The perioperative nurse is a higher level of nursing profession who provides for healthcare (as a surgeon’s assistant) during pre-, intra-, and post-operative stage—contact care of patients, surgeon’s first assistant during operational procedures in theather, and patient assessment before and after surgical procedure—their special role in healthcare is an indispensable in that they provide continuity and direct link between patient and medical protocols. However, their constant clinical participation and contact with the patients makes them highly liable for lawsuits as accorded by the health workforce policy. This does not preclude though that malpractice issues may also extend between medical colleagues as assessed in the litigation of Pettigrew vs Putterman.
The Litigation Case
Here, there is an attempt to assess the litigation case of Alicia Pettigrew against Allen Putterman. The dispute was settled in a civil (between private parties) adversarial (adjunction of guilt over a proof of burden) trial. The plaintiff, a perioperative nurse, filed lawsuit against Dr. Allen Putterman on the basis of clinical negligence and associated emotional distress. The litigation was performed at the First Division Circuit Court of Cook County, 96 L 12507, and last May 28, 2002, with Honorable Jennifer Duncan Price as the presiding judge.
Plaintiff’s allegation against the defendant-appellee Putterman capitalizes on the negligent act of the doctor during a theatrical procedure leaving a laceration on her hand as a result of “negligent” handling of surgical scissors. Her complaints also include psychological and emotional distress/trauma from fear of contracting human immunodeficiency virus through such negligent act.
The defendant-appellee is an ophthalmic surgeon who was performing an “eyelid” surgical procedure on an HIV patient on November 1, 1994. The negligence act was predicated on the following grounds: failure to observe and place the instrument on appropriate area and failure to allow the nurse correct grip on the said instrument. The physical injury is also related to financial losses due to medical cost and absence from a particular illness/injury (in this case surgical laceration) aside from the other factors mentioned above.
Medical torts usually cover medical negligence owing to breach of duty by way of committed errors in surgical procedures which may have resulted to serious physical and/or psychological injuries on the part of the patient. Usual causes are wrong administration of drugs and procedural errors during theatric operations. The case of Alicia Pettigrew falls as “procedural error.”
Although the lacerations may be purely be incidental, the claimant can justify her claims owing to a breach of duty [(by the medical practitioner)] by failing to follow correct surgical protocols in handling the surgical instruments which had caused her harm—physical injury in the form of lacerations, emotional and physical distress owing to the “belief” of possible disease transmission to her person, and associated financial losses due to physical injury. The operation took place at Michael Reese Hospital.
The legal elements involved are the following: (1) an established duty/contract, (2) breach of duty or failure to comply with the required standard of care (3) evidence of damage and (4) damage must be resultant of the negligence act. The appellee, Dr. Pullerman has an established medical duty as a surgeon and must comply with the standards of healthcare/surgical protocols that of which had occurred in the theater room.
His failure to correctly hand-over the surgical scissors to the nurse while in the operating theater makes him a contestant for possible negligence. Pettigrew’s claim on alleged damages must still be proven as a result of the negligent act before any just compensation for punitive/economic damages is decided. Her lacerations were obvious evidentiary claims but the trauma as caused by the belief of HIV transmission should still be proven.
Normal court proceedings require testimony from an “expert” to help assist the decision of the jury and judge regarding the claims/appeal of the plaintiff. Qualification of the expert witness is set by the court proceedings whereby his/her “field” of expertise is considered (in relation to the plaintiff’s complaint) and the information imparted is not readily accessible to the court. In the case of Pettigrew, Dr. Broker acted as a witness in establishing the proof of HIV-patient.
He was present during the time of the operation and stipulated that both the doctor and the plaintiff knew that the patient was HIV positive. Abadiano also testified as to the pending ELIZA result of the HIV patient and the relay of information to the plaintiff. The motion for display of evidence of the ophthalmic surgical patient was dismissed on the basis of misinvolvement and the right of patient for privacy. The court dismissed the claim of Pettigrew due to lack of proof of possible HIV evidence on her side and that of the ophthalmic patient.
Reviewing the Litigation Case
The case of Pettigrew vs. Putterman is reviewed at its weak points. The case was weak and doomed to lose from the start since evidentiary claims and expert testimonies failed to support the negligent act of the appellee. The psychological fear must first be duly notified and well established and it is in this area that the plaintiff has lost her case. First and foremost, she did not contract the HIV virus following the surgical procedure and her fear stemming from the possible contract of the alleged HIV positive surgical patient was not well established either.
Note that the surgical patient was not party to the court litigation so his/her presence is uncaled for in the judiciary proceedings. The testimonies from the experts, one surgical doctor and the other, nurse, were simply downplayed “hearsays” in the absence of substantial evidence (test results) presented at the court. Causation is an important part of the medical tort cases and the absence of such would pave for case loss.
The plaintiff can still call for re-appeal in other courts in different states depending on the medical rulings for that particular state. In her case, if her injuries were really true, she should have opted for the state with high insurance premiums, that is if her case is due to win. Victims of malpractice litigations only benefit if their claims are true and winning. On the other hand, there some medical practitioners who are also victims of the medical tort bills, when the claimant’s lawsuit is simply a ruse or prevaricated for the compensation rewards and penalties incurred.
The post litigation may also have negative drawbacks for the nurse since it fractures her relation with the doctor and the emotional and financial (as per the court finances and lawyer’s fee). All litigation cases should be avoided except if really necessary.
Preventive Action against Litigation Cases
To reduce the prevalence and susceptibility to medical malpractice claims, it is inherent that any medical institution should target the risk of errors at three levels: (1) human error (2) identifiable sensitive zones—surgical infection, perioperative cardiac infarction, and hemorrhaging and venous thromboembolism after surgical procedures (3) stratagem for OR (4) possible legal miscreant source, usually in consent forms.
The organization must provide for an “expert” perioperative nurse surgeon’s assistant with required skills and courses in the particular healthcare division. As a protective preliminary action, perioperative nurse should be insured. Since most litigations occur against a medical group (e.g. hospital), then sufficiency in workforce and supply, is a good step in preventing the occurrence of medical disasters. The role of perioperative nurse in the hospital and as a surgical workforce should be well identified.
Perioperative safety is an absolute requirement if there must be prevention of medical malpractice claims of patients. Additionally, if such safety protocols are well-administered, then the patient would have no cause of complaint. The following areas are sensitive zones that should be well-targeted—surgical infection, perioperative cardiac infarction, and hemorrhaging and venous thromboembolism after surgical procedures. A simple case of leaving a small item of surgical material inside the body of patient can result to infection. Patient harm can be assessed on these sensitive zones and that perioperative nurses and the medical practitioners should adopt an effective method in mitigating the risks in the aforementioned zones.
Any hospital or medical organization who seeks to improve the quality of healthcare services and reduce the financial losses from the medical malpractice lawsuits filed against them should construct strategies in assessing the medical risk assessment processes. The OR stratagem on faculty round-up and distribution of labors as well as consideration of the “well-supplied aseptic medical environment” is central focus. Moreover, assessment of the critical factors above should also be taken in consideration when conducting this plan. It is targeted that the relations of the multi-faceted disciplines in OR works harmoniously with each other to foster theater efficiency.
Most legal suits would file cases on the basis of a sound claim and there are many cases when it is due to “lack of appropriate consent” of the patient to undertake any surgical/medical procedures albeit necessary. The first hand rule in any pre-operative performance is written consent. Consents are necessary in that they foster for autonomy (as implicated by the constitution) for the patient if he/she is willing to subjugate him/herself in the treatment.
Corollary to this is a well-documented assessment of the medical condition of the patient prior to the operation and after it. All information should be complete and well-documented and such information should be bequeathed to the patient. To accomplish such basic things would be a clarified dialogue on the assignment of possible errors and that the care given by the nurse/practitioner is well established.
Medical tort being a part of the constitution, all perioperative nurses and medical practitioners, should give quality health care to the patient that is responsive of the needs and wants of the patients and by way of proper documentation and following standard medical procedures/protocol.
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