractice. As per the hospital’s policies, all malpractices are handled by an arbitrary board established by the hospital administrators and only prosecuted if there is a reasonable cause. Since the patient’s relatives were also pursuing the matter, the hospital’s arbitrary board forwarded the matter to the legal system.

As per Minnesota statutes, the time limit for filling malpractice cases and claims is four years. Minnesota malpractice laws require that the plaintiff presents evidence of malpractice before the case proceeds. These include an expert review affidavit and an expert witness testimony identification. As per the state’s statutes, contravention of malpractice laws attracts financial damages. The state does not have a specific set cap for the number of damages that could be levied on an individual if found guilty as charged (“2021 MN Statutes”, 2022). In the case presented, the two practitioners were found liable and in contravention of the state’s malpractice laws. They were fined 20,000 dollars each, which was awarded to the claimant. The hospital readmitted them back to service after six months of probation with a recommendation for further training and close supervision.

The hospital’s response in this regard was prompt and appropriate. Upon the establishment of an act of neglect, the hospital prioritized the patient and referred her to a tissue viability nurse, who diagnosed her with an infected pressure sore. This was consistent with nursing standards of practice and the provision of ethical codes that require that the healthcare providers do good to the patients. Untreated infected pressure sores can result in septic shock (Espejo et al., 2018). It was thus appropriate for the healthcare organization, in this case, to first consider the welfare of the patient before initiating an investigation of the matter.

The hospital also took responsibility for the case and initiated its investigative process on the matter. The hospital, through its investigative body, did a preliminary search into the matter and placed the burden of proof on a section of its staff. Systemic cover-ups are a common practice among many hospitals in the United States. There have been allegations that hospitals and healthcare providers sometimes cover up acts of malpractice (Heywood, 2021). This is often due to fear of losing accreditation. The Joint Commission prescribes higher standards of healthcare practice and requires healthcare systems and providers to offer safe and quality healthcare to the public. Multiple counts of malpractice and other quality breaches often lead to the revocation of accreditation and certification by this independent body. Healthcare systems sometimes conceal these acts and opt for settlement with the affected patients. This hospital, however, did not cover up these acts of negligence committed by its staff but allowed it to take its course per Minnesota statutes.

Forwarding the case to the legal system within the state was another commendable action by the hospital. As per the Minessota laws on malpractice, a practitioner’s actions surmount malpractice if they cause harm to the patients. Malpractice is a civil case that attracts civil action (“2021 MN Statutes”, 2022). It was, therefore, the legal system, not the hospital’s arbitration office, that decided the appropriate litigation on the involved parties. Furthermore, the family members of the affected staff were also seeking justice for their kin. In the end, justice was served to the complainant, and the hospital was able to single out the root cause of the malpractice and the individuals involved.

The hospital’s response was also robust and thorough. It wedged the burden of accountability on a wide range of the hospital’s personnel. This is an indication of their commitment to safety and quality care provision. This is also a wake-up call to other hospital personnel to maintain responsibility and accountability for their actions. It also demonstrates the significance of shared responsibility in a healthcare setup.

The hospital also allowed the involved parties to resume their duties under close supervision. This was a demonstration of fairness in the hospital’s administration, showing the hospital’s conformity to the principles of social justice in healthcare. Social justice demands that individuals be treated with all fairness regardless of their backgrounds and disabilities (Habibzadeh et al., 2021). The understanding that these practitioners were first-time offenders and had never been involved in such experiences meant they deserved a second chance. In its realization of these individuals’ accountability and responsibility to self, the hospital accorded them this second chance. By supervising their actions, these individuals will regain their confidence, expand their nursing knowledge, and return to their normal practices.

Hospital’s Implementation of Appropriate Changes/ Opportunities to Prevent Further Events

After the incident, the hospital made several changes in its operationalization. The hospital developed a policy of shared responsibility that ensured that the patients’ responsibility was not bestowed on any single individual at any one time. In this regard, documentation, patient handling, and medication administration duties are executed by a nurse in the presence of an overseer nurse, physician, or pharmacist unless there is an emergency. The hospital also developed a handover policy that ensured nurses retiring from their shifts made duplicate report accounts of pending care interventions and sent a copy to the in-charge nurse. The in-charge nurses were expected to overlap their shifts between any two shits to enable a seamless transition of care services.

The hospital also established a framework for reporting suspected negligence and malpractice cases at the point of their discovery. By the new rule, all suspected cases are reported to in-charges at the fastest convenient time and prioritized by the healthcare teams. This was a preventive measure to curtail any delays in reporting and care that may further jeopardize the safety of the patients in the future. The hospital also strengthened its investigative and arbitration offices to enable them to handle quality compromises internally.

As a strategy to restore the faith of their patients in their healthcare delivery processes, the hospital established a platform for reporting complaints and giving feedback on care services provided in the hospital. These feedback platforms allowed patients to comment on health services without disclosing their identity. The hospital further established a framework for auditing these feedback reports to inform on quality enhancement measures within the hospital. All these measures cemented the hospital’s capability to prevent malpractices and negligence and respond to them whenever they occur.

Medical malpractices and negligence remain serious compromises in quality care that often cause harm to the patient. These actions contravene the provisions of ethics and civil law and usually attract litigation. Litigation weighed on malpractices differs by state and is dependent on the statutes of malpractice law of the state. Monetary damages are often wedged on those found guilty of malpractice, as seen in the case.

References

2021 MN Statutes. Revisor.mn.gov. (2022). Retrieved 19 September 2022, from https://www.revisor.mn.gov/statutes/.

Boyko, T., Longaker, M., & Yang, G. (2018). Review of the Current Management of Pressure Ulcers. Advances In Wound Care, 7(2), 57-67. https://doi.org/10.1089/wound.2016.0697

Cheluvappa, R., & Selvendran, S. (2020). Medical negligence – Key cases and application of legislation. Annals Of Medicine And Surgery, 57, 205-211. https://doi.org/10.1016/j.amsu.2020.07.017

Espejo, E., Andrés, M., Borrallo, R., Padilla, E., Garcia-Restoy, E., & Bella, F. (2018). Bacteremia associated with pressure ulcers: a prospective cohort study. European Journal Of Clinical Microbiology &Amp; Infectious Diseases, 37(5), 969-975. https://doi.org/10.1007/s10096-018-3216-8

Gjelten, E. (2022). Minnesota Medical Malpractice Laws & Statute of Limitations. www.alllaw.com. Retrieved 19 September 2022, from https://www.alllaw.com/articles/nolo/medical-malpractice/laws-minnesota.html.

Habibzadeh, H., Jasemi, M., & Hosseinzadegan, F. (2021). Social justice in health system; a neglected component of academic nursing education: a qualitative study. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00534-1

Heywood, R. (2021). Systemic Negligence and NHS Hospitals: An Underutilised Argument. King’s Law Journal, 32(3), 437-465. https://doi.org/10.1080/09615768.2021.1951496

Michalak, M. (2021). Medical Malpractice Liability in the United States of America in the Light of the 19th Century Origins of the American Legal System. Krakowskie Studia Z Historii Państwa I Prawa, 14(3), 287-305. https://doi.org/10.4467/20844131ks.21.023.14088

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Write a 6-page paper reviewing an actual case of medical malpractice or negligence. Describe the response to the healthcare organization involved in the event- did they respond appropriately and implement appropriate changes, or were there opportunities to prevent further events from occurring?