A hospitalized patient admitted due to chest pain and diagnosed with a myocardial infarction developed a sudden inability to move his right arm and leg and was diagnosed with an acute stroke. The patient's wife was present at the time of change in condition, and reported that a nurse had come into the room shortly before and pressed on the patient's neck stating, "Your heart is beating too fast." The wife contacted hospital administration as the patient's physician did not give her a satisfactory answer to her questions. The critical care nurse director was contacted and spoke with the patient's nurse. The nurse director contacted the risk manager for assistance, and the hospital defense attorney was contacted.
Christine assisted the defense attorney with the following: analysis of medical records and the nurse's statements, authoritative research, hospital policies and procedures, and standards of care. Christine educated the attorney regarding the procedure of carotid sinus massage, the indications for the procedure, its benefits and risks. Christine's investigation report to the attorney included an opinion that the nurse was negligent by performing carotid sinus massage, a procedure to be done only by a physician and with prior informed consent, as the procedure has the risk of stroke and is contraindicated in a person with a recent myocardial infarction. Not only did the nurse violate the standard of care by performing a procedure to be done by a physician, she implemented the procedure incorrectly. Christine's investigation revealed that the nurse did carotid sinus massage by pressing on both sides of the neck at the same time; when done correctly, the massage is done only on one side of the neck. The nurse's negligent conduct, deviation from acceptable standards of care, more than likely caused a poor patient outcome with long term deficits. The evidence for causation was strong.
Outcome: The nurse resigned after she was disciplined for failure to follow hospital policies and procedures and acceptable standards of care, and for initially giving false statements to the hospital attorney. Christine's legal nurse consulting expertise assisted the hospital defense attorney to settle the case promptly for an undisclosed amount.
A criminal defense attorney requested analysis of her client's medical records to help the attorney understand the client's medical history and conditions, in order to develop the best possible defense. The accused had been charged with assault and battery causing serious bodily harm to a former friend. The friend sustained a fractured jaw, broken nose, facial lacerations requiring stitches.
Christine investigated and analyzed medical records which spanned several years. Medical records revealed the accused had a history of several witnessed generalized seizures with falls to the ground striking his head. He was hospitalized with diagnoses of seizures and head injuries. During one hospitalization he was diagnosed with status epilepticus when he had repeated seizures unable to be controlled with typical medications; seizures caused respiratory arrest requiring cardiopulmonary resuscitation. Records indicated concern for brain injury related to lack of oxygen to the brain. After a two week hospitalization, he was discharged on anti-seizure medications. Subsequent records showed a pattern of noncompliance with taking prescribed medications, continued episodes of generalized seizures over the next four years, frequent emergency department visits and refusal of hospitalization. He developed personality changes, labile mood swings, poor impulse control, and angry outbursts.
Christine conducted research relevant to the accused's documented medical diagnoses and documented behavior. Authoritative research supported relationships between head injury with loss of consciousness and physically aggressive behavior months or even years after the injury. Additional research reported relationships between seizures and violent behavior.
Outcome: The accused's medical history and conditions did affect his sentencing; he was given the minimum sentence with orders for neurological and psychological evaluations and ongoing medical treatment during incarceration, along with placement at release in a facility with staff experienced with caring for people with brain injuries and seizures.