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case of Bonnie

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  • Jurydoctor@aol.com
    Hi there, I really need your help and thoughts on this case. The trial date is rapidly approaching. Thanks, Amy ... There is a dispute about what the patient
    Message 1 of 4 , Aug 22, 2003
      Hi there,
      I really need your help and thoughts on this case.
      The trial date is rapidly approaching.
      Thanks,
      Amy
      > This is a wrongful death medical negligence case in a conservative venue
      > against Well Health Systems, Inc. for  medical treatment it
      > provided  now deceased wife, Bonnie, through a nurse
      > practitioner that  was not licensed as a nurse
      > practitioner at the time. 


      There is a dispute about what the patient and her
      > husband related in the history of her symptoms versus what actually found
      > its way into the transcribed note I have typed in below. 
      > One of the questions I have for you is  whether Bonnie's husband will be
      > believed.  Before I tell you what the dispute is, please allow me to give
      > you some background.
      >
      > This is an alleged misdiagnosis of a heart attack case that occurred on
      > 11/29/99
      > where plaintiffs contend that based on the history in the dictated note of
      > the
      > office visit that day, the standard of care required the nurse practitioner
      > to rule out a cardiac origin of the cause of the symptoms that brought her
      > into the office before sending her home. 



      Bonnie did not have any chest
      > pain as is classically the case.  However, she did have jaw    pain which
      > can be referred heart pain in patients suffering from decreased blow flow to
      > the
      > heart muscle from obstructed arteries.  PLaintiffs' experts state that based
      > on her
      > risk factors for heart disease and her signs and symptoms, a resting EKG
      > should have been performed.  Instead, this unlicensed nurse practitioner
      > diagnosed an ear infection and a probable viral syndrome, prescribed some
      > medication and sent her home without a doing an EKG.  She was discharged
      > home around 6 PM.


      She took her medicine without improvement and went to bed
      >
      > around 10 PM.  She died at 3:30 AM.  The ambulance took her to the ER where
      > she arrived in full cardiac arrest and was pronounced dead at 4:29 AM.
      > Autopsy showed the death was caused by a heart rhythm disturbance from a
      > build-up of plaque in her right coronary artery.  The pathologist said her
      > heart condition was amenable to therapeutic intervention.
      >
      > The medical questions for the jury in this case are: (1)  whether a cardiac
      > work-up was indicated by the information in the note below and (2) whether
      > the physical exam and history shown in the note rule out a cardiac origin of
      > her complaints without an EKG.
      >
      > The real case turning question is whether the jury will believe what Joe
      > (her husband)
      > says he and his wife told the nurse practitioner about her complaints at
      > home that she felt like she might be having a heart attack. (this is more
      > fully described below)



      The nurse practitioner does not
      > remember this being said and, of course, it is not reported in the 11/29/99
      > note of the office visit.  However, this note was dictated the day after the
      > office visit after Bonnie was dead. 


      Althoush we do not know whether the nurse practitioner knew she was dead at
      the time she dictated the note, but it is
      > a possibility that could explain why the "heart attack" comment is not
      > there.  Also, the nurse practitioner's supervising doctor signed the death
      > certificate and listed as the cause of death:  probable MI (heart attack).
      > The death certificate was signed long before an autopsy was done.  In other
      > words, the only information available to the doctor in order to list a cause
      > of death at all was the information the nurse practitioner had from the day
      > and possibly information from the ER (where she arrived in cardiac arrest,
      > which can be caused by a number of things).



      What do you think about these 2 clues?, In fact are they clues at all?

      >
      > The nurse practitioner testified that she ruled out cardiac as a cause of
      > her jaw pain and other symptoms by pointing to the information in the note
      > below, the physical exam, and specifically, the pink eardrums.  I have typed
      > the note below:
      >
      > CHIEF COMPLAINT:  Headache and Nausea.
      >
      > ALLERGIES:  none known.
      >
      > HISTORY OF PRESENT ILLNESS:  Patient is a 62 year-old Caucasian female with
      > sudden onset of headache, nausea, right ear pain, and jaw pain.  She has had
      > some sweating episodes, none recently.  She has been exposed to her
      > grandchild with otitis media and thinks this may be the origin of her
      > problem.  Patient states "she feels awful".  Husband is with her today.
      > Patient has a history of increased lipids.
      >
      > REVIEW OF SYSTEMS:  As above.  No sinus congestion or drainage.  No chest
      > pain.  No shortness of breath.  No dizziness.  No visual changes.  No
      > syncope.  No cough.
      >
      > PAST MEDICAL HISTORY:  Stable hypertension.
      >
      > SOCIAL HISTORY:  She has a former history of tobacco use.
      >
      > PHYSICAL EXAMINATION:
      > Vital signs:  WT 138,  T 96 orally, P 72 and regular, BP 154/104, left arm
      > sitting, by T. Jenkins, M.A..  This was repeated by D. Price, C.M.A., and
      > found to be 138/76.
      > HEENT:  PERRLA.  EOMI without nystagmus.  TMs are pink, right greater than
      > left.  Turbinates with clear nasal discharge.  No facial tenderness.
      > Oropharynx is unremarkable.  Pink and moist oral mucosa.  Speech is clear.
      > No facial asymmetry.
      > Neck:  Supple.  No JVD.  No adenopathy.  No bruits.
      > Heart:  Regular rate and rhythm.  No murmurs, gallops, or rubs.
      > Lungs:  Clear bilaterally.  No wheezing, dyspnea, or cough.
      > Extremities:  Grips are equal and strong.
      > Neurologic:  Alert but appears mildly ill.  No acute distress.
      > Skin:  Warm, dry, and hydrated.
      >
      > LABS:  Left Pap was within normal limits.  Tympanogram was normal
      > bilaterally.
      >
      > ASSESSMENT:
      > 1.   Headache, consider atypical migraine versus eustachian tube
      > dysfunction.
      > 2.   Nausea, suspect viral syndrome.
      > 3.   Hypertension.
      >
      > PLAN:
      > 1.   Tigan 200mg IM today.  This was given in the right hip by T. Jenkins.
      > 2.   Phenergan 25 mg #20 one p.o.q. six hours p.r.n. nausea and vomiting.
      > 3.   Midrin #20 one p.o.q. four hours p.r.n. headache.  No refill.  Patient
      > is
      > to take one.  If headache worsens, patient is to call office.
      > 4.   Darvocet N-100 #20 one p.o.q. four to six hours pain.
      > 5.   Amoxicillin 500 mg #21 one p.o.t.i.d.
      > 6.   CBC, lipids, and hemoglobin A1C today.
      > 7.   Patient and husband encouraged to increase fluids, rest, steam
      > inhalation, decrease sodium.  Patient and husband were instructed to call
      > immediately if symptoms worsen or change.  Patient verbalized understanding.
      > Patient observed after injection and remained stable.  Discharged with
      > husband driving her home.
      >
      >
      > Bonniehad been treating at this facility for nearly 2 years with this same
      > nurse practitioner.  During the entire two years the nurse practitioner was
      > practicing without a license.  She was licensed as a registered nurse,
      > but she had completed course requirements to become a nurse practitioner.
      > However, Well Health did not verify whether she was actually licensed
      > to practice as a nurse practitioner until this lawsuit.
      >
      > Joe always drove his wife to the doctor's office on each of her prior
      > visits this facility.  However, on 11/29/99 he not only drove her to the
      > office, he actually accompanied his wife into the examination room because
      > he "wanted to be with her because she had not complained exactly this way
      > before.  I wanted to be sure she told the doctor exactly what her feelings
      > were."  Jack's testimony about what he and his wife told the nurse
      > practitioner differs in at least one significant way from what is in the
      > office note above:
      >
      > "Bonnie was on the examining table and I was in conversation with the nurse
      > practitioner.  I told her that when I came in from shopping Bonnie said
      > that she was feeling poorly, and described the headache, earache, pain in
      > the jaw, and the rolling nausea.  She also told me that she had felt like
      > she was having a heart attack.  I said, why didn't you call 911?  She said,
      > oh, I feel better now.  And I asked her to describe it to me and that's when
      > she told me the first time that she felt like she was having an earache and
      > it run down into her jaw, and she felt kind of nauseous, and it would come
      > and go.  She appeared normal when she was telling me this. She went into her
      > room and laid down.  I watched TV in the den.  About an hour later she came
      > out and said, I'm feeling bad again, I've got to do something.  That's when
      > I called the doctor's office."  Then Joe told the nurse practitioner that
      > they had been with their youngest granddaughter the day before who has an
      > ear infection and he asked if this might be what was causing the pain in his
      > wife's ear.
      >
      > My questions are:
      >
      > (1)   Who wins the credibility battle between Jack and the nurse
      > practitioner
      > over what was actually said in the examination room?
      >
      >
      >
      > (2)   What difference, if any, does it make that the nurse practitioner was
      > licensed only as a registered nurse with no license to practice as a nurse
      > practitioner although she had completed the formal schooling to become one?
      >
      >   (3)  what else do you think about the case? Who wins? what is important
      > and what is not
      ?

      As always, thanks for your thoughts:
      Amy



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    • Spies Online
      Hmmm... here are my thoughts. I am not a doctor. Why was this person seeing an unlicensed nurse practitioner? How could one reasonably expect an unlicensed
      Message 2 of 4 , Aug 22, 2003
        Hmmm... here are my thoughts.

        I am not a doctor. Why was this person seeing an unlicensed nurse practitioner? How could one reasonably expect an "unlicensed" nurse practitioner to practice as a cardiologist? It's patently ridiculous. Why didn't this patient choose to see a licensed physician? Clearly, the problem is not that the unlicensed nurse practitioner did not diagnose this. The problem is why was this woman not under the care of a licensed doctor, preferably a cardiologist, with her given medical history. There is no way someone with her symptoms should be seeing an unlicensed person. I don't think we need to go any further than this.

        Joanne, Spies Online Webmaster
        http://www.spiesonline.net



        [Non-text portions of this message have been removed]
      • CHRISINAD@AOL.COM
        ... attention.. ... nurse ... one? None ... either a RN or an NP should have had the Patient seen by the doctor. ... important ... Husband wins ... pain with
        Message 3 of 4 , Aug 22, 2003
          > > (1) Who wins the credibility battle between Jack and the nurse
          > > practitioner
          > > over what was actually said in the examination room?
          > >
          > > I believe Jack, he was concerned about his wife and was paying
          attention..
          > >
          > > (2) What difference, if any, does it make that the nurse practitioner
          > was
          > > licensed only as a registered nurse with no license to practice as a
          nurse
          > > practitioner although she had completed the formal schooling to become
          one?
          None ... either a RN or an NP should have had the Patient seen by the doctor.
          > >
          > > (3) what else do you think about the case? Who wins? what is
          important
          > > and what is not

          Husband wins
          > ? Think the nurse dropped the ball by not calling in the doctor. Jaw
          pain with nausea should have been her clue, My mother had a heart attack the only
          warning was Jaw pain and nausea, no chest pain at all. when she was taken
          to the ER the first thing they did was order and EKG....and other heart tests
          later that day she had a 4 way bypass. The doctor told us that this was a
          very common symptom in women.








          [Non-text portions of this message have been removed]
        • iaoa7@aol.com
          In a message dated 8/22/2003 1:07:03 PM Central Daylight Time, ... She should have consulted with Physician. If investigated properly and evidence is brought
          Message 4 of 4 , Aug 25, 2003
            In a message dated 8/22/2003 1:07:03 PM Central Daylight Time,
            Jurydoctor@... writes:


            > My questions are:
            > >
            > > (1) Who wins the credibility battle between Jack and the nurse
            > > practitioner
            > > over what was actually said in the examination room?
            > > Jack if proper investigation is followed!
            > >
            > >
            > > (2) What difference, if any, does it make that the nurse practitioner
            > was
            > > licensed only as a registered nurse with no license to practice as a nurse
            > > practitioner although she had completed the formal schooling to become
            > one?
            > > Big difference, Nurse should have realized the seriousness of the
            > condition from the call the day before from patient. She should have then consulted
            > and called in the physician to follow up.



            > > (3) what else do you think about the case? Who wins? what is important
            >
            > > and what is not?
            > Important that Nurses past history is investigated.

            She should have consulted with Physician.
            If investigated properly and evidence is brought forward of
            this. JACK WINS!





            [Non-text portions of this message have been removed]
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