Dear readers, here is another great article from Elizabeth Hogue! Be sure to read it carefully!
Practitioners are likely to be held liable if they fail to follow their own internal policies and procedures. They may also be responsible if they do not enforce their policies and procedures or do not inform employees about their requirements. This point is illustrated in the decision of the Court in Barkes v. River Park Hosp., Inc., No. M2006-01214-SC-R11-CV Tenn. October 20, 2010.
In this case, Wayne Barkes tilled his garden on the morning of July 26, 2000. He then used an ax and other hand tools to clear and clean up his yard. Mr. Barkes stopped working around noon and went into the house because his left arm was hurting. He soaked his arm in water and applied an ice pack to it. When the pain did not subside and Mr. Barkes began to feel worse, his wife drove him to the Hospital. When the Barkes’ first arrived at the emergency room (ER), he was seen and triaged by a paramedic employed by the Hospital. Mr. Barkes told the paramedic that he had pain in his left forearm and wrist. Mrs. Barkes also told the paramedic that Mr. Barkes was nauseated. Mr. Barkes’ vital signs were within normal range.
Mr. Barkes was then seen by a nurse practitioner (NP). The NP diagnosed a sprain due to overuse. She did not do a cardiac workup, including asking the patient if he was a smoker or if he had a family history of cardiac problems. The NP then discussed her findings with a physician in the ER who agreed with her findings and signed the discharge papers. Mr. Barkes was then discharged from the ER with instructions to take an over-the-counter pain reliever, to ice his forearm, and to rest his arm. He was not seen or evaluated by a physician.
About two hours after leaving the ER with a diagnosis of sprain, Mr. Barkes collapsed. Mrs. Barkes found him unconscious on the floor of their home. He was transported back to the ER where he could not be resuscitated. Mr. Barkes was pronounced dead of a myocardial infarction and sudden cardiac death.
Mrs. Barkes then sued a number of the providers involved, including the Hospital. In her suit she claimed that care and treatment provided in the ER fell below the standard of reasonable care under the circumstances. Specifically, Mrs. Barkes alleged that if Mr. Barkes had been triaged by a registered nurse instead of a paramedic and seen and examined by a physician instead of a nurse practitioner, as required by Hospital policies and procedures, Mr. Barkes would not have died.
The testimony of expert witnesses at trial supported Mrs. Barkes’ allegations. The Court also agreed with Mrs. Barkes and stated:
Based on the material evidence presented at trial, the jury was entitled to draw the reasonable conclusion that the hospital’s failure to inform the emergency room health care providers of its policies and its failure to effectively implement a system of oversight and enforcement of its policies was negligence that caused Mr. Barkes’ death…
The “lesson” of this case for all types of practitioners is clear: Practitioners will be liable for failure to follow their own policies and procedures. It does not matter whether the policies and procedures are outdated or need to be revised. If it is written in providers’ policies and procedures, then providers must meet their requirements. A crucial question, therefore, for practitioners when developing and revising internal policies and procedures is: Is this the standard to which we wish to be held? If not, policies and procedures must be revised.
Practitioners have an opportunity to define a reasonable standard of care for themselves. This opportunity should not be lost due to inattention to policies and procedures.