Defenses to Malpractice and Risk Management Techniques

Defenses to Malpractice and Risk Management Techniques
Case Study

Defenses to Malpractice and Risk Management Techniques

It is the mandate of every medical practitioner to take care of the clients entrusted under
his care. The doctor should not harm the patients, and neither should they make the existing
illness worse. This case involves Yolanda Pinellas a 21 year old cancer patient entrusted under
the care of Jeffrey Chambers. The client was admitted at Caring Memorial Hospital for
chemotherapy but suffered massive injuries after being left unattended for over forty minutes.
Despite the fact that she rung the bell, the medical staff in charge did not hurry to assuage her
pain. Medical malpractice occurs when the treatment administered by the physician leads to
further injury to the client (Infusion Nurses Society, 2010). Notably, there was an infiltration to
the IV and as a result Yolanda suffered necrosis of the hand requiring her to go through multiple
surgical procedures, skin grafting, and reconstruction. During the skin grafting process, the
surgeon, Dr. William Brady, used a dermatome resulting to uneven harvesting of tissue, further
scarring the patient’s thigh area where the skin was harvested.

The Defenses In This Case

While medical practitioners together with the other health care providers are not required
to be perfect they have the duty to act responsibly and use reasonable care in their medical

profession (Wickham, 2006). In the case of Yolanda VS Caring Memorial Hospital, Diana
Smith, working during the shift heard the pump beep several times. She immediately alerted
Jeffrey who was entrusted to take care of the client. Jeffrey did not take swift action as required,
Diana went to the room after 40 minutes and discovered that IV had dislodged for the patient’s
vein. She cross-checked and found that there was no evidence that the Mitomycin had gone into
the patient’s tissue. Later it was discovered that indeed Mitomycin had gone to her tissue leading
to massive injuries.
In Diana’s case, the practitioners were not apathetic, Diana responded to the patient’s
bell. She took the right precautions by immediately stopping the IV, notifying the physician, and
providing the necessary care to the hand. The major cause of the harm caused to Yolanda was
not as a result of negligence. The Risk Manager Susan Post had noted over the last three months
prior to the incidence that there were challenges of short staffing. Moreover, the nurses were
working double shifts like Jeffery and this could compromise on their performance. Often the
hospital assigned float nurses to several units (Sauerland, 2007). The hospital was in the process
of implementing a training program to bolster the staff performance. In this case the damages
that Yolanda occurred can be blamed on multiple acts of negligence, the burden of proof lies
with the plaintiff to proof that more likely than not, the injuries she incurred were as a result of a
particular negligent act.

How The Incident Could Have Been Avoided

This incident could be avoided by foremost ensuring that the ward in which Yolanda was
admitted was sufficiently staffed because there were critically ill patients admitted in that ward.
Infiltration which caused the leaking of the IV fluid could have been avoided if only one

practitioner was assigned to conduct the operation. The staff who inserted the IV was not the one
who administered the drug through the infusion machine. The practitioner should have applied a
splint for stability and to prevent dislodging the IV infusion machine (Infusion Nurses Society,
2010).The hospital should have ensured that only qualified, chemotherapy-certified nurses
trained in venipuncture are allowed to allowed administer vesicants. When Diana Smith heard
the first bell from the client she should have respondent aptly knowing that the ward comprised
of critically ill patients.

Management techniques That Could Have Been Used

During the administration of IV fluid the practitioner should have chosen a large vein
with good blood flow for the placement of infusion machine. This would have minimized
chances of infiltration (Ener, 2004). The venipuncture site must have been monitored closely to
make sure that there was no infiltration, pain or discomfort.



Ener R., A. (2004). Extravasation of systemic hemato-oncological therapies. Ann Oncol.
Infusion Nurses Society (2010). Infusion Nursing. [3rd edition] 2010
Sauerland C,. A.(2007). Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing
care to reduce risk. Oncol Nurs Forum. 2007 Nov 27;33(6):114-41.
Schrijvers DL. Extravasation: a dreaded complication of chemotherapy. Ann Oncol. 2003;14
Suppl 3:iii26-30.
Wickham, R.(2006). Vesicant extravasation part II: Evidence-based management and continuing
controversies. Oncol Nursing Forum. November 27;33(6):1143-50.

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