An article for physicians by physicians
Originally published March 2008
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
Of interest to all physicians
Physicians and other health professionals working in hospitals routinely rely on each other when caring for patients. When patients suffer harm following that care, all of the involved health care providers may be named in an ensuing legal action. The Court will examine whether each health professional fulfilled all of his/her obligations, and if any of them did not, whether the harm was caused as a result. Two cases from the Association's files illustrate some of the principles involved.
A paediatrician ordered capillary blood gases on a 25-week premature baby. To increase peripheral circulation, the nurse placed the baby's foot in water that was thought to be lukewarm. She subsequently noted the foot was reddened and eventually blisters formed and the skin sloughed. The paediatrician was notified and diagnosed second degree burns to three to five percent of the baby's body. The doctor prescribed fluids to compensate for the losses, a narcotic for pain, antibiotics, and physical therapy. The baby was transferred to a plastic surgeon for burn management. Ultimately, the baby was left with a significantly deformed toenail on the great toe, with no nails on the other toes. The baby also had significant scarring on the dorsal surface of the toes and foot.
When the child became older and aware of the foot's appearance, he was embarrassed by it. A lawsuit was brought on behalf of the child alleging inadequate supervision and care by the paediatrician, as well as negligent care by the nurse. Ultimately, the hospital made a settlement with the patient on behalf of the nurse, and the action against the doctor was dismissed.
A patient underwent an angiogram and angioplasty by an interventional radiologist for treatment of subclavian steal. The catheter usually used at that facility was not available, and the one used was from a different supplier. After the balloon was advanced, it could not be readily inflated. Manipulation was unsuccessful and the physician specifically asked the nurse about the balloon sheath. The nurse told him that the sheath had been removed, but had fallen on the floor.
Ten days following the procedure, the patient returned to the hospital with neck pain and headache. An ultrasound revealed a foreign body in the right internal carotid artery. At surgery, the sheath was removed from the artery. There were some postoperative complications and the patient was left with a significant scar.
An expert testifying for the radiologist stated that it is primarily the responsibility of the nurse to ensure the equipment is appropriately prepared for use. It was also noted that the nurse did not tell the physician that she had not been able to find the sheath she believed had fallen on the floor. Despite this, the fact the physician did not investigate any further was considered a contributing factor in this case and a settlement was made by the CMPA on behalf of the physician as well as by the hospital insurer on behalf of the nurse.
Case one confirms the legal principle that a physician is entitled to expect that other health care professionals, including hospital staff members, will perform their duties properly
Case two serves as an example of the risks that may occur with teams working in unfamiliar environments or with unfamiliar equipment. In this specific example, each member of the team shared in the responsibility for determining the correct operation of the new catheter which was unfamiliar to them.
The bottom line
Each member of the team is responsible, accountable and potentially liable for their role on the team.
Health care professionals should consider that there may be potential risks associated with working in new environments, with new equipment or with new individuals on the team.