Mary age 34, fell from a ladder while hanging decorations for Halloween. She fell onto her outstretched hands from the top rung of the ladder.Immediately after, Anna notes that her wrist is swollen and painful and decides to go to an area Urgent Care. There she saw NP, a recent graduate and has finished orientation. The NP examines her hand and wrist and notes the tenderness, swelling and ecchymosis. It is also noted the Anna cannot flex or extend her wrist, nor pronate or supinate either. The NP orders a 2 view x-ray of the wrist. The NP looks at the x-ray and diagnoses Anna with a sprain. The NP enters the findings of "normal study" in the radiology notes in the radiology EMR. Post injury day 7, Mary sees her Primary Care NP. This NP looks up the UC visit and x-ray results.

The radiologist who read Anna's x-ray wrote final impression: within normal study, no fracture or dislocation. Pt has decreased ROM- unable to flex or extend, pronate or supinate the wrist. There is point tenderness over the distal radius. After reviewing the EMR from UC, the NP explained that the x-rays were negative as read by the radiologist and NP. The NP agrees with the diagnosis of sprain. Mary is instructed that sprains take time to heal and may be painful for several weeks. The NP denies Mary's request for stronger pain medication. She is instructed to follow up in 1-2 weeks for recheck. The NP notes in the chart that if not improved will repeat x-ray and potentially order an orthopedic specialist at that time.

Mary had no time off from work and could not afford time off without pay. With her high out of pocket deductible she decides not to follow up with the NP when her wrist remains painful as she knows that the x-ray is negative and nothing can be done for a sprain. No one at the Primary NP office notices that the patient does not keep the appointment. Mary starts to notice that her hand is going numb off and on, she is dropping things frequently. The pain just is not getting better. She decides to go back to the Primary NP office now 6 weeks later. The NP calls an orthopedic specialist who sees her the next day He repeats an x-ray and looks in the EMR . Upon review of the chart and x-rays, he realizes that the initial x-ray was misread and the second ray reveals a significant subluxation as well as the unhealed fracture. Surgery is scheduled the next day to stabilize the fracture and release the nerve.

Mary is suing for lost wages, pain and suffering.

1. How was there a duty of care between each of the NP/Practitioners owed to the client (client ispotential plaintiff because a lack of duty of care)?
2. How did each of theNP/Practitioners conduct fall below standard of care?Be specific.
3. How did the NP's/Practitioner's conduct / actions cause injury or harm?
4. What risk reduction (risk management) strategies could each of the NP/Practitioners perform toreduce risk for malpractice and/or negligence?
5. How could these NP/Practitioners develop a tracking system for client laboratory/diagnostic testing, health maintenance examinations and an intervention forfollow up if the client fails to follow through withrecommended testing?