Blog Articles

  • New 2013 Gudelines for Spinal Injuries - No Steroids First 48 Hours
    The biggest change in the 2013 guidelines on the management of acute spinal injuries is the recommendation NOT to use high-dose steroids in the first 48 hours due to lack of evidence of their benefit and high risk of harmful side effects.  Read chapter 8:  http://www.slideshare.net/INUB/guidelines-for-the-management-of-acute-cervical-spine-and-spinal-cord-injuries-neurosurgery-supplement-march-2013

  • In Texas, One Theory of Liability Enough in Expert Report
    Perhaps you heard the recent good news for plaintiffs regarding the Texas Supreme court ruling in Certified EMS, Inc. v. Potts, No. 11-0517 (Tex. Feb. 15, 2013). This is a small step supporting the plaintiff since Texas tort reform in 2003.More often than not the preliminary documentation and information about the case is not complete but enough to support at least one point of liability.  Additional issues become revealed during the recovery process and can be added later
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    The Chief Justice himself held that if the plaintiff report shows a reasonable basis for at least one theory of liability it permits forward movement. The law doesn’t require an all-encompassing expert report to include all potential grounds for liability on the front-end.

  • Friday, July 15, 2011  Expert Report Needed for Spider Bite Case in Texas Healthcare Setting
    Classie Mae Reed died as a result of a being bitten by a brown recluse spider while a resident of the Omaha Healthcare Center, a Texas nursing home. Her sister, Wilma Johnson, sued Omaha for wrongful death in a Texas state court, alleging the nursing home was negligent for failing to inspect and properly clean its premises, as well as for failing to implement an appropriate pest control program.

    Under Texas law implementing medical-malpractice reforms, a plaintiff bringing a “health care liability claim” must serve an expert report within 120 days of filing suit. Moreover, a trial court “shall” dismiss the claim if no report is served. The nursing home argued there was no expert report and moved to have the case dismissed.

    Johnson argued that her claim was one for ordinary negligence rather than a health care liability claim within the meaning of the statute. This argument was accepted by a state trial court and the Texas Court of Appeals, but of course the Texas Supreme Court would have the final say in the matter.

    The Texas Supreme Court reversed the appeals court judgment and remanded it to the trial court with instructions for dismissal. “Those claims fell within the statutory definition of a health care liability claim. Because they did, the statute required the suit to be dismissed unless Johnson timely filed an expert report,” the court said.

    Justice Debra Lehrmann in a dissent complained, “the Court essentially declares that all injuries in a health care setting are subject to [the Texas medical-malpractice reform statute], without explicitly saying so. …
    “As a result of the Court’s holding, any patient injured in a hospital will be required to file an expert report even though the injury is entirely unrelated to the delivery of health care services.”

    Susanna Neahusan, M.Ed., RN
  • Minimizing Tube Feeding Complications in the Long Term Care Setting
    Feeding tubes are common in nursing homes today. Nursing Home administrators may be tempted to accept large number of residents with feeding tubes since payment is higher for residents with this skilled need. However, if staffing ratios do not take into consideration the time required for assessing and administering medications to the tube feeder, the quality of nursing care may suffer.

    Failure to provide necessary assessments and to follow precautions can result in serious harm to residents. If the resident has a serious complication and the family did not fully understand the risks associated with feeding tubes the facility faces possible legal action by an unhappy family member because they failed to ensure the family’s expectations were realistic.
    We have developed a course to enlighten nurse administrators and staff RNs to the true requirements of those being tube fed. We offer 1.5 contact hours for RNs.
    Minimizing Tube Feeding Complications in the Long Term Care Setting
  • Nursing Failure to Note Abnormal Vital Signs

    Vital signs are objective measurements of the patient’s most basic body function. A change in vital signs can be a strong indicator of a decline in the patient’s health status. Normal readings are widely agreed to be within a specific range. In a medical setting, vital signs are often documented on the patient’s graphic page or flowchart to facilitate trending of the data. What is “normal” for the patient is established upon admission to a facility and monitored throughout the stay. Therefore, a change is the patient’s norm is the most important reading to note.

    Abnormal readings should be pointed out to the physician during morning rounds or reported by telephone to the physician. The frequency of vital sign measurements is ordered by the treating physician or according to a set protocol of the unit. This frequency is a minimum of how often vital signs should be measured. Taking them more frequently is up to the discretion of the nurse and is based on the nursing plan of care.

    The cases I have reviewed involving failure to note abnormal vital signs have two patterns I have seen repeated many times. The first is that the person taking the vital signs is a non-licensed person or LVN who is not noting a change or abnormality in the readings. Often, this is a situation where frequent vital signs are ordered for a post operative patient. They are moving in and out of the patient’s room without doing much more than this task alone because the patient may not have any demands or complaints due to being sleepy from recent anesthesia. A non-licensed person should report any abnormal vital sign readings immediately to their supervising RN.


    The second pattern I have seen, besides failing to note and report abnormal vital signs, is when the licensed nurse is not observing other changes or taking the next step in nursing care of assessing the patient more thoroughly. As stated before, the frequency of vital sign readings can be done more frequently in an unstable patient. Abnormal findings should trigger further investigation of the cause. Unfortunately, I have seen many situations where the RN allows a nurses aide to continue taking abnormal vital signs as ordered even when the patient needs to be observed more closely. The RN may be coming into the patient room and noting some obvious changes or complaints without recognizing the significance or reporting this to the physician. I have seen this kind of deterioration documented in the medical record where the RN finally acts when the patient loses consciousness, loses their heart rate or blood pressure completely.


    While there would be little debate that not reporting abnormal vital signs is below the nursing standard of care one has to ask if this omission impacted the patient’s condition to the point of proximately causing significant damages. In many states, physicians cannot provide expert opinions about nursing care and nurses cannot opine on causation issues since the scope of nursing practice does not encompass diagnostics. Determining which expert to review the records first depends on the many complexities of the case. Often, a step-wise approach is best.

  • Wyeth Effexor Suit
    Aaron v. Wyeth, No. 2:07cv927 involves a patient on Effexor who eventually committed suicide. Instead of suing the doctors, the estate representative sued Wyeth, the maker of Effexor.

  • Supreme Court Rules in Wyeth v. Levine 
    The Supreme Court, by a vote of 6-3, just ruled against Wyeth v. Levine. This case turned on the concept of “pre-emption,” which says basically that federal regulations should trump state actions. Wyeth argued that because the federal government (FDA) regulates drugs, patients shouldn’t be allowed to sue in state court when drug makers follow the rules established by the FDA.
  • AstraZeneca Agrees to Bolster Seroquel Warning Label 
    "AstraZeneca Plc agreed to strengthen warnings on its antipsychotic Seroquel at the request of U.S. regulators.  The company agreed to move a statement on the risk of increased blood-sugar levels to the warnings and precautions section of Seroquel’s label.
  • Redefining death: A new ethical dilemma 
    "A days-old infant sustained severe neurological injury after being asphyxiated during birth, but the dying baby's condition did not meet the criteria for brain death -- long the only circumstance under which vital organs were procured."
  • FDA issues 'black box warning' for psoriasis drug - Raptiva 
    "The Food and Drug Administration is requiring a boxed warning to highlight the risk of life-threatening infections stemming from the use of Genentech's psoriasis drug Raptiva."