Civil law Case study# 1. Case Study: Post-Operative Care of a Patient Following Esophagoscopy and Bronchoscopy

The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”
The next day the patient was discovered dead in her bed at 4:00 A.M.
The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation.
The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.
Given the medications administered and the post-operative state of the patient, was there a legal duty to ensure that this patient be admitted for an overnight stay for observations?

The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”
The next day the patient was discovered dead in her bed at 4:00 A.M.
The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation.
The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.
Did the nurses, in this case, act as patient advocates? Was there an ethical duty to act as an advocate for this patient?

The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”
The next day the patient was discovered dead in her bed at 4:00 A.M.
The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation.
The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.
Which of the models of patient advocacy should the nurse have considered in this case and why?

The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”
The next day the patient was discovered dead in her bed at 4:00 A.M.
The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation.
The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.
Who should be found to have liability in this case?

The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”
The next day the patient was discovered dead in her bed at 4:00 A.M.
The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation.
The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.
From the following potential measures, which could have been implemented by the hospital to better ensure patient safety following procedures that involve heavy sedation or administration of multiple medications?

The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”
The next day the patient was discovered dead in her bed at 4:00 A.M.
The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation.
The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.
Given the unfortunate outcome following the patient's surgery and discharge, which of the following situations or conditions is the nurse most likely required to report by law?