It Happens (Niki sees in contrast)

Chapter 39

“Good work, Niki. Knowing the lab results and rash indicated a severe infection, yet this information was not reported to our client, Dr. Staid until after the boy’s death points the responsibility away from him, towards the nurse, and therefore at the hospital. That’s exactly the thing we’re looking for in the chart.

There’s an old saying among lawyers though, ‘Never ask a question in court that you don’t already know the answer to.’

So Niki, my question is: What difference would it have made in the patient’s outcome if Dr. Staid had been informed of the critical lab value and the rash sooner? Would the boy have received different care? Would he have survived?”

“I can’t answer that definitively, Grant. I mean, had the severity of the boy’s infection been diagnosed sooner, the shock that killed him would have been anticipated. Once the antibiotic came in contact with the bacteria in the boy’s bloodstream, the the bacterial cell walls burst, releasing their toxins and setting up a cascading circulatory reaction. That’s why the rash worsened from pinpoints to the huge purple blotches the nurse describes in her late entry note after the failed code. If this reaction had been anticipated, perhaps the boy would have been transferred to a pediatric intensive care unit where the technological support he needed was available, instead of admitted to a hospital unfamiliar with pediatric emergencies. Maybe he would have survived if that had happen. Maybe not. This kind of infection spreads like wild fire through the body of its host. Saving the boy’s life would have been challenging even for a PICU team. However, by the time they realized how sick he really was, it was too late. A small community hospital without a PICU couldn’t keep up. I feel bad for the family and for the staff.

As a nurse, Grant I have to admit I wonder why Dr. Straid didn’t come in to assess the child when it was decided to admit him? I know that happens a lot though. They leave it in the hands of the ER doc or a resident, and then see the patient in the morning. We have hospitalists where I work. A pediatrician is available both day and night.”

Mentally, I think of all of the times we’ve summoned Dr. Polk from the call room because a patient needed him.

“That question has been addressed,” replied Grant. “It’s our theme that, had he been informed of how sick the child was, he most certainly would have been at the bedside long before the code, when more treatment options could have been considered. The nurse did not inform our client of how sick his patient was in a timely manner, limiting our client’s ability to help the child.”

“Well, then you’ve got what you need, I guess.” Why does my stomach churn every time Grant and I reach this conclusion?

“Yes, and thank you Niki. We’re deposing the nurse tomorrow. Are you willing to sit in? I don’t want you to say anything, but maybe by hearing her deposition you’ll pick up on something else to strenghten our defense.”

The idea of being face to face with a nurse whose testimony I’m hired to shred makes me uncomfortable, but since I don’t have to ask her any questions, just listen, I figure it will be alright. I’m sort of interested in this whole legal process anyway.

“Sure. I’ll do that,” I tell Grant.

“Excellent,” he replies. “We meet in this conference room in the afternoon.

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