Articles Posted in Nursing Negligence

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According to the Boston Globe, between 2005 and 2010, more than 200 hospital patients died nationally from an improper response to “patient monitors.” Patient monitors are those machines that keep track of heart function, respiratory rate and other vital signs. Typically, nurses are responsible for watching monitors.

“Alarm fatigue,” a phenomenon where nurses become desensitized to frequent monitor beeping and constant false alarms, may contribute to instances of nursing negligence. A study at Johns Hopkins Hospital in Baltimore revealed 942 critical alarms on one floor, in one day. “That’s one alarm every 91 seconds,” said New York hospital negligence lawyer Michael A. Bottar, Esq., of Bottar Leone, PLLC, a Syracuse based law firm representing patients injured due to hospital mistakes and errors.

“The alarms become background noise,” Bottar said. In one case, a patient who was wheeled into an intensive care unit and connected to a cardiac heart monitor. The leads slipped off and the machine sounded an alarm, but nursing staff did not respond. The patient stopped breathing and died without anyone noticing. At a different hospital, a patient’s heart monitor displayed a flat line for more than two hours because the battery was low. Even though they were checking on the patient, the nurses did not change the battery. The patient suffered a heart attack without anyone knowing, and died.

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“A sponge was left inside our client for nearly one year,” said Syracuse medical malpractice lawyer Michael A. Bottar, Esq., an attorney representing the patient and his family. “We believe it was a laparotomy sponge measuring nearly 12 inches by 18 inches. That’s the size of a kitchen dish towel. And it had a radio-opaque strip woven into the fabric so it should have been identified on a post-operative xray — had a study been ordered. The surgical team forgot that too. This was a complete comedy of errors.”

A retained surgical sponge is an avoidable mistake. To leave a sponge behind is either the result of surgical malpractice or nursing negligence. This is because surgeons and operating room nurses are supposed to know exactly how many sponges are used during a procedure and should not close until the sponge count is correct. “Ten in, ten out,” Bottar added.

Surgeons have an independent duty to check the abdominal cavity for sponges, even if advised by the nursing staff that that all sponges have been counted. This is because sponges and pads are known to stick together so a nurse, thinking that one sponge has been handed to a surgeon has actually handed over two. When one sponge is counted at the end of the procedure, it appears that the count is correct.

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As Syracuse medical malpractice lawyers, the Bottar Leone, PLLC legal team frequently handles cases where surgeons fail to properly count and remove surgical instruments and/or supplies from a patient. Common examples of surgical instruments left in the abdomen after surgery include sponges, pads, towels, needles, clips and clamps. Most of the time, sponges are left behind during abdominal surgery (55%) and vaginal deliveries (16%).

When a surgical instrument is left behind, it is typically the result of negligence on the part of the surgeon or the operating room nursing staff. This is because a surgeon should not close a patient until s/he knows that the surgical “count” is correct. Meaning, if ten sponges and two clamps were used during surgery, the surgeon should not close the surgical site until s/he knows that the sponges and clamps are accounted for. When counts are incorrect, the surgeon should look for the missing items before closing. If they cannot be found by visual inspection, then radiographs should be ordered. Most surgical instruments are embedded with a thin wire that is visible on an x-ray.

Often, due to fatigue by a member of the surgical team, which includes the surgeon and operating room nurses, the count will appear correct when it is not. The most common reason for an inaccurate count is when sponges or pads stick together. In that instance it looks like one pad was used when, in fact, two pads were used. Since no one in the operating suite would be on the look-out for the second pad, it may be left behind.

In 2000, the AORN Recommended Practices Committee stated that sponges should be counted five times during a procedure: (1) before the procedure starts (to determine how many sponges are in the suite); (2) before closure of the cavity; (3) before closure of the wound; (4) at skin closure; and (5) when the scrub nurse or circulating nurse permanently breaks scrub.

There are many complications associated with a retained surgical instrument, including pain, infection, organ perforation, and death.
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The American Congress of Obstetricians and Gynecologsts, lead by Syracuse OBGYN RIchard A. Waldman, M.D., recently released a position statement on New York State bill S5007/A8117 which, once signed into law, will repeal a state requirement that certified nurse midwives execute “written practice agreements” with hospitals and doctors. In sum, the new law will permit midwives to manage low-risk deliveries, which account for 60-80% of all births, completely independent from a medical doctor or hospital facility. ACOG insists that the “written practice agreements” remain in place to ensure the safety of pregnant women by requiring that a doctor or hospital be available in the event of an obstetrical emergency.

According to Syracuse birth injury lawyer Michael A. Bottar, the passage of the Midwife Modernization Act may contribute to a rise in preventable birth injuries, such as cerebral palsy and Erb’s palsy, from at-home births that appear “low-risk” but evolve into complicated deliveries due to, e.g., umbilical cord compression, shoulder dystocia, fetal distress and/or maternal hemorrhaging. Simply stated, a “low-risk” birth can become a “high-risk” birth in a matter of seconds and, where a laboring mother and fetus attended to by a midwife (who is not qualified to perform a cesarean section), a mother and baby may suffer harm before there is time to relocate to a hospital for surgical or therapeutic intervention. This is why, according to American Medical Association Resolution 205 (2008), “the safest setting for labor, delivery and the immediate post-partum period is in a hospital or birthing center within a hospital.”

At the present time, there are approximately 1,000 licensed midwives practicing in the State of New York, with more than one-half practicing in and around New York City. The balance are spread around the State, with roughly 50 practicing in and around Syracuse, Binghamton, Utica, Herkimer, Oneida, Oswego and Watertown.
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Syracuse medical malpractice lawyer Anthony S. Bottar, managing partner of Bottar Leone, PLLC, one of Upstate New York’s oldest law firms with a practice limited to medical malpractice, wrongful death, birth injuries, work injuries, brain injuries, and product/premises liability, was elected president of the New York State Academy of Trial Lawyers, an organization dedicated to protecting, preserving and enhancing the civil justice system.

The New York State Academy of Trial Lawyers boasts a membership of more than 1400 judges, law clerks, law firms, lawyers, paralegals and law students, including: Syracuse medical malpractice lawyers handling cases concerning stroke misdiagnosis, failure to diagnose cancer and failure to prevent a heart attack; Syracuse work injury lawyers handling cases concerning construction site accidents, scaffolding accidents and injuries caused by a fall from a height; Syracuse birth injury lawyers handling cases concerning fetal hypoxia and ischemia, cerebral palsy and Erb’s palsy; Utica brain injury lawyers handling cases concerning concussions, post-concussion symdrome and TBI; Watertown medical malpractice lawyers handling cases concerning Samaritan Medical Center negligence and Fort Drum physician mistakes; and Watertown injury lawyers handling New York State Thruway accidents.

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It is well-known that very sick patients, especially those in the intensive care units at Central New York hospitals, e.g., Crouse Hospital (Syracuse), St. Joseph’s Hospital Health Center (Syracuse), Community General Hospital (Syracuse), SUNY Upstate University Hospital (Syracuse), Faxton-St. Luke’s Healthcare (Utica), St. Elizabeth’s Medical Center (Utica), Oswego Hospital (Oswego), United Health Services Hospital (Binghamton), and Samaritan Medical Center (Watertown), require close monitoring. According to Dr. Phillip H. Factor, of Beth Israel Hospital in New York, “[r]elying on electronic monitors is not sufficient in the sickest of the sick; these patients require direct observation.”

A recent study suggests that very sick patients assigned to ICU rooms that could not be directly observed from a nursing station, were more likely to die while hospitalized. Data from the study is still being analyze to determine why deaths were more likely and what can be done to lessen the risk, such as increasing the nurse-to-patient ratios for remote ICU beds so that nurses spend more time at the bedside.
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