(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)
B. WAS A DOCTOR CALLED?
Nurse Brown (11 p.m. to 7 a.m. shift) claims she called Dr. Y. and told him the patient could not longer move his legs. She does not document that she gave Dr. Y. this critical information.
Nurse White states the nurses are trained to document that they notified the doctor of the change in condition:
Page 42, lines 6 through 16:
“A. We have to do a, you know, like a documentation of our observations.
Q. So in the medical records you’d document the fact that he could no longer move the legs?
A. Yeah.
Q. And you’d document that you notified the doctor?
A. On what case?
Q. You’ve been trained – –
A. Yeah, yeah, based on our training, yes, we’d do that.”
The written policy of ABC Hospital regarding contacting physicians states in part:
“ATTACHEMENT A
6. Be concise and organized in your presentation of appropriate information: state clearly why you are calling; what the problem is; get to the point.”
The policy goes on to state:
“IMPORTANT NOTES
1. All of the above should be carefully timed and documented.
2. Do not hesitate to get help from other sourced and higher authority such as: other physicians known to be within the facility; section, department and executive staff chiefs.”
At the very least, Nurse Brown violated the above procedure because she did not document that she told the doctor of the developing paralysis.
Nurse Black (7 a.m. to 3 p.m. shift) admits he did not notify anyone of the onset of Mr. Smith’s paralysis:
Page 20, lines 1 through 5:
“MR. COLLINS: Q. Well, sir, let me just ask a question which really doesn’t require that foundation. Did you ever contact a physician regarding Mr. Smith’s apparent onset of paralysis?
A. Not to my recollection.” (See Part 16 of 23.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.