Question

Read the case brief and I need assiting with the three questions at the end ..

Citation: Greer V. Bryant, 621 A.2d 999 (Pa. Super Ct. 7993)

While at the Philadelphia College of Osteopathic Medicine (PCOM) and under the care of her physician, Dr. Bryant, Greer was diagnosed with preeclampsia, a condition characterized by high blood pressure in the mother that poses a risk to the unborn child. On September 20, the patient suffered symptoms of fetal distress and was examined by the hospital's interns and residents. Tests ordered at the time of her visit revealed that the fetus was suffering from "decelerations," a periodic lowering of the heartbeat. Following her examination, Greer was instructed to return to the hospital on September 23. During that visit, it was noted that the fetus was experiencing "poor beat-to-beat variability." Greer was once again sent home with instructions to return to the hospital on September 27. However, on September 26, Greer, experiencing severe pains, called the hospital emergency department. She was told to wait until her scheduled appointment the following day. Her appointment was subsequently canceled because of weather. Upon the insistence of her sister, Greer went to the hospital on September 27, where she delivered her child. The infant, suffering from "severe meconium aspiration" (inhalation by the fetus of its own fecal matter while in utero), died several days later. The plaintiff alleged that the hospital, through its negligence, contributed to her child’s death. Greer sued Bryant and PCOM separately. She alleged that based on the prenatal test results during her September 23 visit to PCOM, she should have been delivered on that date by Bryant. The plaintiff argued that even if the test results had been communicated to Bryant and he decided to send her home, the residents should have recognized the serious condition of the fetus and, if necessary, sought approval from their superiors to keep her at the hospital. Bryant made an offer to settle, and the plaintiff accepted. The Court of Common Pleas, upon jury verdict, entered judgment for the mother, finding PCOM 41% liable to the plaintiff. PCOM appealed. The plaintiff's expert witness, Dr. Gabrielson, opined in her medical report that Greer should have been admitted and the child delivered despite the private physician's instructions.

1. Determine what effect, if any, such cases should have upon the training of students and residents

2. Propose the actions a nurse or other health professional should take when faced with questionable actions by physicians and residents.

3. Recommend the safeguards hospitals should put into place to prevent situations in which a patient receives life-threatening test results and the attending physician makes a determination to send the patient home

Answer 1

1. The case study clearly shows lack of seriousness, experience and medical ethics on the part of interns and resident doctors who after examining the patient sent her home despite critical medical diagnosis. The hospital staff also simply followed routine administrative protocols irrespective of the patient's critical condition even after repeat visit and frantic telephone calls. The hospital authorities failed in their basic duties and were rightly held liable for penalties.

This case is very much a learning experience for the students and resident doctors wherein they know that each and every medical case has to be taken seriously and if not sure they must consult their superiors. The routine approach of following set protocols is administrative in nature but the doctors have to follow action based on their diagnosis, medical test reports and patient's condition.

2. The nurses and other health professionals who attend to the patient most of the time can understand the conditions better than physicians and residents. The physicians and resident doctors visit the patient once in a while to check their condition and medical test reports. Thereafter they move to other patients. The nurses and attendants on the other hand are in service to the patients throughout their treatment. They should therefore give their opinion to the doctors too when they realize the actions taken by physicians and resident doctors is contrary to what they had observed.

3. The simplest protocols that can be implemented is the classic "check and balance" system. Any instruction by attending physicians and resident doctors should be counter signed by superior heads before a major decision like sending patient home or discharge is taken. This counter check system will ensure any such decisions are also reviewed by more experienced doctors and proper accountability for any action is endorsed.