Legal Aspects Of Health Care Administration 11th Edition by George Pozgar

Exercise 2

Facts
While in the intensive care unit (ICU), a nurse's note indicated that the grip in appellant-Seavers's right hand was weaker than that in her left hand. Both of her hands had been placed in wrist restraints, fastened to bed rails, to prevent her from pulling out her endotracheal tube. When the endotracheal tube was removed and the appellant could speak, she complained that her right arm was numb; Seavers had suffered severe damage to her right ulnar nerve. The appellant and her husband filed suit against the medical center, alleging that the injury was the result of the nurses negligently restraining her arm. She later amended her complaint to include the theory of res ipsa loquitur.
The medical center filed a motion for summary judgment, supported by the affidavits of two experts. Both experts opined that the nerve damage in the appellant's right arm was "of unknown etiology" and that the injury could have developed during her stay in the ICU without any deviation from standards of professional care.
The appellant opposed the medical center's motion for summary judgment, arguing that there were genuine issues of material fact. The appellant's response was supported by the deposition of Natelson, a neurosurgeon, and the affidavits of both Natelson and Woodworth, a registered nurse who worked in the ICU. Both Natelson and Woodworth opined that the appellant was under the exclusive control and care of the medical center's nursing staff when the nerve injury occurred. Natelson and Woodworth stated that when treating ICU patients who are unconscious or under heavy sedation or restraint, the standard of professional care requires the protection of the patients' extremities so that injuries to the ulnar nerves do not occur. Based on their independent review of the appellant's medical records and electromyography (EMG) results, they opined that the injury was the type that would not have occurred if the nursing staff had upheld the standard of care.
Finding no genuine issues of material fact, the trial court granted the medical center's motion for summary judgment. A majority of the court of appeals affirmed the trial court's order granting summary judgment for the medical center. The court of appeals held that res ipsa loquitur did not apply because the appellant's injury was not within the common knowledge of laypersons.
Issue
Does the doctrine of res ipsa loquitur apply in this case?
Holding
The doctrine of res ipsa loquitur may be applied in this case.
Reason
The parties agreed that the appellant was under the exclusive control and care of the medical center when the nerve injury occurred. The record further shows that the appellant's right arm and hand were fully functional when she entered the medical center's ICU and that no problem was detected until the ICU nurses noticed that the grip in her right hand was not as strong as the grip in her left hand. During that time, the appellant was heavily sedated, restrained, and under the complete care of the ICU nurses. Based on EMG results, the appellant has shown that the dysfunction in her right arm resulted from damage to her right ulnar nerve. According to Natelson, this injury was likely caused by prolonged pressure on the nerve from a hard object such as a bed rail. This theory was corroborated by evidence that the appellant's arms were strapped to the hospital bed during her stay in the ICU. The appellant satisfied the res ipsa loquitur requirements under Tennessee code and raised a genuine issue of material fact on the allegation of negligence. Summary judgment in favor of the medical center was improper in this case.
What procedures should the medical center implement to reduce the likelihood of similar occurrences?