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Who is Taking Care of This Patient?

Medical Malpractice occurs on a daily basis. When it happens in a hospital setting, it can be difficult to figure out who was responsible.  There are two to three nursing shifts every day, attending physicians, consulting physicians, physician assistants, and resident physicians.

Take this case, for example: Our client went to the emergency department with a broken leg. The emergency department physician evaluated her and admitted her — not for the broken leg, but for the dizziness that caused her to fall in the first place.  Then began the extensive workup and multiple consults (physician examinations from different specialists).   On day one, the broken leg was placed into a removable walking boot for the next three weeks – a simple break that needed some stability.  No orders were written about that boot, (but remember, it was a removable boot). Throughout the next five days in the hospital, the patient saw several different consulting physicians for an extensive workup to uncover why she became dizzy and fell.  The patient also had 24 hour nursing care. On a daily basis, the patient saw several different doctors who reviewed and assessed different test results, the patient’s clinical presentation, and radiology/laboratory findings.  As each physician or nurse assessed this patient, s/he was advised of the extreme pain experienced by the patient.  Each physician reviewed and agreed with the existing pain medication order or orders more/stronger pain medication – and with the medication, the patient’s pain subsides temporarily. But by day five, the pain was excruciating.  Someone finally took off that removable walking boot…only to discover that the “simple broken leg” is gangrenous.  The end result: a below the knee amputation.

So, who was responsible for the treatment and care of this patient?

The neurologist, who saw the patient on day two, defended the case on the fact that s/he was called in only to consult on the headaches portion of the admission – though s/he wrote in the report, “continues to have severe leg pain.”

The orthopedist, who was treating the broken leg, noted “continued pain, as to be expected from a break,” and increased the pain medication.  He assumed that the nurses were checking the skin under the boot every shift.

The hospitalist, a physician providing the day-to-day care during admission, increased the medication to a stronger narcotic every three hours. She was clearly aware of the ongoing pain.

The resident evaluated the patient on day four for continued headaches and wrote “headaches continue, send for MRI of the head.  Continued leg pain, patient crying in pain when I saw her. Continue meds as ordered.  Will follow-up.”  The resident’s defense was that s/he was only asked to see the patient for continued headaches and that s/he was just a resident – s/he work under an attending physician.

And what about the number of nurses that care for this patient?  There are three shifts within a 24 hour day.  Throughout each day, as the patient complained, the nurses administered the narcotic/pain medication as ordered.  Their defense: they each followed the doctor’s orders.

So, who was responsible for this patient?

The answer:  All of them. Why?  For each doctor and nurse there are rules that apply – standards of care.  Each was responsible for her/his own interactions with the patient.  If a doctor/nurse’s substandard care caused harm to the patient, then that provider was negligent – even if she/he was not the only negligent provider.

Figuring out who was responsible requires understanding of the medical situation, reviewing the records, interviewing witnesses, and consulting with medical experts – the unique skills of the attorneys in our Medical Malpractice Department. If you feel you are the victim of medical malpractice, do not hesitate to contact me.

Kathryn Wickenheiser Attorney at Law Keches LAw Group Medical Malpractice Lawyer Milton Boston Massachusetts Law Firm

Kathryn J. Wickenheiser
Keches Law Group
Milton, MA



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