Causation Issue for Improper Blood Draw Resulting in Infant Finger Loss

A doctor ordered a blood culture for a premature infant. A nurse drew blood from the infant’s right arm. Later that day the fingertips of the infant’s right hand turned blue. The nurse applied a warm compress to the infant’s right hand. The blueness moved up the infant’s arm. Two days later the infant was transferred to another hospital for treatment of a perforated bowel. While at the other hospital, the fingers of the infant’s right hand fell off.


The mother sued the first hospital and the nurse on behalf of her son. Specifically, the mother claimed her son lost his fingers as a result of an improper arterial stick to his right arm by the nurse. The complaint alleged that the nurse performed an arterial stick on the infant’s right arm instead of an arterial stick to his heel, causing poor perfusion to his hand with resulting thrombosis of the fingertips. The complaint contended that the recommended location for blood collection on a newborn baby is the heel and the prior sticks for the infant had been to his heel. The mother identified a registered nurse as a medical expert.


The defendant nurse filed an answer denying that she was guilty of negligence and denying that there was a causal relationship between her and the injury alleged in the complaint. The hospital was dismissed on a joint motion. The nurse filed a motion for summary judgment arguing that the mother failed to offer expert testimony as to causation in the case.


The mother filed a response to the nurse's summary-judgment motion arguing that the registered nurse who the mother identified as a medical expert was qualified to testify as an expert witness and that the second hospital’s records showed that the cause of the auto-amputation of her son's fingertips was poor perfusion and thrombotic fingertips while at the first hospital. In support of her opposition to the nurse's summary judgment motion, the mother submitted excerpts from her deposition; excerpts from the defendant nurse's deposition; excerpts from the expert nurse's deposition; the first hospital's progress note; certified copies of the medical records of the second hospital; various photographs; and the first hospital's Interdisciplinary Standard Regarding Arterial Punctures for Specimen Collection.


The Jefferson Circuit Court entered summary judgment in favor of the nurse. The trial court concluded that summary judgment was proper because the mother lacked an expert capable of testifying as to causation and there had been no evidence presented that the infant's injuries were probably a result of a breach of the standard of care by the nurse.


The Supreme Court of Alabama reversed holding that the mother's evidence sufficiently overcame the nurse's showing in support of her motion for summary judgment. Specifically, the court noted that the record supported a logical sequence of cause and effect based on the time line and the absence of any other explanation in the record. This logical sequence was corroborated under the facts of this case by certified medical records that were before the trial court and by the testimony of the registered nurse expert. The mother presented certified medical records and testimony that would support a reasonable inference that the nurse’s negligent conduct probably caused the auto-amputation of the infant's fingertips. The evidence submitted by the mother in opposition to the nurse's summary-judgment motion showed that the nurse breached the appropriate standard of care in her arterial stick to the infant's arm and in applying a warm compress to that hand, which worsened a problem with perfusion of blood circulation.


The certified medical records established that the injury occurred following the arterial stick and that the infant had poor perfusion of his right hand and thrombotic fingertips which had developed while at the first hospital. The registered nurse expert testified at her deposition that the arterial stick in this case was too high and that this could cause and did cause occluded blood flow to the infant's right hand. The defendant nurse, during her own deposition, acknowledged that an improperly performed stick can cause occlusion or blockage of blood flow to the hand.


The court concluded that the certified medical records and the testimony sufficiently established causation for the purpose of rebutting the nurse's motion for a summary judgment. The certified medical records, the registered nurse expert's testimony, and the nurse's acknowledgment provided substantial evidence that the improperly performed arterial stick caused the infant's injuries. Therefore, the summary judgment in favor of the nurse was improper.


See: Boyles ex rel. Boyles v. Dougherty, 2013 WL 5394326 (Ala., September 27, 2013) (not designated for publication).