Avoiding Liability Bulletin – April 1, 2015
Diagnostic errors are the most common reason lawsuits are filed against nurse practitioners in office practices, as the following case illustrates.
A 15-year-old female student left school early due to a severe headache, joint stiffness, over-all aching, and a fever. The student’s mother gave her Tylenol and took her to see an NP that evening.
The student told the NP of her symptoms and took her temperature, which was 103.7 degrees. The NP’s assessment indicated no cough, no chest congestion, no abdominal complaints and no rhinitis.1 The student’s CBC showed a white cell count of 16,600 but tests for meningeal irration were negative. A pediatrician in the same office did a quick exam of the patient as well.
The NP diagnosed the patient’s condition as “probable flu” and instructed the mother that if her daughter vomited or had changes in her symptoms to call the NP. The student and her mother left the office for home.
Later that evening, the mother called to tell the NP that her daughter had vomited several times. The NP instructed the mother to keep her daughter at home that evening and to come to the office in the morning. By the next morning, the patient was lethargic to the point of being only “marginally responsive” when brought to the clinic. Clinic staff called 9-1-1.
At the hospital, the student was diagnosed with meningitis, placed on antibiotics, intubated, and admitted to the ICU. Her condition continued to worsen, suffered a brain herniation and died one week after her initial visit to the NP.2
The mother sued the NP, alleging that the NP improperly performed the tests for meningitis, especially since it was “certain” that the patient had neck stiffness. The NP argued that the student had the flu that quickly progressed overnight into meningitis.
The case settled for $500,000.3
This case illustrates the importance of you carefully and fully assessing a patient’s symptoms when presenting in your practice setting. Although the NP’s argument as to what happened to cause this young student’s death may have been proven to be true, the question arises as to the completeness of the tests the NP performed for the presence of meningitis.
Moreover, when the mother called the NP after the office visit to tell the NP that the daughter had vomited several times, it would have seemed prudent to instruct the mother to take her daughter to the ED right away rather than wait until the next clinic day to evaluate the increase in vomiting.
The precautionary bottom line in this case seems clear: as an NP, instruct your patients to seek medical treatment immediately when there is a reported change in symptoms that could indicate a further decline in a patient’s condition, a decline which may result in a path to the patient’s death.
1. Carolyn Buppert (2001), “Questions and Answers on Malpractice Insurance for Nurse Practitioners, 6(1) Topics in Advanced Nursing eJournal, 2. Available at: http://www.medscape.com/viewarticle/520660 . Accessed 3/25/15.
THIS BULLETIN IS FOR EDUCATIONAL PURPOSES ONLY AND IS NOT TO BE TAKEN AS SPECIFIC LEGAL OR OTHER ADVICE BY THE READER. IF LEGAL OR OTHER ADVICE IS NEEDED, THE READER IS ENCOURAGED TO SEEK ADVICE FROM A COMPETENT PROFESSIONAL.