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Failure to Timely Diagnose and Treat Hemorrhagic Stroke; Nursing Malpractice


A woman was admitted to the hospital for complications arising from recurring pneumonia. She remained hospitalized for about five weeks. Two weeks into her hospital stay, the woman complained of a pounding headache. The hospital nursing staff contacted her doctor and the doctor ordered Tylenol for pain relief. About three hours later, the woman’s husband reported to the charge nurse that the woman was suffering certain changes in mental status. Her doctor ordered a CT scan that showed that she had suffered an intracerebral hemorrhage or hemorrhagic stroke. The results of the CT scan were communicated to the charge nurse within approximately 35 minutes and a neurologist and neurosurgeon assumed responsibility for the woman’s care. As she was monitored throughout the night, it became apparent that the hemorrhage continued to grow. Surgery to resect a hematoma was completed the following day. As a result of the hemorrhagic stroke, the woman suffered significant vision loss, had certain cognitive defects and was no longer able to walk without assistance.

 

The woman and her husband sued the hospital for medical malpractice. The complaint argued that the hospital’s nursing staff failed to recognize and timely report that the woman was experiencing visual symptoms indicative of a stroke.

 

The hospital moved for summary judgment dismissing the complaint against it. In support of its motion the hospital included the affidavit of a board-certified neurologist. The neurologist opined that the charge nurse on the day that the woman suffered her stroke provided care in accord with the standard of care by contacting the woman’s doctor to report her headache and vital signs. The neurologist stated that even if the woman was seeing psychedelic colors, that was not a neurological change or symptom that would have required a CT scan. Also, the neurologist explained that at the time of the woman’s hemorrhagic stroke, the only treatment was to surgically remove the resulting hematoma, which was the procedure that was performed the following day.

 

The Ulster County Supreme Court granted the hospital’s motion for summary judgment dismissing the complaint against it.

 

The Appellate Division of the New York Supreme Court, Third Department, reversed. The court held that the hospital did not sustain its prima facie burden relative to the nursing standard of care and the couple’s submissions were sufficient to raise a triable issue of fact with regard to causation.

 

The hospital did not sustain its prima facie burden relative to the nursing standard of care. The record presented a clear factual question with regard to whether the husband told the charge nurse that the woman was seeing psychedelic colors. The hospital’s expert neurologist’s opinion that if such symptom were present, it would not have warranted a CT scan did not directly confront the couple’s claim that vision changes are indicative of a stroke and did not account for her doctor’s testimony that he would have ordered a CT scan if he had known of other neurological symptoms. The opinion also did not address whether the charge nurse deviated from the applicable nursing standard of care by failing to report this visual symptom to the woman’s doctor.

 

The couple’s submissions were sufficient to raise a triable issue of fact with regard to causation. In response to the hospital’s expert’s opinion that at the time there was no method to medically treat a hemorrhagic stroke and that it was speculative to conclude that lowering her blood pressure would have reduced the size of the hemorrhage, the couple’s neurologist opined that given her risk factors the hospital should have intervened more quickly to provide treatment to prevent and control the stroke. He opined that the failure to do so deprived her of a better clinical outcome resulting from hypertensive encephalopathy resulting in hemorrhage, or a primary cerebral vascular event. The couple also submitted an epidemiologist’s affidavit stating that, given the general association between blood pressure and stroke outcome as compared to her blood pressure at the time that she experienced the vision changes, earlier aggressive intervention to reduce or control her blood pressure would have improved her outcome.

 

The Appellate Division of the New York Supreme Court, Third Department, reversed the trial court’s grant of the hospital’s motion for summary judgment dismissing the complaint against it.

 

See: Randall v. Kingston Hosp., 2016 WL 155539 (N.Y.A.D. 3 Dept., January 14, 2016) (not designated for publication).

 

See also Medical Law Perspectives, December 2015 Report: Pneumonia Complications, Hospitalizations, Deaths: Risks and Liabilities

 

See also Medical Law Perspectives, October 2013 Report: Brain Aneurysm and Subarachnoid Hemorrhage: Failure to Diagnose, Delayed Diagnosis, Misdiagnosis

 

See also Medical Law Perspectives, June 2012 Report: Too Much, Too Little, Too Late: Injuries from Delays and Failures to Perform CT Scans or Overexposure to Radiation

 

See the Medical Law Perspectives June 29, 2015, Blog: Hospital Can Be Liable for Employee Following Instructions from Non-Employee, Private Attending Physician

 

 

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