Question

Ms. Gadner was driving her car on the highway when another car driven by Mr. Sneed passed her, sideswiped her, ran her off the road, and drove off. She caught up with Mr. Sneed and forced him to stop. She got out of the car and started to walk to his car when he drove away. When she was walking back to her car, Mr. Otis struck her with his vehicle. Gadner was transported to Bay Hospital, a small rural hospital, where Dr. D, a second year pediatric resident, was the attending emergency room physician.

Upon arriving at Bay, Gadner's skin was cool and clammy and her blood pressure was 95/55, indicative of shock. Gadner received 200 cc's per hour of fluid and was x-rayed. She actively requested a transfer because of vaginal bleeding. Nurse Gilbert voiced her own concerns about the need for a transfer to the other nurses in the emergency room, but not to Dr. D. Dr. D did not order a transfer.

Bay is a rural hospital and is not equipped to handle trauma patients with multiple injuries like Gadner. Bay had no protocol or procedure for making transfers to larger hospitals. Bay breached its own credentialing procedures in hiring a physician who lacked the necessary training, expertise, or demonstrated competence to work the emergency room. Dr. Moon, the hospital's chief of staff, had screened Dr. D, but a proper evaluation was not performed before he was hired. A second year pediatric resident is not normally assigned to an emergency room setting, because they lack enough experience to handle true emergency cases.

The nurses failed to notice that Gadner was in shock and this failure was substandard. After they initially noted that she arrived with cool and clammy skin and a blood pressure of 95/55, they did not advise Dr. D that the patient was likely in shock; they failed to place her on IV fluids, elevate her feet above her head and give oxygen as needed. Dr. D ordered the administration of 500 cc's of fluid per hour, but Gadner received only about 200 cc's per hour because the IV infiltrated, delivering the fluid to the surrounding tissue instead of the vein. The nursing staff normally would discover infiltration and correct it. Scanty nurse's notes reveal that vital signs were not taken regularly, depriving Dr. D of critical and ongoing information about Gadner's condition.

Nurse Gilbert administered Valium and morphine to Gadner, following Dr. D's orders, a mixture of drugs counter-indicated for a patient with symptoms of shock. Nurse Gilbert did not notice or protest. Three hours after arriving at Bay, Gadner "coded" and Dr. D tried unsuccessfully to revive her. After she "coded,” Dr. D attempted to use the laryngoscope, following standard practice, but the one provided was broken. He then ordered epinephrine, but there was none available in the emergency room. A coroner performed an autopsy and it was determined that Gadner died of treatable shock.

1. Develop a VERY SPECIFIC list of short term (next 1 - 2 months) corrective actions the hospital must take immediately to remedy the problems. Be sure to have at least one short term corrective action for EACH of the legal issues you identified.

Answer 1

Shock refers to depression/supression of bodily functions produced by disorder.It refers to insufficient blood flow to tissues particularly in brain , main cause is reduction in cardiac output.

Traumatic shock:- Trauma means injury or wound caused by external force occurs due to damage of muscle and bones,Apart from loss of blood plasma escape into tissue spaces

LIST OF TERMS (Corrective Options) HOSPITAL MUST TAKE

1) Hospital should not give the give the responsibility to Dr D as he is just a 2 year resident and he must have lots to learn and he is not having enough skills to tackle with this kind if trauma situations

2) Nurse Gilbert should not give the commands of ordering blood of 200cc/ hour without consulting with any senior doctor / resident without proper screening/ diagnosis it may proove fatal to the patient

3)We understand Bay is a rural hospital and its obvious for not having high quality of techniques/medical innovation but at least it should have transportation facility like if an emergency case appears and if they are unable to treat them , atleast they can transfer it some other hospital

4) Its a great negligence of hospital at bay they should hire the doctor who is having sufficient skills and a doctor should be hired only if he fullfils all the critera required to work there

5)Since ,Dr Moon has screened Dr D but a proper evaluation was not provided before his joining, this also comes to be a negligence of head of hospital

6)Since Dr D ordered of 500cc / hr patient receives only 200cc / hour due to Iv infilterated and transferring blood to surrounding tissue instead of vein , special care should be taken regarding it

7) Proper Vitals Signs were not recorded periodically which deprived the Dr for making descions which also come back to be a drawback for nurses

8) Administration of Valium and morphine counteract and put the patient on shock and the nurse Gilbert doesnt notice for 3 precious hours which was a negligence afterwards the patient was coded

9)When Dr D ordered for Laryngoscopy, Laryngoscope provided to him was broken and no one near to replace it

10)Last attempt when Dr D ordered for epinephrine there was no one there who can provide its also a negligence seen in respect of nurses

So the above measure should be taken immediately by the hospital at BAY as shortly as possible!!