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Clinic Ignores Clear Patient Safety Concern
ISSUE: What liability is a healthcare provider subject to when repeated patient safety warnings are ignored?
A man visited a surgical center to undergo an outpatient procedure to alleviate his snoring. During the surgery, he went into cardiac arrest. Despite resuscitative efforts, he sustained anoxic encephalopathy and died at a hospital one week later. The delay in resuscitation was, in part, due to the medical staff's difficulty in using the defibrillator. The patient's wife and children filed a wrongful death and survival action for medical negligence. During the discovery phase of the case, the family's attorney took the deposition of the center nurse. The nurse testified that the center had recently replaced its defibrillator with a different model. Her testimony was:
Q. Did you ask the anesthesiologist any questions about the new defibrillator on the day you saw him handling the dials?
A. I just made a statement. I said, Oh wow, this is our new one. We need to be in-serviced.
Q. What was his response?
A. You will be.
Q. And that - and your testimony is that for several months those surgeries went on at the center with a defibrillator that no one had been trained to use?
A. Yes.
Q. Did you ever bring that to the anesthesiologist's attention again?
A. Yes
Q. What did you tell him?
A. We need to be in-serviced. We still have not been in-serviced.
Q. And what did - what was his response?
A. Yes, we do.
Following the deposition, the family filed to add a claim for punitive damages. They alleged that the clinic knew for at least several months prior to the surgery that no one at the facility had been trained on or knew how to operate critical medical equipment, such as the center's only cardiac defibrillator. The patient's family further alleged that, "the defendants deliberately shut their eyes and avoided making reasonable inquiry with a conscious purpose to avoid learning the truth of the extreme risk," and that the medical clinic had actual knowledge of these unsafe and hazardous practices because they had been warned about and been urged to stop them several months before the patient's death.
To be awarded punitive damages in this state, the patient's family needed to demonstrate (1) actual knowledge of the defect on the part of the defendant, and (2) the defendant's conscious or deliberate disregard of the foreseeable harm resulting from the defect.
A man visited a surgical center to undergo an outpatient procedure to alleviate his snoring. During the surgery, he went into cardiac arrest. Despite resuscitative efforts, he sustained anoxic encephalopathy and died at a hospital one week later. The delay in resuscitation was, in part, due to the medical staff's difficulty in using the defibrillator. The patient's wife and children filed a wrongful death and survival action for medical negligence. During the discovery phase of the case, the family's attorney took the deposition of the center nurse. The nurse testified that the center had recently replaced its defibrillator with a different model. Her testimony was:
Q. Did you ask the anesthesiologist any questions about the new defibrillator on the day you saw him handling the dials?
A. I just made a statement. I said, Oh wow, this is our new one. We need to be in-serviced.
Q. What was his response?
A. You will be.
Q. And that - and your testimony is that for several months those surgeries went on at the center with a defibrillator that no one had been trained to use?
A. Yes.
Q. Did you ever bring that to the anesthesiologist's attention again?
A. Yes
Q. What did you tell him?
A. We need to be in-serviced. We still have not been in-serviced.
Q. And what did - what was his response?
A. Yes, we do.
Following the deposition, the family filed to add a claim for punitive damages. They alleged that the clinic knew for at least several months prior to the surgery that no one at the facility had been trained on or knew how to operate critical medical equipment, such as the center's only cardiac defibrillator. The patient's family further alleged that, "the defendants deliberately shut their eyes and avoided making reasonable inquiry with a conscious purpose to avoid learning the truth of the extreme risk," and that the medical clinic had actual knowledge of these unsafe and hazardous practices because they had been warned about and been urged to stop them several months before the patient's death.
To be awarded punitive damages in this state, the patient's family needed to demonstrate (1) actual knowledge of the defect on the part of the defendant, and (2) the defendant's conscious or deliberate disregard of the foreseeable harm resulting from the defect.
From your analysis of the case, assess whether the following statesments are true or false:
| * | Punitive damages are intended to compensate patients or families for injuries resulting from substandard care. | True or False |
| * | Most medical malpractice juries do not consider awards of punitive damages. | True or False |
| * | Consciously ignoring a significant patient safety hazard can result in considerable liability. | True or False |
Expand to check answers
GENERAL PRINCIPLE: Punitive damages in medical malpractice cases may be awarded to punish a defendant whose conduct is characterized by evil motive, intent to injure, fraud or conscious disregard for patient safety, and to warn others contemplating similar conduct of the serious risk of monetary liability.
APPLIED PRINCIPLE: The clinic had replaced its defibrillator with a newer model, recognizing that a facility performing surgical procedures had to be prepared for possible resuscitation of patients. When the newer model arrived, it operated differently than the previous one, and the staff needed instruction in its use.
Even if the anesthesiologist was previously unaware that such instruction was necessary, the nurse's comment that the staff would require in-service training made him aware of the need. It also should have signaled to him that serious patient injury could occur if that instruction was not immediately accomplished. For unidentified reasons, the anesthesiologist chose not to conduct the training, even after he was again reminded, much later, that the training had not been done and was still needed.
Such conduct could be the basis for allegations of substandard care, could violate statutory requirements and could be considered egregious enough to allow the family to seek punitive damages. Although many states allow punitive damages in medical malpractice lawsuits, they are awarded rarely and there may be limits on damages recoverable or may require a stricter burden of proof. However, punitive damages may or may not be covered by malpractice liability insurance. Even if the jury were to find that the conduct was not sufficiently outrageous to award punitive damages to the patient's family, the jury's possible anger toward the anesthesiologist's conduct could influence the award of compensatory damages.
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APPLIED PRINCIPLE: The clinic had replaced its defibrillator with a newer model, recognizing that a facility performing surgical procedures had to be prepared for possible resuscitation of patients. When the newer model arrived, it operated differently than the previous one, and the staff needed instruction in its use.
Even if the anesthesiologist was previously unaware that such instruction was necessary, the nurse's comment that the staff would require in-service training made him aware of the need. It also should have signaled to him that serious patient injury could occur if that instruction was not immediately accomplished. For unidentified reasons, the anesthesiologist chose not to conduct the training, even after he was again reminded, much later, that the training had not been done and was still needed.
Such conduct could be the basis for allegations of substandard care, could violate statutory requirements and could be considered egregious enough to allow the family to seek punitive damages. Although many states allow punitive damages in medical malpractice lawsuits, they are awarded rarely and there may be limits on damages recoverable or may require a stricter burden of proof. However, punitive damages may or may not be covered by malpractice liability insurance. Even if the jury were to find that the conduct was not sufficiently outrageous to award punitive damages to the patient's family, the jury's possible anger toward the anesthesiologist's conduct could influence the award of compensatory damages.
| * | Punitive damages are intended to compensate patients or families for injuries resulting from substandard care. | False |
| * | Most medical malpractice juries do not consider awards of punitive damages. | True |
| * | Consciously ignoring a significant patient safety hazard can result in considerable liability. | True |