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Copy of Medical Malpractice Case Study for UMHB

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Talana Walker

on 30 March 2016

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Transcript of Copy of Medical Malpractice Case Study for UMHB

Case Study:

Boy Dies After Call to Nurse Practitioner for Flu Symptoms
Suggested Recommendations
Thank you for your attention!
LaValley, Debbie. (2012). Boy Dies After Call to NP for Flu Symptoms. Retrieved from: www.rmf.harvard.edu/Clinician-Resources/Case-Study/2012/Boy-9-Dies-After-Offhours-Call-to-NP-For-Flu-Symptoms
Description of the Case
The father of a 9-year-old boy called the on-call NP at 8:00pm Saturday night for flu-like symptoms.
Symptoms Included:
Decreased oral intake
3 day history of :
Dad is concerned because.....
In 24hrs the boy has only woke up once to go downstairs to watch TV briefly and he also had some rectal bleeding and some bleeding from his mouth
The Nurse Practitioner's response
The boys symptoms sound like a viral illness and the rectal bleeding is probably unrelated.
Further questioning by the NP...
Was he alert?
Father's response was yes but very tired

Had he passed any urine?
Father's response was yes

Did he have a fever or rash?
Father's response was no.

Do you feel the child is "ok" tonight or do you feel he should be seen right away?
Father replied that he didn't think he felt he should be seen right away
The NP made plans to see the boy the next morning (Sunday) at 8:00am and was told to call back if anything develops during the night
The Father asked...
"Should I worry about my son not taking any food"?
NPs response:
He is taking ginger ale so push the ginger ale and make sure he is urinating periodically
The NP documents the call in the medical record, as well as, that she offered the father an ED visit which is a false statement
When the father checked on the boy at 4:00am he was sleeping but he was breathing faster
, the father went to check on his son who was not breathing

911 was called and CPR was initiated

EMT's arrived within minutes and the boy was apneic, pulseless, with fixed and dilated pupils, and his corneas were cloudy

the boy was pronounced dead.......
An Autopsy was done with the following findings:
Cause of Death: Diabetic Ketoacidosis (DKA)
(the child had undiagnosed diabetes mellitus)

Blood Sugar was 1165 (nl 50-80)
Potassium was 7.1 (nl 3.5-5.3)
HgA1C was 15.3% (nl 4-5.9%)
The parents sued the nurse practitioner, alleging wrongful death of their son due to negligent delay in diagnosis and treatment of DKA
The NP neglected to adequately assess the severity of the patients symptoms. He has been extremely weak and sleeping most of the day with blood coming out of his mouth and rectum with the cause unknown.
Communication Barriers:
The NP failed to offer the father the option of taking his son to the ER and there were different interpretations between the father and the NP as to the severity of the symptoms
What went wrong?
The NP did not properly assess the severity of the symptoms.
The NP did not document the conversation with the father accurately in the medical record and it was audio recorded
The NP did not give the father any referral to other providers or facilities such as the ER
Take home lessons:
Err on the side of caution and request the patient come in to the clinic or present to the ER for evaluation. Many illnesses can mimic others, and being able to notice subtle differences can be very difficult without physically seeing the patient and obtaining diagnostic tests

The case was settled in the high range against the nurse practitioner
Obtain a careful history and document accurately.
Ask a lot of questions
With phone only consultation the provider is deprived of non-verbal cues
Common senses are limited to only hearing so careful analysis is needed when gathering information from speech (content, rate, rhythm, tone, and emotion), and non-speech sounds (cough, wheeze, background noises).
Verify that the patient/parent/family understand the risk and if face-to-face is not immediately necessary provide an explanation of when to be concerned and provide safety-netting advice and present to ER if symptoms worsen or do not improve.
The use of protocol may improve the standard of
history taking and symptoms so that nothing is missed allowing to see the big picture.
(The Medical Protection Society [MPS], 2012)
The Medical Protection Society. (2012, October 2012). In the Dark Risks of Telephone Consultations. Sessional GP, 4(2), 1-20. Retrieved from http://www.medicalprotection.org/uk/sessional-gp-issue-6/risks-of-telephone-consultations
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