Read The Following Case And Address The Questions That Follo ✓ Solved

Read the following case and address the questions that follo

Read the following case and address the questions that follow in an APA formatted paper. Patient J.W. presented to the emergency department of Community Hospital with a severe headache that had persisted several days. Nurse Jackie, a graduate nurse three days out of precepting, was assigned. J.W. denied prior neurological history due to disorientation, though she had prior headaches and cerebral hematomas. Nurse Jackie charted symptoms but did not notify the physician. Dr. James, a family physician with intermittent ED privileges, ordered morphine only. Jackie administered morphine; pain decreased but other symptoms persisted. Dr. James discharged J.W.; four hours later J.W. returned by ambulance and died from a severe brain hemorrhage. Address: 1. Important facts. 2. Are elements for negligence present? 3. Required standard of care. 4. Potential plaintiffs and defendants. 5. Who plaintiff would allege was negligent. 6. Evidence against each defendant. 7. Defenses each defendant would raise. 8. Additional information needed. 9. Who is responsible. 10. Apportion fault by percentage and assign amounts.

Paper For Above Instructions

Title

Legal and ethical analysis of an ED fatal intracranial hemorrhage case

Introduction

This paper analyzes the presented emergency-department case of patient J.W., who presented with a severe, persistent headache and later died of a massive brain hemorrhage after initial discharge. The analysis applies negligence law elements, professional standards of care for emergency and nursing practice, potential parties, evidence, likely defenses, missing information, responsibility, and an apportionment of fault. The discussion uses accepted tort principles and clinical standards (Prosser & Keeton, 1984; Restatement (Second) of Torts, 1965), emergency medicine guidance (ACEP, 2019), and nursing standards (American Nurses Association [ANA], 2015).

1. Important facts

Key facts: J.W. had a multi-day severe headache and prior cerebral hematomas but—due to disorientation—denied relevant history. A triage nurse and Nurse Jackie asked about past neurological history. Nurse Jackie is a new graduate nurse three days post-precepting; she charted symptoms but did not escalate them. Dr. James, an intermittent ED physician and family practitioner, ordered only morphine and no diagnostic testing. Morphine reduced pain but not other neurologic signs. Dr. James discharged J.W.; within ~4 hours J.W. returned and died from a severe brain hemorrhage.

2. Elements of negligence

Negligence claims require duty, breach, causation, and damages (Prosser & Keeton, 1984; Restatement (Second) of Torts §283A). Duty: healthcare providers owed J.W. a duty of care. Breach: potential breaches include failure to perform indicated diagnostics (CT, labs) and failure to escalate abnormal findings. Causation: plaintiff must show that the breaches more likely than not caused or substantially contributed to the fatal hemorrhage or a missed opportunity to mitigate harm. Damages: J.W.’s death establishes damages. Thus, prima facie elements appear present, subject to causation and proximate cause proof (Studdert, Mello, & Brennan, 2004).

3. Standard of care

The applicable standard is that of a reasonably competent emergency care provider under similar circumstances (Prosser & Keeton, 1984). For nurses, the standard aligns with ANA practice expectations: assessment, recognition of abnormal findings, escalation to responsible provider, and appropriate documentation (ANA, 2015). Emergency medicine guidance states that acute severe headaches with neurologic signs warrant consideration of neuroimaging (ACEP, 2019; Tintinalli et al., 2016). A reasonably prudent ED physician should consider imaging to rule out subarachnoid hemorrhage or intracranial bleeding when red flags are present.

4. Potential plaintiffs and defendants

Potential plaintiffs: J.W.’s estate or surviving family (wrongful death). Potential defendants: Dr. James (treating physician), Nurse Jackie (new graduate nurse), the triage nurse (if omitted escalation), and Community Hospital (vicarious liability, negligent credentialing, inadequate supervision or staffing).

5. Allegations of negligence

Plaintiff would likely allege: Dr. James negligently failed to order appropriate diagnostic tests and discharged a patient with concerning neurologic symptoms; Nurse Jackie negligently failed to recognize the significance of symptoms and failed to escalate; triage nurse failed to obtain or to escalate a critical history; Community Hospital negligently credentialed or supervised staff and maintained unsafe ED processes (Kohn, Corrigan, & Donaldson, 2000).

6. Evidence against each defendant

  • Dr. James: ED record showing only analgesic order, no CT/lab orders, notes on reevaluation and discharge despite persistent symptoms; expert testimony comparing his actions to emergency medicine standards (ACEP guidance; Tintinalli, 2016).
  • Nurse Jackie: charted assessments showing persistent neurological signs without escalation; testimony regarding training level and failure to consult supervising nurse/physician; hospital orientation and precepting records.
  • Triage nurse: triage documentation and any interview records indicating failure to communicate red flags.
  • Hospital: staffing logs, credentialing files, policies on supervision and onboarding of new nurses, ED protocols for headache evaluation, and prior sentinel event history (Joint Commission standards; AHA credentialing resources).

7. Defenses each defendant would raise

  • All defendants: comparative fault or contributory negligence defense citing J.W.’s denial of prior history and disorientation as misinformation that impeded accurate diagnosis.
  • Dr. James: exercised clinical judgment; pain reduction after analgesia supported discharge decision; lacked clear objective findings to mandate CT at that time; standard-of-care compliance given intermittent ED practice.
  • Nurse Jackie: acting within scope as a novice under supervision, followed orders, charted observations honestly, and was reasonably reliant on physician direction (ANA Code; employment policies).
  • Hospital: claims of independent-contractor status of physician or that credentialing and supervision met regulatory standards; unforeseeable and rapid clinical deterioration (To Err Is Human factors) (Kohn et al., 2000).

8. Additional information desired

Critical missing data: vital signs and neurologic exam findings at triage and during ED stay; triage and nursing notes in full; timestamps for all assessments, orders, and discharge; imaging or lab orders (if any) and contraindications; nurse precepting documentation; Dr. James’s ED volume and supervision arrangement; hospital protocols for headaches and escalation; autopsy details describing timing and nature of hemorrhage; any patient comorbidities and medication use (anticoagulants).

9. Responsibility assessment

Responsibility is shared. Dr. James had primary clinical decision-making authority and decided against diagnostic testing; therefore he bears substantial responsibility for the missed diagnosis. Nurse Jackie had a duty to escalate persistent neurologic signs, especially as a newly graduated nurse who should seek supervision; failure to do so increases her share of responsibility. The triage nurse’s role is smaller but relevant if triage missed critical cues. Hospital systems (training, supervision, staffing, and credentialing) created an environment in which inexperience and intermittent physician coverage increased risk (To Err Is Human; Joint Commission standards).

10. Apportionment of fault (percentage)

Based on the facts and typical legal allocation frameworks, a reasonable apportionment could be: Dr. James (50%) for primary diagnostic and disposition decisions; Community Hospital (25%) for systems, supervision, and credentialing failures that allowed inexperienced staff and intermittent physician coverage without adequate oversight; Nurse Jackie (15%) for failure to escalate or seek supervision; Triage nurse (10%) for potential missed or un-escalated red flags. These percentages reflect the centrality of the physician’s diagnostic duty, the hospital’s systemic responsibility, and the contributory role of bedside nursing and triage omissions. Actual legal apportionment would depend on discovery, expert testimony, and jurisdictional comparative-fault rules (Studdert et al., 2004; Furrow et al., 2013).

Conclusion

The available facts suggest that the elements for a negligence claim are present. Establishing breach and proximate causation will rely on clinical evidence and expert testimony showing that earlier imaging or different management would likely have altered outcome. Defendants will assert clinical judgment and patient-provided misinformation as defenses. Hospital policies and documentation, precise clinical data, and autopsy findings are pivotal for case strength. Given the facts, shared liability among the treating physician, the hospital, and nursing staff is a legally and ethically defensible conclusion, with the treating physician bearing the largest share of responsibility.

References

  • American College of Emergency Physicians. (2019). Clinical policy: Critical issues in the evaluation and management of adult patients presenting with acute headache. Annals of Emergency Medicine, 74(6), 777–797.
  • American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. American Nurses Association.
  • Furrow, B. R., Greaney, T. L., Johnson, S. H., Jost, T. S., & Schwartz, R. W. (2013). Health Law: Cases, Materials and Problems (6th ed.). West Academic Publishing.
  • Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To Err Is Human: Building a Safer Health System. National Academy Press.
  • Prosser, W. L., & Keeton, D. (1984). Prosser and Keeton on Torts (5th ed.). West Publishing.
  • Restatement (Second) of Torts §283A (1965). American Law Institute.
  • Studdert, D. M., Mello, M. M., & Brennan, T. A. (2004). Medical malpractice. New England Journal of Medicine, 350(3), 283–292.
  • Tintinalli, J. E., Stapczynski, J. S., Ma, O. J., Cline, D. M., & Meckler, G. (2016). Tintinalli's Emergency Medicine: A Comprehensive Study Guide (8th ed.). McGraw Hill Education.
  • Joint Commission. (2020). Comprehensive Accreditation Manual for Hospitals. Joint Commission Resources.
  • American Hospital Association. (2014). Credentialing and privileging resources. American Hospital Association.

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