Hospital discharge can be a risky time for patients

Being discharged from a hospitalization seems straightforward, but with so many fingers in the pie it’s a time fraught with opportunities for endangering patients.

In recent years, Medicare and private insurance companies have pushed a trend that requires discharge planning to start immediately upon admission. The reason—cost savings—is completely transparent.

The heavy lifting of discharge planning falls on registered nurses, case managers, and social workers. The standard of care requires registered nurses to document a discharge plan in the patient’s medical record within the first 24 hours after admission to the hospital. The initial discharge planning note, of course, is a work in progress that’s updated based on physician input and changes in the patient’s condition.

Despite the heavy involvement of nursing and other hospital employees in the discharge planning process, it’s ultimately the responsibility of a doctor (or mid-level provider, such as a nurse practitioner or physician assistant) to issue the order to discharge a patient from the hospital. Once that order is been made, though, it’s up to registered nurses and other hospital staff members to implement discharge.

The standard of care requires registered nurses involved with discharging a patient from the hospital to ensure that there is no disruption of the continuity of safe care once the patient is sent home. While some patients may require nothing, others may immediately need home health nursing support or durable medical equipment (DME).

In recent years, Painter Law Firm has handled a number of cases where there were terrible patient outcomes when patients were pushed out the door before the necessary home arrangements were secured.

One post-operative patient died over the Christmas holiday after being discharged from a Kingwood, Texas hospital without arrangements for supplemental oxygen.

In another medical negligence matter, a patient was admitted through the emergency room for cardiac symptoms. After being stabilized, he was discharged from the hospital without clear follow-up instructions to see a cardiologist. He died at home from a heart attack within a month.

In yet another medical malpractice case, a patient with textbook stroke symptoms (i.e., facial droop, one-sided weakness, and slurred speech) was discharged from a comprehensive stroke center hospital in Houston’s Texas Medical Center without treatment. Oddly, her discharge paperwork instructed her to return to the emergency room if she had any of the same symptoms that were present while she was being discharged.

Each of these cases demonstrates a situation where the nursing staff was going through the motions rather than exercising independent critical thought and judgment during the discharge process. When working within their training and experience, registered nurses are tremendous resources for patient safety. In fact, the standard of care for nurses requires them to be patient advocates.

As patient advocates, when nurses see something that’s unsafe for a patient—including a doctor’s discharge order—they’re obligated to speak up, provide additional information and recommendations to the doctor, and even invoke the chain of command, if necessary, to protect their patient.

These are basic and well-known principles around hospitals and in nursing practice. Yet, in medical malpractice litigation many hospitals try to diminish the independent training and duties that nursing personnel owe to their patients.

This is the situation in a case that was recently decided by the 5th Court of Appeals in Dallas, Texas. The case is styled Antoinette Dion Decker v. Columbia Medical Center of Plano, subsidiary, L.P. d/b/a Medical City Plano; No. 05-19-01508-CV. You can read the opinion here.

The crux of the medical care leading to this medical malpractice lawsuit deal with cardiac issues. The patient collapsed at work and was taken to Medical City Plano. An electrocardiogram led to a diagnosis of acute cardiac tamponade because of a syncopal episode and ectopic tachycardia. Cardiac tamponade is a dangerous medical condition where excess blood or fluids between the heart muscle and the pericardium (the sac that surrounds the heart) creates intense pressure on the heart. The excess pressure interferes with normal ventricular contraction and can cause a cascade of problems.

In this patient’s case, the cardiac tamponade was caused by bloody fluid. A cardiologist was consulted, who used ultrasound guidance to insert a needle into the pericardium and drain the bloody fluid. The patient was admitted to the intensive care unit, with placement of a pericardial drain to allow additional removal of bloody fluid.

After two days, the cardiologist removed the drain and ordered the patient discharged. At the time of discharge, some cytology lab results hadn’t been reported back. Less than two weeks later, the patient died from cardiac tamponade.

In the medical negligence lawsuit, the patient’s family alleged that the hospital and cardiologist were negligent. As in all Texas state court medical malpractice cases, the plaintiffs were required by the tort reform law codified at Texas Health & Safety Code Section 74.3512 provide a medical expert report early in the litigation.

In this case, the plaintiffs timely produced an expert report from a physician who was a medical school professor, board certified in cardiovascular medicine, and actively practicing a cardiology. In addition to his medical duties, the plaintiffs’ medical expert also had experience in hospital administration.

The hospital quickly objected, alleging that this expert was not qualified to give opinions as to the hospital and its nursing staff. A Collin County, Texas trial court agreed, and the plaintiffs appealed the decision to the Dallas Court of Appeals.

The court noted that the plaintiffs’ expert was licensed to practice medicine in several states, board-certified in cardiovascular medicine, and actively engaged in the practice of cardiology as a clinician and professor.

Additionally, the court noted that the expert’s report stated that he had a background including “the development, implementation and enforcement of safe, appropriate and efficacious cardiovascular care pathways as well as guidelines and policy development for optimal interventional clinical care for hospital cardiovascular treatment.”

The appellate court entered an opinion finding that the trial court abused its discretion by dismissing the case under the tort reform statute. In finding that the plaintiffs’ expert report was adequate, it reversed and remanded the case to the trial court for further proceedings.

If you’ve been seriously injured because of poor hospital or medical care in Texas, then contact a top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys 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 for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.