Nurse Administers "Underdose" of Clot Busting Drug Ordered by Doctor Leading To Progression of Stroke-Malpractice or Ordinary Negligence?
This month an appellate court covering Tompkins County, New York addressed the issue of whether a nurse's error in administering medication ordered by a doctor would be resolved under an "ordinary negligence" or a "medical malpractice" standard of law. The plaintiff arrived at an emergency room with a clinical presentation of stroke confirmed by CT scan which revealed an embolic (clot) stroke (as opposed to a hemorraghic or bleeding stroke) in the left cerebral artery. The treatment of an embolic stroke includes blood thinners or the clot busting drug called tissue plasminogen activator ("tPA"), if the stroke symptoms are present for less than 3 hours. Time is of the essence in treating an embolic stroke.
A physician entered an order directing that the patient be administered an intravenous infusion of 90 milligrams of tPA with 10% of the medication delivered in the 1st minute and the remaining 90% over the next 59 minutes. Unfortunately, a nurse charged with implementing the doctor's order programmed the initial dose to be given over 11 minutes rather than in 1 minute. The error was discovered and corrected after 3 minutes and 30 minutes later the patient showed signs of distress so the tPA was stopped. An MRI taken the next day showed that the clots remained in the cerebral artery. The patient was ultimately left with significant cognitive and expressive deficits. The Court denied the defendants motion for summary judgment (dismissal of the complaint) finding that a jury should consider and decide the issues of departure and causation - whether any departure deprived the plaintiff of a substantial opportunity to attain the benefits of tPA based on its improper administration.
The Court also held that that the claim of a nursing error in complying with the doctor's order on dosing was a malpractice claim and did not constitute a negligence theory stating the nurse "was assisting the physician by administering the prescribed medication and was an integral part of the process of rendering medical treatment to the patient." The Court also explained that: "Conduct may be deemed malpractice, rather than negligence, when it constitutes medical treatment or bears a substantial relationship to the rendition of medical treatment by a licensed physician".... This distinction has an impact on the statute of limitations, how the jury will be instructed on the law and even the amount of fees charged by the attorney. Holland v Cayuga Medical Center at Ithaca, 2021 N.Y. Slip Op. 03896