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How a pre-existing condition or frailty impacts a Texas medical malpractice case

The so-called eggshell skull rule applies to medical negligence

In law school, professors delight in sharing the story of the eggshell skull.

The eggshell skull rule is a common law principle applicable in tort cases. It basically stands for the proposition that when you negligently injure someone who’s unpredictably frail and prone to injury, you’re still liable for the injury. Take, for example, a person who has a skull that’s as fragile as an eggshell. Even a minor collision could injure a person like that, unlike a person with a normal skull.

Other people describe the rule as “You take your plaintiffs as you find them.”

When defending medical malpractice claims, some hospitals and physicians seemingly think that the eggshell skull rule doesn’t apply to them. That’s simply not the case, though.

Take for example a situation where a patient has a congenital heart condition. We represent a client with a heart disorder that makes his baseline oxygen saturation rather low. Oxygen saturation is typically measured using a pulse oximeter device that clips onto a finger that approximates the percentage of hemoglobin molecules carrying oxygen.

For most patients, a normal oxygen saturation by pulse oximeter is 95%+, and anything under 90% would be considered dangerous.

For some patients, though, like our client, a pre-existing cardiac condition can make their oxygen saturation much lower, say in the low 80s.

When these patients are taken to surgery and put under anesthesia, physicians, nurses, and respiratory therapists have to take extra care on timing when to remove the breathing tube. This is a process called extubation.

Many hospitals are aggressive in trying to extubate patients as quickly as possible in general because of the health benefits of not being on a ventilator. It’s never appropriate, though, to remove a breathing tube prematurely, when the patient is not ready to handle the transition from ventilator to spontaneous breathing.

But in a patient with a pre-existing cardiac disorder or other condition, if you extubate him or her prematurely, it’s done at your own peril. As a hospital, physician, nurse, or respiratory therapist, you take your patients as you find them. It’s the eggshell skull rule.

The standard of care requires a thorough evaluation of any patient before extubation, but when a patient has a heightened risk, it’s doubly important. The reason is that patients with pre-existing conditions don’t have the same functional or respiratory reserve to weather the storm of even a short period of hypoxia (low oxygen levels) during the transition from ventilator to spontaneous breathing.

If you’ve been seriously injured because of poor hospital, physician, nursing, or therapy care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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