Legal Background

During the discovery process, several expert medical reports were filed by the plaintiffs pointing out the substandard care the child received from the nurses, PAs, and physicians responsible for his treatment at the first hospital. Among these was a report by an expert nurse stating that the defendant nurses had deviated from the accepted standards of emergency nursing practice by failing to properly assess and document findings of Joe’s complaint of lower leg pain and swelling, as well as failing to communicate the findings of that assessment to the physician or physician assistant.

Another expert testified that the PAs had deviated significantly from the standard of care by, among other things, failing to ensure that the nursing assessments were adequately performed. The expert concluded that the failure of the PAs and supervising physicians to ensure that every nursing assessment was adequately completed contributed to the patient’s ultimate outcome.

Finally, a third expert stated that had the appropriate testing been done, Joe would have been correctly diagnosed on his second visit to the ED, and the DVT would not have occurred, avoiding the leg amputation.

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During discovery, the PAs and supervising physicians, who were employed by another company (not the first hospital), settled the case out of court, leaving just the nurses and the hospital as defendants. The defense attorney made a motion to dismiss the case against them, objecting to the expert testimony and claiming that no expert had directly tied the nursing deviations to the proximate cause of the amputation. The lower court agreed and dismissed the case against the nurses and the hospital. The plaintiffs appealed.

On appeal, the higher court reversed the lower court’s decision and found that there were grounds for a negligence case against the nurses and the hospital. The case has been remanded back to the lower court for a trial.

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In its decision, the court faulted the nurses for not conducting a proper assessment of the child’s leg. “The patient’s nursing expert’s opinion is that the [ED] nurses’ negligence delayed a correct diagnosis,” wrote the court in its decision. 

“Although the child was brought in several times for severe persistent pain in his injured foot and ankle, no nursing assessment of the lower extremity was ever performed. The nurses should have done a visual exam of the foot and ankle, noted the color of the skin, felt for the temperature of the skin and checked the pulses and capillary refill. An x-ray ordered by a physician’s assistant showed no fractures, but it did not rule out vascular damage in the lower extremity. During three visits to the [ED] the nurses never saw to it that the boy was examined by a physician.” These errors led to a delay in diagnosis such that a bad outcome was inevitable.

A proper nursing assessment of a lower extremity injury should provide the data needed to confirm or to rule out DVT or compartment syndrome. The treating physician will need the nurses’ assessment of skin condition, capillary refill, and pulse, as well as the patient’s report of sensation and pain. The only information gathered in this instance were the parents’ reports of the child’s extreme pain, which should have alerted the clinicians that something was seriously wrong.

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Ms Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.