| Nurses Leave Patient in Distress |
| "Reeling From One Side of the Bed to the Other" |
| From 5:30 p.m. to 6:45 p.m. |
| Nurses' Negligence Denies Patient the Chance of Survival |
| Two Registered Nurses and One LPN to Care for 32 Patients |
Facts: On May 3, 1984 Devon Ard was admitted to East Jefferson. His admitting diagnosis was a past history of myocardial infarction, stroke and unstable angina. He was 64 years old at the time. Devon Ard subsequently underwent a five-vessel coronary bypass surgery on May 8, 1984. He remained in intensive care until May 13, 1984 due to respiratory problems. On May 15, 1984 he had respiratory failure and was transferred to the critical care unit. A bronchoscopy was performed to determine the cause of the respiratory problems. He was transferred from the critical care unit on May 20, 1984.
Lorena Ard, Devon Ard's wife, testified the nursing staff did not respond timely to her calls for assistance from 5:30 p.m. to 6:45 p.m. At approximately 6:45 p.m. he stopped breathing and a code was called. He never gained consciousness and died two days later, May 22 1984, from respiratory failure and cardiac arrest.
Lorena Ard, who at the time of trial was 70 years old, testified as follows. She stated that on the afternoon of May 20, 1984 she was with her husband. He began feeling nauseous and experiencing shortness of breath. She rang the bell several times and got no response. Finally someone did respond sometime in the evening and brought him a tablet. His nausea worsened. He also vomited once or twice and was in "terrible pain." She described him as "reeling from one side of the bed to the other." She was trying to hold him so he would not fall off the bed.
She testified she continued to ring for a nurse when she noticed he was having difficulty breathing. She called ten or twelve times and was told a nurse was not there. She estimated she rang the bell for an hour and fifteen minutes to an hour and half. She told the nurse as she rang he was nauseous and vomiting and she could not hold him down. She also noted he was pale. The last time she called she noticed his eyes were rolled back. She reported he was dying and needed a nurse. Someone finally did respond and called a code.
East Jefferson Hospital was sued on the basis of the negligence of its nurses. The trial judge granted judgment in favor of the plaintiff, Lorena Ard, in the amount of $50,000 in general damages. All parties have appealed.
Court Decision: In a medical malpractice action against a hospital, the plaintiff must prove, as in any negligence action, that the defendant owed the plaintiff a duty to protect against the risk involved, that the defendant breached that duty, and that the plaintiff suffered an injury, and that the defendant's actions were a substantial cause in fact of the injury.
There is ample evidence in the record to support the trial judge's evidently concluding the nursing staff at East Jefferson breached the standard of nursing care in the community. Celia Krebs, an expert in general nursing, testified she reviewed the medical records and various documents. She determined there were six breaches of the standard of care. She particularly stated that after May 15, 1984 it was obvious to the nurses from the doctors' progress notes that Devon Ard had a floppy epiglottis and trouble swallowing. Mentioned in the progress notes were references to his past stroke and pseudobulbar palsy which was related to the stroke; the possibility of decreased respiratory drive; limited neck movement; recent problems with exudation, and difficulty with glotic function. These indicate he was a high risk for aspiration. This problem was never addressed in the nurses' care plan or in the nurses' notes. It would be something which would be absolutely addressed.
She also indicated the progress notes by the doctor on the 17th indicated a secretion problem. At this point, she
stated, the problem became an actual one instead of a potential one. On May 20, 1984 Devon Ard's assigned nurse was
Sally Florscheim. Krebs stated Florscheim did not do a full assessment of his respiratory and lung status. There is
nothing in the record indicating Florscheim did such an evaluation after he vomited. Furthermore, Krebs testified no
total swallowing assessment was made at any time by a nurse.
Although Florscheim testified she checked on Devon Ard around 6:00 p.m. on the 20th there is no documentation in the medical record.
She denied that the next time she saw him was 6:45 p.m. She stated she saw him around 6:00 p.m. She stated he was resting more comfortably and still had a little nausea. She did not take his vital signs at that time. She did not know if anyone else did. Afterwards she went downstairs to eat dinner, leaving two registered nurses and one LPN to care for 32 patients. She next saw him at 6:45 p.m. When she got off the elevator she saw Ms. Ard waving her arms screaming for help. She asked for help in getting her husband up in the bed. No other nurses were present and Florscheim went to help. She saw that Ard had vomited and was heaving. He was having problems catching his breath. His respiration was rapid and there was gurgling. He was a little blue around the lips which suggested he was not getting enough air. She lifted him so that he could catch his breath and ran to the door yelling for the suction and Dr. Preis. When she went back to the room Ard was slumped over and not breathing. She called the code and did mouth to mouth resuscitation. He never regained consciousness. He was taken to the coronary care unit and died May 22, 1984.
Krebs stated the rule in registered nursing is to write down such information. She testified it is also important to write down a response medication. She stated there was no documentation that anyone checked on him between 5:30 p.m. and 6:45 p.m. on the 20th. He should have been checked more often because he was a high risk for aspiration and had vomited at 5:30 p.m. The nurses' failure to check him in that period was below the standard of care in community.
In a situation where the patient dies, we have held that plaintiff does not have to shoulder the "unreasonable burden" of providing that the patient would have lived had proper treatment been given. Instead, the plaintiff must prove "only that there would have been a chance of survival," and that the patient was denied this chance of survival because of the defendant's negligence.
Ard v. East Jefferson General Hospital, 636 So. 2d 1042; 1994 La. App.
Chapter 4