A Tiny Diamond in Her Nose (The deposition)

Chapter 41

Extending his hand to introduce himself, Grant stood up to meet the nurse and hospital lawyer as they entered the conference room. Then he introduced me as part of the legal team.

I don’t know what I’d expected, but I was surprised the nurse facing deposition appeared to be in her thirties. Like me, she wore a dark blazer over a fitted blouse with dark slacks. Her blonde hair hung above her shoulders in an angled bob. Under the fluorescent lighting of the conference room, a tiny diamond above her pierced right nostril flashed when she turned her head, and a quarter-sized tattoo of the sun on her wrist was visible beneath the cuff of her blouse..

I also sport a tiny diamond in my nose, and a tiny red heart is tattooed at the nape of my neck. This is going to be harder than I thought.

I’d guess the hospital lawyer to be in his sixties, with a shock of thick, silver hair. The absence of telltale clipper marks as it formed around the shape of his head bespoke of a meticulous, and expensive scissor cut.  He wore a navy blue jacket, which he carefully removed before taking his seat at the table, revealing a pale blue dress shirt with French cuffs. His formal attire was at odds with Grant’ business casual look: a sport coat over an open neck dress shirt, no tie, and khakis. I got the sense something was being communicated between the two of them, but I couldn’t quite grasp the message.

After introductions, Grant explained that the deposition is a discovery process performed under oath, and would be videotaped.

“Before we begin, would anyone like a glass of water?”

“Yes, please.” Grant poured a glass of water for Melissa, the other nurse, from a pitcher of ice water and set of glasses conveniently placed on the table.

“Okay, let’s begin,” Grant started. “Melissa, how long have you been a Registered Nurse?”

“Seven years.”

“And, have you been employed at Sand Bluff Hospital for all of that time?

“No. Only for five years.”

“Have you worked all of those five years on their pediatric unit?”

“No. Only the past three years.”

“Were pediatrics part of your nursing school curriculum?”

“Yes.”

“What pediatric education or training have you received since nursing school?”

“I’ve taken a few pediatric continuing education courses.”

“Describe these pediatric continuing education courses, please.”

“I’ve completed a course in common pediatric diagnoses, and an overview of pediatric assessment.”

“Were these courses provided to you by your employer, Sand Bluff Hospital?”

“No. I took these courses on my own, as part of the continuing education required by the state of California to renew my license.”

“Has Sand Bluff Hospital provided you or other nurses in your unit with pediatric specific education?”

“Yes. All nurses assigned to the pediatric unit must complete age-specific competencies, and have current PALS certification.”

“And what is PALS certification?”

“Pediatric Advance Life Support.”

“Does this certification make you competent in the care of pediatric patients?”

“Objection!” This from the hospital lawyer.

“Okay,” says Grant, “Let me rephrase the question. What is the significance of PALS certification for nurses?”

“PALS certification signifies a nurse is competent in the necessary skills to assist in a pediatric code under the supervision of a physician.”

“But not specific to a particular diagnosis?”

“No. PALS certification is not specific to diagnosis. PALS certification outlines responses to specific patient conditions.”

“Like respiratory failure or cardiac arrest?”

“Yes.”

“PALS certification and, what did you say, age-specific competencies are provided to you by Sand Bluff Hospital, at their cost?”

“Yes.”

“So further pediatric nursing education regarding specific diagnoses is something, for the most part, you have taken on your own initiative, at your own expense?”

“Yes.”

“With no other education provided by Sand Bluff Hospital other than what you’ve just described?”

“Yes.”

“Melissa, have you reviewed the medical chart of the deceased patient from the night of the event”?

“I went to medical records and reviewed them once.”

Grant gives a sharp look to the other lawyer. I know what he’s thinking. This nurse isn’t the target of the suit, so no one’s taken time to prepare her for this deposition. That energy’s been reserved for damage control for the hospital. They’re the “deep pocket.”

“Melissa, tell us about that night, leading up to the event.”

 

The Wrong Side of a Sentinel Event Review (Niki empathizes)

Chapter 40

I woke up in Raquel’s and Grant’s guest room when a bright shaft of morning light slipped between the honeycombed shades and into my eyes. This never happens at home where I’ve installed black out shades in my bedroom, because I work night shift. My hand, tingly-numb from sleeping on it, reaches for and locates my phone on the nightstand. I check it for texts.

There’s one from the PICU manager asking if I’m interested in picking up an overtime shift. She doesn’t realize I’m out of town.

Next, Maddie’s sent a selfie of her and Wade eating hot dogs in Amber’s backyard after our phone conversation yesterday.

I’m disappointed there isn’t one from Corey. It hurts a bit, but I remind myself this is a tough time for him. Then I dismiss the matter from further thought.

After a serving a quick Raquel drops her kids off at school, we go to a cross fit workout at her gym. She’s is an animal, performing amazing feats with weights, pull-ups, and standing squats. I admire her “guns,” the well-defined muscles of her upper arms, noticeable in her tank top.

“Niki, you should work on your core. You’d gain a lot of strength with a little work,” observes Raquel.

“Maybe, but I rarely go to gyms. Don’t judge me. I like the outdoors, running or riding a bicycle. Maybe because hospitals are such closed environments. You are a lot stronger than me though.”

Afterwards, we stop for smoothies before going home. Then I shower, and borrow a pair of slacks and a blazer from Raquel, hoping I don’t look out of place at the deposition this afternoon.

Grant greets me in the conference room at his office building, fifteen minutes before the deposition is scheduled. We choose our places at the conference table, facing the door before the other nurse and her legal representative arrive.

“Thanks for coming Niki. I realize you hadn’t expected to sit in, but I think it will be useful to us. I don’t want you to say anything, just listen. Have you sat at deposition before? No, of course you haven’t, because I would have been there for you. Sometimes it’s good to have a lawyer in the family, right?”

“Absolutely Grant, I just hope I never need you. The long-term goal of my career is to never sit on the wrong side of a sentinel review committee.”

“Well, unfortunately, it happens to very good nurses sometimes. I’ve seen my share,” admits Grant.

“I guess I’m kind of feeling bad for this nurse I’ll meet today, Grant. I mean, good or bad aside, I don’t know anyone in health care who starts a shift thinking, ‘today I’m going to hurt a patient.’ People go into nursing to help others, not to cause accidental harm.”

“I understand, Niki. What you have to realize, is that this case isn’t really about placing blame on the nurse. What we want to establish is that an employee of the hospital, in this case a nurse, made a mistake contributing to a wrongful death, making it the hospital’s responsibility. Nobody is interested in suing the nurse. We’re defending Dr. Straid from being sued. He stands to lose a considerable amount of his financial assets. He has a couple kids in college, a house, and a business to protect.

Maybe the nurse won’t get sued, but she’s going to have to find a way to sleep at night for the rest of her life if she’s blamed for contributing to the death of a child, I think to myself. I keep forgetting which team I’m on.

“But Dr. Straid’s not guilty, is he Grant?”

“Of course not, the nurse didn’t inform him of how sick the boy was. The hospital is the deep pocket here Niki, not the nurse. A patient should be safe in a hospital, right?”

“Yeah, you’re right, Grant. Patients should be safe in any hospital.”

“That a girl. Now, here comes the nurse, and the hospital lawyer. Remember, don’t talk just listen.”

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.