Sunday, September 24, 2006


If a nurse or doctor sees medical malpractice occur in her NICU, should she tell the parents to sue?

I think of a case that happened about 18 years ago. A baby was born very prematurely at 23 to 24 weeks gestation and weighed very little, about 500 grams. I remember that the survival statistics at that time showed about a 10% chance of survival for this unfortunate child. We got the baby through the first three weeks of life, but then, in spite of our best efforts, she developed an infection and died from infection related renal failure. It was a not atypical way for such a premature baby to live and die.

One of the NICU nurses thought she detected malpractice and told the parents to sue. Sure enough, one of our town's most prominent malpractice attorneys came sniffing around and deposed a few of us neonatologists. After he found, appropriately, that no malpractice had occured, he and the hospital settled for a small amount of money, (about $10,000, I think) enough to cover the attorney's expenses up to that point, but small enough that it wasn't worth the hospital's time to fight it further. There was no admission of guilt by the neonatologists or the hospital.

I think the nurse told the parents to sue because the physician chief of that NICU had recently been demoted and a new chief brought in. Some of the nurses remained loyal to the old chief and were happy to keep the pot stirred up. I think the nurse really thought malpractice had occured, but she was biased and also not knowledgeable enough to determine whether malpractice had occured. I mean, it's not likely malpractice when a baby with a 90% chance of dying actually dies. Her telling the parents to sue did no one any good, except the attorneys involved. It just sustained the parents' grief, rather than helping them deal with the sad loss of their child.

I don't know whether a health care worker should tell the parents to sue if they see malpractice occur or not, but I do know this: You had better be sure you know what you're talking about, or else you'll look like a jackass and lose some friends and your job, which is what happened - appropriately - to the nurse in this case.


Blogger Flea said...

Consider the source of this comment, but I don't believe a healthcare provider should advise folks to sue under almost any circumstances.

There's a special ring in hell for such people. Here on earth, they deserve losing a judgment beyond what their policy covers, then lose their house, their car, and their shirts.



6:05 PM  
Anonymous Anonymous said...

It was probably the nurses' way of gaining some importance. Nurses badmouth physicians in front of parents all the time, and because they get to spend more time with the parents by default, sometimes they can turn the patient against the doctor. Parents should remember that it is the doctor who makes all the decisions and all the nurses do is implement them....and a lot of times, bad things happen when a lazy nurse does not execute orders. If your baby is sick, who would you rather have...a gabbing nurse OR a doctor with the skills and knowledge to know what to do?

8:09 PM  
Blogger Dream Mom said...

I think there would be better ways to handle a situation than to recommend that a patient sue a physician.

I also believe that's why it's important to have a relationship with your healthcare provider, so that if issues do occur, you can have an opportunity to address them directly with the physician, as opposed to sharing your story with someone else or suing someone.

I can also say, that in all the years Dear Son's been in the hospital, I've never had a nurse badmouth a physician. I guess I've been lucky.

8:13 PM  
Anonymous Anonymous said...

For a minute, I though this post was about me, since my name is Sue. LOL!

8:36 PM  
Anonymous Christina said...

In response to Anonymous 8:09,
I think statements such as "nurses badmouth physicians in front of patients all the time" is inflammatory, overly dramatic and patently false. It just seems that on a thoughtful, well-written blog such as Neonatal doc's, we should seek to avoid such polarizing statements such as "lazy and gabbing" nurses, etc, etc. I think this blog, along with others in the medical blog community shows that there are good nurses and bad nurses, good doctors and bad doctors everywhere. I myself seek to be an excellent bedside nurse, which means I take pride in my job and don't need to "gain importance" by encouraging a family to sue. I would never badmouth a physician to a parent. And if my baby were sick I'd want both a doctor there AND a nurse- as both their skills and knowledge are necessary to care for a sick baby.

12:12 AM  
Blogger stockingup99 said...

I thought about suing my ex OB. He continued to cut an episiotomy over my objections and said he'd do it again. I only thought about it as a way to stop him from harming others. He bullied pregnant women, and I wanted to stop him. Fortunately he retired and saved me the trouble.

my name is also Sue, we had fourteen Sues in my highschool.

Every sOB I have met has bullied or lied in one way or another. From telling me that if I don't fast and then drink sugar water, my baby will be born too big for it's lungs (gestational diabetes testing), to saying, yes we facilitate natural birthers here.

In one practice I got four different conflicting answers why they would need to cut the cord right away. Too much blood, not enough blood, mom will hemorage if the cord isn't cut immediately, and have to get baby under the warmer. Delayed cutting and clamping in a healthy birth is proven to help prevent many minor problems. Immediate skin to skin contact is proven to be best. And breastfeeding immediately makes for a much better start. Why take the baby, and shoot mom with pitocin, when she could just feed the baby?

Thanks NeoHero for cleaning up their mess. I think your job would be a whole lot easier if moms like me could birth in a hospital, but with the freedom to eat and drink and move like at home. The standard protocols may not include a shave, but I think they will fall by the wayside, like shaving and enemas have.

I read in horror that you have to wait for Dad to cut the cord, when the baby is in trouble. You just meant sometimes right? I hope that for serious isssues, Dad would be asked to just trim the stump later or forgo it altogether?

8:56 AM  
Anonymous Anonymous said...

So, what do you think a nurse should do when malpractice has occurred? Or do you believe malpractice does not exist?

9:49 PM  
Anonymous Anonymous said...

It is not the nurse's business to decide if malpractice has occurred. It is human tendency to try to find someone to blame when something has gone wrong with their baby, especially in this country. The reality is that premature babies are very fragile and even with the best care, things can go either way. Anyway, if the nurse really thinks some mistake has occurred, she should take it up with her managament instead of going to the patient. What the nurse did in this situation was disgusting and unethical, and I am sure if the management has any brains, they will give her the boot.

8:53 AM  
Blogger neonataldoc said...

Thanks, all. I mostly side with Flea's comment. As to anonymous 9:49, who asks what nurses should do if they see malpractice, I think they should bring it up with nursing management or the physicians at the time they see it happening.

I don't think nurses bad mouth docs all the time,and I don't think they should. Also, docs shouldn't bad mouth nurses.

Stockingup99, have you tried a midwife?

7:41 PM  
Blogger stockingup99 said...

Yep, I found an unlicensed midwife to help with my third birth. Underwater out of hosptial, in her office, seven minutes away from a level four neonatal intensive care hospital. If things seemed to need a hospital she could call and have them prep the OR and we would have arrived just as they had it ready.

Very nice, peaceful, and we didn't cut the cord for hours. She just put us all to bed together, The hubbby, The baby, The Placenta, and me. It was a very different experience than fighting against interverntions for my other two births.

There is no licensing for Direct entry midwives in my state, and the certified medwives only do the same as the medicos.

I'm out three weeks of my salary since my employer asked me to find a doctor, after I had already returned to work for three weeks. They have advised me that I know better now, and must have a doctor next time.

Since I was almost fourty, and the baby was 9.5 pounds, I knew a hospital would likely feel the need to cut me open. There was a 29.1% C section rate that year.

I didn't even tear enough to need stitches. The tub made a huge difference for pain relief and better postioning. Two hours from waking to birthing, and only fifteen minutes of pushing. The baby came out, and lifted it's head to look around at the new world.

That's why I feel so bad about the doctors who bully women into feeling that they need a managed delivery instead of a peaceful birth. It hurts so much less without the drugs. The baby nurses so much easier when it's not all doped up. It's like I know a secret, and no one will listen.

8:10 AM  
Blogger Terrible Palsy said...

Sorry Neonatal Doc, I know that this is an old post. I was just flicking through to find the post referred to in a comment in a new post.

I thought I should give you my thoughts. Though I live in Oz, I am both a personal injuries lawyer and a mum of a 27 weeker. My son was the recipient of 3 medical "accidents" during his NICU stay, one of which was pretty serious and may or may not be the reason why he now has CP. Hubby and I have talked about bringing a suit (ironically he is also a lawyer though does criminal law) and we decided against it for many reasons. The three main ones being - everyone makes mistakes (me included);
how do you sue the people who are responsible for giving you your precious child; and lastly, money wouldn't make our child CP free. Just as it won't bring your dead child back.

As for whether the healthcare provider should advise the parents - i think that it would depend on the circumstances. It the circumstances you describe, no but for a 32 weeker, I wouldn't have the same response.

4:13 AM  
Anonymous Anonymous said...

Reply to Sue
I think of a case that happened about 18 years ago. A baby was born very prematurely at 23 to 24 weeks gestation and weighed very little, about 500 grams. I remember that the survival statistics at that time showed about a 10% chance of survival for this unfortunate child. We got the baby through the first three weeks of life, but then, in spite of our best efforts, she developed an infection and died from infection related renal failure. It was a not atypical way for such a premature baby to live and die.

I have a feeling this case is repeating with my baby daughter.
Born at 24 weeks, 600gms, very feisty and strong, doc put prongs in nose, developed infection there, columela is pretty much infection spread in her body, not peeing anymore,not able to feed her anymore. pale(as in weak) also whole baby is swollen up. they're gonna try a caterer, in case kidneys failing. i'm worried. any advice?

9:59 AM  

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