Tort Law Case Study #5

Nurse P is a staff nurse in the coronary care unit of a large medical center. One morning he is informed that a patient from the recovery room will soon be admitted to the coronary care unit and assigned to him. The patient, a white man, 67 years of age, with known history of myocardial infarction, also has cancer of the prostate. The initial hospital admission was for a transurethral resection, which had been aborted in the operating room when the patient developed cardiac changes following spinal anesthesia. The patient had been transported to the recovery room with the diagnosis of possible myocardial infarction and was to be transferred to the coronary care unit for management and evaluation.

Nurse P heads to the recovery room with a bed, to pick up the patient. When he arrives, the patient is being coded. He had apparently gone into ventricular tachycardia/ventricular fibrillation in the recovery room and had required countershock, cardiopulmonary resuscitation (CPR), intubation, lidocaine, and vasopressors to maintain his blood pressure. A Swan-Ganz catheter was put in place. Recovery rhythm was sinus bradycardia to sinus tachycardia with occasional pauses. The patient was acidotic, in pulmonary edema by chest x-ray with an alveolar oxygen partial pressure (PaO2) of 50–60 mm Hg, a fraction of inspired oxygen (FIO2) of 100%.

During the events of the code, an attending cardiologist (Dr. D) passed by, observed the code, and made the following statement to the recovery room staff and coronary care unit resident: "Say, that's Mr. S. I know him from his last hospitalization of 1 month ago when I was attending in coronary care unit. I believe he has a living will." While the patient is stabilized, Dr. D calls the patient's relative, who happens to work in another part of the medical center. The relative also expresses the belief that Mr. S has a living will and does not want to receive extraordinary support measures. Dr. D relays this information to the other physicians, and there is general agreement that conservative measures to ensure support are indicated while the living will is located.

The coronary care unit resident and Nurse P transport Mr. S to the coronary care unit. When admitted, the patient's systolic blood pressure is 70 mm Hg while on dobutamine 8 mcg/kg and dopamine 26 mcg/kg. The patient occasionally responds to verbal commands, opens his eyes, grips Nurse P's hands, and responds to pain in the upper extremities (his lower extremities are still under the effects of the spinal anesthesia). Cardiac monitoring shows that the patient is still having sinus tachycardia.

At this point, the coronary care unit resident and an intern approach Nurse P and inform him that they believe that the present treatment of the patient is cruel. Upon locating old medical records, they learned that the patient had been designated "do not resuscitate" (DNR) on his last admission, and the patient is supposed to have a living will, although it has still not yet been located. They order Nurse P to slowly turn off the intravenous (IV) drip of dopamine and dobutamine. Nurse P is faced with an ethical dilemma.

1. What is an intentional tort? What is an unintentional tort?

Does your assigned case involve an intentional tort an unintentional tort, both or neither? What specific kind of tort is involved? (negligence, direct cause, false imprisonment, invasion of privacy, etc. see pages 145-146 in Yoost & Crawford.)

2. Were there tasks that the nurse did not perform that had bearing on the case?

A. Were there documentation issues that were significant in the case? If so, what were they?

B. Were there issues involving lack of patient care/assessment or monitoring that were significant in the case? If so, what are they?

C. Were there issues involving lack of communication or improper communication that were significant in the case? If so, what are they?

3. Are there any risks of harm to the patient indicated in the case? If so, what are they? Are there risks of harm to the nurse or doctor?

4. Do you think you need additional information to reach a resolution for this case? If so, what additional information is needed?

5. Overall, what do you think is a fair resolution to the case?

Grading Rubric : 5 points maximum. You are doing two case studies, each case study is worth 2.5 points

Question 1- ½ pt per case/1 point total. These questions require a correct short answer, maximum one paragraph per question.

Question 2 – 1 point per case/2 points total. These questions require a description of your ideas/answers pertaining to the question. If your answer requires a yes/no, and your answer is yes, provide a concise answer, maximum 2 paragraphs per question, or a list of answers.

Question 3 is worth ½ point per case/1 point total. 2 paragraphs maximum per question

Questions 4 & 5 are worth ¼ point per case/½ point each (x2 questions), 1 paragraph maximum per question.

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