At 6AM, Dr. S returned to Mrs. C’s room. An examination determined that Mrs. C had no pulse in her right leg. An angiogram revealed that the catheter inserted into her leg for the arterial line had blocked blood flow to the leg, resulting in ischemia of the right lower leg.Due to the level of irreversible tissue damage caused by the blocked artery, Mrs. C’s right leg had to be amputated.

After she recovered, Mrs. C sued the hospital and the surgeon. Ms. M was not sued personally, but the hospital was sued as her employer, based on her alleged negligence. The surgeon was sued personally and retained his own defense attorney. 

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The hospital’s defense attorneys attempted to have the case against it dismissed. They argued that the plaintiff had not established that Ms. M had breached the standard of care and that once the surgeon was notified of the patient’s complaints by the family, it was his responsibility and not Ms. M’s. 

The plaintiff argued that once the family told Ms. M that Mrs. C described her leg as “hot and numb,” Ms. M had a duty to act. The plaintiff introduced an expert who reported that the standard of care required that nurses and doctors who become aware of a patient’s leg complaint look for and respond immediately to any of the following characteristic symptoms of limb ischemia, often grouped into a mnemonic known as the six Ps: pulselessness, pain, pallor, poikilothermia, paresthesia, or paralysis.

The expert noted that a patient exhibiting any of these symptoms should be evaluated for ischemia without delay, as it is an emergency that requires rapid restoration of blood flow. 

The expert also noted that Mrs. C had complained of two of the six signs of ischemia: poikilothermia and paresthesia. It was a breach of the standard of care for Mrs. C not to be assessed immediately for ischemia. The expert said that Ms. M was “required by the standard of care to chart the complaint and promptly report it to the patient’s doctor. This was not done.”