Malpractice
Malpractice refers to professional negligence. Nursing responsibilities include both actions taken and those omitted. The concept of malpractice must contain four key elements. Each of the elements must be present for liability to be established.
Box 2-2 Busta v Columbus Hospital Corporation (1996)
While he was a postoperative patient at Columbus Hospital in Great Falls, Mr. Busta died from injuries sustained in a fall from his third-floor window; apparently, he had tried to climb down on an improvised rope. At trial, the nurse assigned to care for Mr. Busta testified that during her last evening visit with him, he had experienced an episode of tachycardia and hypertension. He had also behaved atypically, desiring isolation and refusing all nursing care and his prescribed medication, known to have adverse effects, including confusion, anxiety, and psychosis. The nurse did not report the symptoms and the change in behavior to the physician. She also testified that when she observed the patient at midnight, he appeared to be sleeping; she did not reassess his vital signs.
Mr. Busta’s surgeon testified that, because of the mind-altering adverse effects of the patient’s medication, he would have reassessed his patient if he had been notified of the changing signs and symptoms. Expert testimony opined that the nurse was negligent in failing to adequately monitor Mr. Busta on the evening and night before he died and in failing to report the constellation of signs and symptoms to the surgeon and that the hospital was negligent in failing to maintain a safe environment (evidence presented at trial showed that the hospital had not acted on a directive from The Joint Commission [TJC] to restrict the opening of windows in patients’ rooms).
The jury found that the negligence of Columbus Hospital combined with the patient’s contributory negligence caused the patient’s injuries and death; the jury apportioned 70% of the liability to the hospital and 30% to Mr. Busta. The jury found that Mr. Busta and his estate were damaged in the amount of $5000 and his heirs $800,000. On the basis of the jury’s apportioned liability, the district court entered a judgment in favor of Mr. Busta’s estate in the amount of $3500 and in favor of his heirs $560,000.
From Croke E: Nurses, negligence and malpractice. Am J Nurs 103(9):59-60, 2003.
- Duty: refers the established relationship between the patient and the nurse.
- Breach of duty: failure to perform the duty in a reasonable, prudent manner.
- Harm has occurred; this does not have to be physical injury.
- The breach of duty was the proximate cause of the harm; the occurrence of harm depended directly on the occurrence of the breach.