Ms. X was the senior nurse practitioner of the emergency department (ED) nursing team in a midsize regional medical center. As the senior staff member, her duties, besides caring for patients, included coordinating lab tests, maintaining communications with physicians and other departments in the hospital, and helping to train new nursing staff. She was widely regarded as the go-to person for information and was often asked to give short orientations of the ED to new employees in other departments.
Mr. P, a former physician from the Philippines, now worked as a phlebotomist for the company that provided the hospital’s lab services. When Mr. P was hired, Ms. X was asked to walk him through the ED, where he would occasionally be called to take blood samples. The two chatted as they toured the area, and Mr. P confided that he was only working temporarily as a phlebotomist to support his wife and young child while he tried to get into a U.S. residency program as a foreign medical graduate.
“Having been a physician,” said Ms. X, “you already know that you should always use caution while in the ED. It’s not like working in a lab or a private office. While most of the patients are fine, we do get a few crazies. And we can be quite understaffed at times.”
After the tour, Mr. P thanked Ms. X and went back to the lab. Over the next couple of months, she saw him sporadically when he came down to take blood samples for lab work.
The ED was a frenetic place, and Ms. X and the nursing staff were often stretched thin trying to care for all the patients who came in. This was especially true on weekends, particularly Saturday nights, when the ED saw an influx of injuries resulting from drunken brawls and car accidents. Ms. X tried to avoid the Saturday night shift when she could, but this particular weekend she was asked to fill in for a sick colleague.
Ms. X could tell early on that it was going to be a bad night. Almost all the beds were in use, and there were still a dozen people in the waiting room. During the evening, she submitted several requests for lab work, and out of the corner of her eye she saw Mr. P making his way around the ED taking blood samples. She turned away for a few moments and heard Mr. P’s scream coming from one of the treatment rooms. She ran in and found that a patient—a homeless woman whom she knew to be mentally unstable and sometimes violent—had stabbed Mr. P with the needle he had used to draw her blood.
Security rushed in and subdued the incoherent patient. One of the physicians took Mr. P aside and informed him that the homeless woman was HIV-positive and had hepatitis C. Mr. P looked stricken as the physician told him that he should see an infectious-disease specialist right away. Mr. P went home immediately.
Ms. X and the other nurses felt sorry for Mr. P, but patients had to be cared for and there wasn’t much time to discuss the incident. Over the next few months, Ms. X occasionally saw Mr. P around the hospital, but he looked sullen and worn, and she wasn’t sure whether to approach him and ask about his health. She heard that the prophylactic HIV drugs he was given had caused side effects and that he had changed emotionally from pleasant and lighthearted to moody and depressed. Ms. X felt sorry for the phlebotomist, but didn’t see how his problems related to her until she was called into her supervisor’s office several months after the incident.
“Mr. P is suing the hospital,” said the supervisor. “He’s claiming that the nursing staff was negligent in not warning him that the patient was violent and positive for HIV and hepatitis C. He claims that you and the other nurses knew that the patient was mentally unstable. Is this true?”
Ms. X was taken aback. “Well,” she stammered, “the nursing staff was aware of the patient’s HIV and hepatitis diagnoses. We’d had experience with this patient in the past, and knew that she could be emotionally unstable.” She paused and then added, “But Mr. P had been a physician. Of course he knew that you always have to be careful with patients in the ED. In fact, I mentioned that to him during his orientation.”
“You are going to be called as a witness if this goes to trial, so be prepared,” warned the supervisor. Ms. X soon received a call from the attorney representing the hospital, who reiterated that she would be called to testify about the incident.
Almost two years after the incident occurred, the case finally was ready for a jury trial. During the trial, Mr. P gave compelling testimony. He described his terror during the attack and his subsequent horror and dismay when he was informed that the patient was HIV-positive.
“I felt like my life was over,” he told the jury. “I went to see an infectious-disease specialist who told me that I should consider myself HIV-positive for the time being. I was afraid to make love to my wife or share a toothbrush with my child.” He continued describing the emotional devastation that he felt to the jury. “I felt like a pariah around the hospital. Everyone looked at me with pity. And the treatments made me ill. I was depressed and anxious. Even after I was informed that I was 95% likely not to develop HIV or hepatitis, I still had to wait another six months before I could finally relax. If only the nursing staff had told me about the patient’s status. Had I known about her diseases and violent history, I could have protected myself.”
The jury appeared moved by Mr. P’s experience, which was followed by testimony from the infectious-disease physician and a psychologist who explained the trauma that would result from this situation.
The defense called Ms. X as a witness. She testified that she had discussed the hazards of the ED with Mr. P and explained that his training as a physician equipped him with skill to assess whether a patient was dangerous. On cross-examination, however, Ms. X was forced to admit that she was aware that the patient was violent and had tested positive for HIV and hepatitis C, yet neither she nor any of the nursing staff informed Mr. P of these facts or noted them on the lab request.
The jury deliberated for two hours before returning a verdict in favor of Mr. P and awarding him $375,000 in damages.
Ms. X was not sued individually. Instead, the plaintiff’s attorney made a tactical decision to sue the hospital. This is a common practice. It makes more sense to sue the entity with deep pockets rather than an individual who is likely to have a low cap on liability insurance. Also, proving the case against Ms. X as an individual would have been harder than establishing that the hospital had poor practices in place in their nursing department.
Knowing that the patient was potentially dangerous and had communicable diseases, the nursing staff should have warned Mr. P. This could have been done via a note on the lab request or a phone call. Had Mr. P been warned in advance, he might have been properly prepared, and this incident might never have happened. In the event that the attack still occurred, the hospital and nursing staff would have been much less likely to have been found liable for Mr. P’s injuries.