Medico-legal Issues in Radiology Analaysing - Case Study Example

Discuss this case, in terms of negligence. Focus on the roles of both Leo and Polly. Comment on any shortcomings in the procedures and suggest how this event may have been avoided? What do you consider to be the main issues relating to consent in this case? Do you think that Jason may be successful in a negligence claim? This case of negligence in a hospital setting is common to all the workplaces. It involves lack of attention on the part of workmen and occurs even before any negligence unique to treatment related procedures or conduct takes place. As it happens in a hospital setting, it is bordering on core medical negligence. Medical negligence is characterised by four aspects. 1) The medical professional is obligated to the patient by a duty stemming out of standard of conduct laid down by professional bodies and statute.2) This must have been violated by the professional concerned. 3) The patient must have incurred bodily injury, undergone stress or died as a result. 4) The patient or his/her legal representatives must establish that the harm etc took place because of the failure to carry out the obligation by the medical professional towards the patient. Further it should be foreseeable that such a situation can occur as a result of the medical professional’s failure. For instance, prescribing a medicine incompatible with the disease that could result in allergies or severe side effects (Heath 1998, 34) A legal principle called the doctrine of res ipsa loquitur, meaning “the thing speaks for itself’ permits bypassing of the procedure of going through these four aspects.. This is based on the premise that a thing which the professional can control causes harm otherwise impossible to occur but for the professional’s negligence. It can be an actionable tort which the plaintiff need not prove that defendant was negligent. For example, during the course of repeat operation, discovery of failure to remove the remnants of body parts or possibility of an object used in the earlier procedure having been left behind. Further there is the doctrine of respondent superior (let the master answer) by which an employer is answerable for the tortious wrongs committed by his workers. In this type, the patient need not prove that the employer was negligent but his employee provided it was during the course employment (Heath 1998, 34-35). To make the explanation simpler, the happening of the injury should have been reasonably foreseen by the defendant, steps must have been taken to prevent such a happening, and there is a failure to take necessary steps that should have been taken. In cases of civil nature, negligence can be proved “on the balance of probabilities” (Otto 2004) and the burden of proof is on the patient who must prove the carelessness on the part of the professional and the resultant injury. In criminal cases, evidence must be brought by an expert determination to prove absolutely that a man of ordinary prudence would not have acted the way the professional has acted (Otto 2004) In the instant case Leo and Polly are the radiographers to whom the emergency department sends a15-year old Jason who is a minor for taking X ray accompanied by two nurses. He is already in a state of semi-consciousness with injuries and suspected fractures likely to have been caused by his fall aggravated by his consumption of ketamine in a rave party. The two nurses who brought the patient stayed back outside as if it is none of their concern after having handed over Jason to the radiology technologists who also do not display professional care in their conduct. While Leo, the senior radiographer goes to speak on phone asking Polly, his junior staff to take care of the patient, Polly leaves the patient alone in search of cassettes required for the procedure probably assuming nothing would happen within a short period of few minutes, without asking at least the nurses who wait outside to take care of the patient. In a typical case, Jones v Axelrod, a nurse’s aide left a patient sitting on the edge of the bed after transferring to bed from wheelchair and the patient fell to the floor. The aide agreed that patient had needed restraints. Her supervisor also testified that leaving patient on the edge of the bed unrestrained and unattended was not proper and not in conformity with the procedure. It was held that the nurse’s aide’s conduct constituted patient neglect (Pozgar 2004, 218) In another case Bowe v Area Medical Center, a nurse’s aide had kept a patient on the commode and left him unattended for ten minutes. On her return, the patient was found in a pool of blood as he had apparently hit his head on the sink while he fell. The hospital found her grossly negligent and therefore dismissed her. Although the Circuit Court held in favour of the aide and awarded $ 36,238.17 in lost wages and $ 15,000 for mental suffering, the West Virginia Supreme Court reversed the Circuit Court’s judgment holding her liable for leaving behind the patient without attention for ten minutes which contravened hospital’s policy. (Pozgar 2004 , 218) Procedures Standards prescribed for radiological examination of a child involving certain procedures should have been followed as per the prescribed standards meant for children which can serve as guidance in this case Two radiographers must do the examination by working together. There must also be another profession responsible for the child’s safety during the examination, preferably a paediatric nurse or any other professional from the paediatric department. At the time, a child sent to radiology department, best interests of the child should be served allowing carers to accompany the child (Standards for Radiological Investigations of Suspected Non-accidental Injury 2008) In the above case, some procedures seem to have been followed as there are already two radiographers and two nurses. Hence the hospital cannot be blamed for lack of procedures. The pity is that in spite of four persons available to take care of the patient, none of them took take care of the patient resulting in his fall. Consent Consent is necessary for all types of medical care including the one carried out in this case. The informed consent can be of varying degree. Most common type is implied consent where actions and demeanour of the patient implies consent. This implied consent would only extend up to certain preliminary steps when the patient is brought to the hospital such as usual diagnostic methods of interview, inspection, palpation, percussion and auscultation with stethoscope. Beyond this, express consent is required especially for X- ray etc. In urgent situations with life threatening conditions such as in this case, no consent is required for most urgent matters. Where the patient is unconscious, if there is no consent possible to be obtained from relatives or parents, the hospital should decide what is best for the patient by waiving the need for consent (Knight 1998, 75-76) Jason, being a minor and unconscious or semi conscious, consent of his parents or guardians are required in the normal course. Even in such situations, some times a minor can over rule his parent’s or guardian’s decision as a grown up child with sufficient maturity to understand the implications as established in Gillick’s case (Rose 2007, 30) and (Gillick 1986). No consent appears to have been taken for Jason’s treatment as the circumstances has warranted that it would be in the interests of the minor to proceed with X-ray procedures to start with. Probably after X ray result, the hospital may have planned to obtain consent especially he being a minor by trying to establish contact with his parents. It would not be problem because of his friends’ presence. Possibility of a successful claim by Jason for negligence As seen above, there is every possibility of a claim being allowed for negligence on the part of both the radiographers and the two nurses who were in charge of Jason. All their actions and non-actions meet the criteria to establish negligence. The appropriate way would be to proceed against the hospital authority for vicarious labiality for the acts and omissions of its employees. The hospital authority that will have to pay damages to the patient can also dismiss the services of the four employees for being negligent. The fact that Leo asked Polly to take care of the patient while he went to speak on phone cannot be an excuse as he was not supposed to do any other act than attending to the patient. The idea of two radiographers being assigned to attend on the patient is that two technicians are necessary beside the patient. The fact that two nurses have been assigned to the patient is to assist the radiographers by taking care of the patient while they concentrate on X-ray taking. Their staying outside aggravated the risk of patient falling down without care. Perhaps radiographers might have called the nurses inside when they were to begin the procedure. It is a classic example wherein nothing should be left to chance. All the four personnel could have reasonably foreseen that a person unconscious or otherwise needs to be constantly monitored and should have taken steps to prevent any thing untoward for the patient. And it is patently clear there has been utter failure to take such steps. As such, Jason or his legal representative is entitled to claim for negligence against the hospital for its vicarious liability and also individually on these four personnel and the court would decide whom to be held responsible for payment of damages to Jason whether the hospital and employees jointly or hospital alone after ensuring that Jason really suffered damages as a result of the fall. References Gillick v West Norfolk and Wisbech Area Health Authority and another [1986] 1 AC 112, [1985] 3 All ER 402, [1985] 3 WLR 830, [1986] 1 FLR 224, [1986] Crim LR 113, 2 BMLR 11 Heath Stephen W, 1998. Risk Management and Medical Liability: A Manual for Indian Health Service and Tribal Health Care Professionals. Diane Publishing. Otto S F, 2004. Medical Negligence, SA Journal of Radiology August Knight Bernard ,1998. Lawyers Guide to Forensic Medicine, Routledge, ed 2 Pozgar George D, 2004. Legal aspects of health care administration, Jones $ Bartlett Learning, ed 9 Rose James, 2007. You and your mid-adolescent: the hour of the stranger, Kamak Books Standards for Radiological Investigations of Suspected Non-accidental Injury- March 2008. Read More