Legal Pearl: Can a Physician Be Liable for Bad Advice Given By a Nurse Practitioner?
This month we look at a situation where 2 clinicians were sued, although only 1 had actually treated the patient.
Clinical Scenerio
A nurse practitioner was working at the emergency walk-in clinic where she had been employed for the past 5 years. It was a quiet afternoon and she was covering the clinic herself when a young man limped in. The patient, a 25-year-old man, and his wife were newly married and had been spending part of their honeymoon camping and hiking in the nearby national park.
“I was a little worried about taking her on the expert trail,” said the patient, gesturing towards his wife. “She has less mountain climbing experience than I do, so I was watching out for her and didn’t pay enough attention to what I was doing.” He gestured to his leg, where his torn jeans were caked with blood and dirt. “I lost my footing and gashed my leg on an outcropping.”
“Okay,” said the nurse practitioner. “Let’s take a look.” She examined the wound, which was deep and contaminated with soil. She administered a local anesthetic to the patient’s leg, irrigated the wound, removed dirt, leaves and other foreign material, cleaned the wound thoroughly and then sutured and dressed the leg.
”No more hiking on this trip,” said the nurse practitioner as she finished dressing the wound. When she was done, she handed the patient a prescription for cephalexin with instructions to take the antibiotic if an infection occurred. She wished the patient and his wife well and sent them on their way. She noted the treatment protocol in the patient’s file, but did not call the on-call physician to go over it with him. She simply left it for the physician to sign off on, as required by the clinic protocol.
The patient and his wife stayed in the area for a few more days, but then decided to cut their trip short and return home. Within 2 weeks, his wound became severely infected to the point where he required hospitalization and several skin grafts. He had permanent muscle loss in his leg due to necrosis of the area surrounding the wound. At the suggestion of his wife, he consulted with a plaintiff’s attorney.
The attorney obtained his medical records and hired an expert to review them. According to the expert, the records indicated that the wound was very complex and involved multiple layers of the fat, fascia, and muscle as well as being grossly contaminated. “There’s no doubt in my mind,” announced the expert, “that this patient was not treated appropriately.” He pointed out several breaches in care to the plaintiff’s attorney, including that the nurse practitioner should have cleaned the wound more thoroughly, should have left a drain in the wound, should have given him a tetanus shot, and should have instructed the patient to follow up with a physician in 48 to 72 hours. “Worst of all,” said the expert, “was the way the antibiotics were handled. You can’t tell a patient to take antibiotics if an infection arises—patients can’t be expected to diagnose infections themselves.”
The attorney filed a lawsuit against the clinic, the nurse practitioner and on-call physician, alleging negligent treatment of the patient.
NEXT: The Case