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

Exercise 15

Facts
During an automobile accident, Liesl, an infant, was thrown to the floor of her mother's car. Rescue squad personnel examined the infant and found nothing seriously wrong. Liesl was transported with her mother, Mrs. Porter, to Hospital A's emergency department. Ogelsbee, an RN, took Liesl's vital signs and recorded them on the medical chart. She reported the vital signs to Dr. Singh, the emergency room physician on duty. The only observable sign of injury was a small bruise on the right side of Liesl's head. Ogelsbee reported this to Singh, who found all of Liesl's extremities functioning normally and ordered several laboratory tests and x-rays. He did not, however, order any spinal x-rays and failed to diagnose spinal instability. Ogelsbee did not repeat the vital signs during or after Singh's examination, claiming that she received no physician's instruction in this regard. After reviewing the x-rays and laboratory tests, Singh discharged Liesl and provided her mother with written instructions concerning her head injuries.
While awaiting a ride home, Liesl's mother reported a short period of irregular breathing by Liesl to one of the nurses. The nurse examined Liesl and determined that nothing was wrong. Porter testified that the nurse told her that "babies just breathe funny." When she reached home, Porter noted that Liesl's condition was worsening. She then decided to take Liesl to Hospital B, where physicians determined that Liesl's legs were not moving. They ordered x-rays and laboratory tests, and eventually, another hospital staff physician diagnosed a subluxation at her first and second lumbar vertebrae, which resulted in Liesl's paralysis from the waist down. Experts who testified in trial agreed that Liesl suffered paralysis sometime after Singh's examination and before her arrival at Hospital B.
Singh was the primary person who could have prevented the spinal injury by diagnosing Liesl's unstable spine before it became critically injured. Singh settled for $2.5 million. The district court denied the hospital's motion for judgment, notwithstanding the verdict in favor of the mother, but ordered a new trial, at which the jury found the hospital not liable for the infant's injuries. Both the hospital and the mother appealed.
Issue
Did the conduct of Hospital A's nurses proximately cause the infant's paralysis?
Holding
The US Court of Appeals for the Sixth Circuit held that the nurses' failure to repeat vital signs was legally insufficient to establish a connection between the failure to repeat vital signs and the eventual paralysis.
Reason
The experts on both sides generally agreed that the nurses had no independent duty, apart from a physician's instructions, to immobilize the infant. The plaintiff's experts made it clear that the physician is ultimately responsible for determining the patient's medical diagnosis and then to order the necessary and appropriate medical treatment. Singh did not diagnose any spinal cord injury and discharged the baby after examining and x-raying the infant. It was Singh who was responsible for treating Liesl's spinal cord injury, or at least he was responsible for ordering Liesl to be immobilized and hospitalized for further care and workup. The vital signs had no causal relationship to the paralysis.
Discuss the importance of collaboration of the transporting ambulance crew with the receiving hospital's nurses and physicians.