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Background

On October 3, Mr. Todd, a 60-year-old male, was admitted to Rapides General Hospital reporting chest pain. The patient was otherwise a healthy adult. On October 4, the patient underwent bypass surgery performed by a cardiothoracic surgeon, Dr. Sauls. Post-surgery, the patient developed an infection and received substandard care provided by the nursing staff and the surgeon, Dr. Sauls resulting in Mr. Todd's death.

History

In this case, the following is a chronological order of facts to determine the level of negligence. Mr. Todd was admitted to Rapids General Hospital on October 3. He underwent bypass surgery on October 4, and during post-surgery care, the patient had a decline in ambulation and a 19.5-pound weight loss. On October 17, medical records indicate that the patient's sternotomy and mid-lower left leg incision were reddened, and the patient had a temperature of 99.6 F. Records do not indicate that Dr. Sauls was contacted by nursing staff with the patient's status. On October 18, Dr. Sauls documented that no drainage or redness was noted at the surgical site. The same day nursing notes documented redness and drainage at the chest tube site, and the patient had a temperature of 101.2 F. Dr. Sauls notes documented the patient was afebrile.

On October 19, Dr. Sauls documented the patient's wounds were improving, and the patient continued to be afebrile. The nursing notes contradicted Dr. Sauls's documentation and indicated redness and drainage at the wound site, with the patient having a temperature of 100 F. Also, the nursing notes document that the bedside nurse notified Dr. Sauls. There were no new orders documented in the medical record, and Dr. Sauls and not provided new orders. On October 20, the nursing notes report indicated that the patient's surgical site continued to show redness, drainage, and the patient was febrile. At this time, there have been no additional orders by Dr. Sauls documented. One of the treating physicians, Dr. Kamil, saw the patient and notified Dr. Sauls to consider supplemental feedings due to the patient's nutritional status. There is no documentation indicating that Dr. Sauls followed-up on Dr. Kamil's recommendation.

The patient's health continued to decline and transferred to the Intensive Care Unit on October 21. The nurses' notes on October 21 indicated that the chest tube site was draining foul-smelling bloody purulence. The patient registered a temperature of 100.6 F. Dr. Sauls ordered an initial chest tube site culture. The culture's results received October 23indicated a staph infection, and the patient started on antibiotics. The patient transferred to St. Luke's Hospital at the request of the family. At admission to St. Luke's Hospital, every wound site was infected, and despite antibiotic intervention, the patient died November 2.

Elements of Negligence

Based on the above-listed facts, in this case, the four elements of negligence are evident. Pozgar (2020) outlines the criteria for a negligence case: duty of care, breach of duty, injury, and causation.

Duty to care represents the legal relationship between the medical staff (nurses and physicians) with the patient. The legal obligation between the physician and nurses, too, Mr. Todd had been established. At the time of the injury, these legal relationships were clearly defined. Breach of duty is failing to comply with the accepted standard of care (Pozgar, 2020). A breach of duty occurred on multiple occasions, demonstrated by inconsistencies in the medical documentation. The standard of care for follow-up care post-surgical procedure was not followed. "In legal terms, the level at which the average, prudent provider in a given community would practice. It is how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances" (Shiel, n.d.). The case demonstrates injury to the patient based on inconsistencies in the medical records, miscommunications, or lack of communication, and this negligence resulted in Mr. Todd's death. The significant neglect in post-operative care demonstrates causation in this case.

Plaintiff / Defendant

The plaintiff, in this case, would be the family or Estate of Mr. Todd. The defendant would likely establish a shared liability between Rapids General Hospital and the surgeon, Dr. Sauls.There is not enough information provided on this case to determine if the nurses providing care will be named as defendants.

Evidence for the Plaintiff

The plaintiff's evidence would include medical records showing the inconsistencies in care, providing expert testimony defining the standard of care, and the outcome of the patient's symptoms if treated by the standard of care.The plaintiff will argue that there are significant discrepancies in the medical records. Dr. Saul did not respond timely in treating an infection, despite medical documentation indicating the patient had signs and symptoms of an infection and significant weight loss.

Defense Options

The defense strategy could include the argument that the standard of care meets the requirement under the law. Supreme Court Justice Robertson states, "Negligence may not be inferred from a bad result. Our law says that a physician is not an insurer of health, and a physician is not required to guarantee results. He undertakes only to meet the standard of skill possessed generally by others practicing in his field under similar circumstances" (Moffett, 2011). The defense could argue that the surgeon met the minimal requirement required when treating the patient.

Outcome

There is likely a clear and convincing case in favor of the plaintiff with a significant finding of negligence against the defendants, Raids General Hospital, and Dr. Saul. If this case follows other successful malpractice cases in the state of Texas, there would be a finding in favor of the plaintiff with significant financial compensation required by the defendants.

Damages

According to Texas HB 4 (2003), the plaintiff awards include up to $500,000, a maximum amount for wrongful death cases that include compensatory, non-economic, and exemplary damages (McCarthy, 2003). This legislation applies in Texas, and other states have different rules on malpractice cases. However, this cap indexes for inflation, and as of 2002, the amount is approximately 1.4 million (McCarthy, 2003). In 2018, the largest financial award for medical malpractice in Texas history was awarded by a Texas jury. In the case, Billy Piercev. East Texas Medical Center and Dr.Gary Boydand the ETMC Digestive Disease Center, the"$43 millionverdict included$18.57 millionfor past and future pain, anguish, loss of earning capacity, and medical care and expenses. The jury also awarded$25 millionin punitive damages, after concluding the hospital's conduct involved an extreme risk of potential harm to others (Walker, 2019). Damages, in this case, may result in a significant financial award for the plaintiff.