Ms. D, age 36 years, was one of two nurse practitioners in the busy office of a pediatrician and general practitioner. She had been working for the practice for close to eight years and had gotten to know many of the patients well.

Mrs. V was being treated for lupus, coronary artery disease, diabetes, and arthritis. Now in her 70s, she had also become a foster parent for a 10-year-old autistic boy. Ms. D admired the fact that Mrs. V was willing to open her heart and home to a needy child who had little hope of adoption. The boy, Bobby, had spent several years being shuffled from foster home to foster home before being taken in by Mrs. V five years ago.

One afternoon, Mrs. V brought Bobby in for his routine well-child checkup. Ms. D chatted with Mrs. V as she weighed and measured the boy and took his BP. Bobby was due for a purified protein derivative (PPD) injection to test for TB. Ms. D prepared the syringe and stood next to the boy while Mrs. V put her arm around him. Bobby had been calm and detached throughout the whole exam, so both Ms. D and Mrs. V were surprised when he suddenly flailed, knocking Ms. D’s hand away.

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“Ouch!” cried Mrs. V. “You just stuck me in the hand!”

“I’m so sorry!” exclaimed Ms. D. “Please let me take a look at it.” She examined Mrs. V’s hand and noted no trauma, breaks in the skin, or bleeding. It did not appear that any of the PPD test material had been injected into the hand. “It looks fine,” she told Mrs. V. “I’m sorry for the scare.”

Ms. D finished the exam, calling in the other NP to hold the boy during the PPD injection, and then walked Mrs. V and Bobby to the lobby. She felt a bit embarrassed when she thought about the incident later, but as the weeks passed she soon forgot about it. Several months later, she was served with papers notifying her that Mrs. V had instituted a lawsuit against her and her employer for injuries allegedly resulting from the accidental needle stick.

Ms. D immediately contacted the defense attorney provided by her insurance company, who filled her in on the details of the case.

“Mrs. V is alleging that the incident caused an allergic reaction that required overnight hospitalization and the administration of steroids,” said the attorney. “She was diagnosed with inflammatory arthropathy and inflammation of the thumb extensor tendon—De Quervain’s tenosynovitis. She claims that arthroscopy of her left wrist and surgery on the thumb tendon was necessitated by the needle stick.”

“That can’t be!” gasped an outraged Ms. D. “I looked at her hand. There was no puncture, no bleeding, nothing! This isn’t my fault. How can she sue me?”

“Suing someone is the easy part,” said the attorney. “The hard part is going to be for Mrs. V to prove that her problems were the result of that incident.” The attorney explained to Ms. D that they would subpoena Mrs. V’s medical records and have their own medical expert determine the cause of Mrs. V’s hand problems.

Over the next few months, Ms. D had to miss work to attend depositions and meetings with her attorney. The stress of the case took its toll on her, resulting in increased sick days, tension headaches, and weight loss.

At the trial, each party put their own expert medical witness on the stand. The plaintiff’s medical expert testified that exposure to the PPD material caused an allergic reaction that resulted in joint swelling and the development of De Quervain’s tenosynovitis requiring surgery.

When it was the defense’s turn, Ms. D’s expert physician testified that the swelling of the plaintiff’s hand and the base of her thumb was an acute episode of pseudogout having nothing to do with the alleged needle stick. The expert testified that the plaintiff’s post-surgery medical records stated that there were calcifications in the wrist and significant synovitis consistent with gout or pseudogout.

“Furthermore,” the expert explained, “there is nothing in medical literature to support the association of PPD material with joint swelling. The plaintiff’s condition was unrelated to the needle stick.”

The jury deliberated for two hours before returning with a verdict finding Ms. D and her employer not liable for Mrs. V’s hand injury.

Legal background

Experts play a key role in medical malpractice cases. The testimony of an expert physician or health-care professional can help to establish or rule out a cause of injury. An expert will review medical records, do research, review lab reports and diagnostic test results, and prepare testimony. Experts are essential in helping judges and jurors understand complex medical evidence. Defendants often use expert witnesses to discredit the extent or cause of the claimed injuries.

Whether an expert is hired by the defense or by the plaintiff, he or she must uphold strict ethical standards when providing testimony that relates to medical evidence.

Protecting yourself

Ms. D knew she was dealing with an autistic child who, although seemingly calm, could react unpredictably. She was relying on the boy’s elderly foster mother to secure the boy so that she could administer the injection. What ensued was not entirely surprising.

A better practice would have been to call in another clinician to hold the child while Ms. D administered the injection, thus avoiding any chance of liability.

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