Nursing Liability

Nursing Liability

The issue of nursing liability today is a hot topic of concern for nurses in the United States. Many more responsibilities associated with advanced practice nurses increases possibilities of a medical malpractice claim. There is a perception of physicians facing more lawsuits than nurses, but more and more nurses are finding themselves defending their practice evolving from patient care. This is a case in 1997 of three nurses in Colorado criminally indicted for a medication error resulting in the death of one day-old Miguel Sanchez. This paper will investigate the occurrence, liability issues, and the steps required to avoid errors and future lawsuits.

The Case

The setting of this case begins in the neonatal unit at Centura St. Anthony Hospital North in Denver, Colorado. The physician had ordered a lumbar puncture suspecting the infant to be at risk for syphilis followed by one dose of a 150,000 units of penicillin G benzathine IM. The pharmacist miscalculated the dose and dispensed two syringes totaling 1,500,000 units-ten times stronger than the amount ordered. The nurses on duty were the primary nurse Kathleen King, RN, Linda Fitchett, APRN, and Barbara Golz, a neonatal nurse practitioner. King was concerned about the infant who had already endured a lumbar puncture and now was facing multiple intramuscular injections. King approached Golz, the neonatal practitioner regarding her dilemma. To avoid further trauma to the infant, Golz and Fitchett researched the medication to see if it could be safely administered intravenously as opposed to intramuscularly. They both concluded the medication could be administered intravenously. The infant was administered the medication intravenously and in a period of minutes, went into respiratory distress and died later that day from a massive pulmonary embolism as a result of the medication penicillin G benzathine administered intravenously. It is unknown of the exact amount of monetary compensation awarded to the Sanchez family.

The Charges and Results

After the death of the infant, Golz stood before the Colorado State Board of Nursing to answer police inquiries regarding the tragic event. She also wrote to the Neofax '95 publishers for clarification on the administration routes she had used as a reference when researching the medication. As a result of the event, Golz's license was suspended. Five months later, the district attorney's office submitted the case to a grand jury resulting in indictment of all three nurses on criminal negligent homicide. They were now facing loss of their licenses and jail time due to a medication error. The attorney in this case felt the nurses should be held publicly accountable since they knowingly went against the physician's order. The nurses plead guilty on the advice of their attorneys, and in return Fitchett and Golz were offered a 2 year deferment which would keep their records clear if they kept out of trouble. The primary nurse King who was not directly involved was acquitted ("Voices from Colorado", 1998, p. 52).

What Went Wrong

The most obvious error made by the nurse was the fact that the physician's order for the medication route was changed from intramuscular to intravenous without first consulting the physician. But, two of the three nurses are an advanced practice registered nurse and the other, a neonatal nurse practitioner, which is a specialty. Under their scope of practice, they have dispensing privileges which allows them to write prescriptions associated within their specialty, and their licenses require annual continuing education credits in pharmacology ("Position statement on nurse practitioner prescriptive privilege", 2010). But, the problem comes back to the beginning: The physician's orders were not followed as written! The nurse practitioners did not write the order; therefore, they were wrong when making the decision to change the order without first speaking with the physician. What about the pharmacist who dispensed the order? Why were no charges brought against him? The attorney was informed by the "experts" if the order was followed as written,