Standard of Care for Nurses and Technicians in Cardiac Catheterization Procedures
By Benjamin A. Post, Esquire & Gabrielle P. Kelerchian, Law Clerk, Post & Post, LLC
In 2012, a Pennsylvania jury awarded a $6,000,000 verdict to a plaintiff in a wrongful death action in which the patient died as a result of internal bleeding after a cardiac catheterization. In Burkhardt v. Cardiac Diagnostic Associates, the jury attributed the patient’s death to the nurses’ failure to notify doctors of a change in the patient’s heart rate or systolic blood pressure after the procedure. Doctors and residents attending to the patient were found liable for not recognizing the symptoms as signs of internal bleeding, thereby failing to order necessary tests.
Failure to adequately monitor patients and report changing conditions can subject nurses, hospital technicians and other attending staff to malpractice liability. When complications arise in the aftercare of cardiac catheterization patients, healthcare providers and nurses are obligated to evaluate patients’ symptoms and provide adequate treatment, which often involves knowing when to defer to a physician. Recognition of normal and abnormal symptoms of post-cardiac catheterization recovery is an essential role of nurses and hospital staff in accordance with the standard of care.
Cardiac catheterizations are common procedures provided by physicians and healthcare providers in cardiac departments all across the country. Although cardiac catheterizations are rarely accompanied by serious side effects, physicians and healthcare providers must follow the proper procedures and standards of care in the performance of the catheterizations, as well as the follow-up care delivered to patients.
Nurses also have a duty to advocate on behalf of patients and monitor the patient’s condition both before and after a cardiac catheterization procedure. In Estate of Dorothy Kubacki v. Crawford (2013), a Michigan jury delivered a verdict of $2,855,781 against a cardiologist and hospital for failure to perform a timely cardiac catheterization and failure to report to the cardiologist or internal medicine physician on staff the plaintiff’s repeated bouts of chest pain. In this case, the hospital lacked the necessary equipment to perform the needed cardiac catheterization. Additionally, the nurses’ failure to advocate for the patient delayed the patient’s transport to a hospital, where she could have received the essential procedure.
Cardiac catheterizations guidelines require hospitals and other healthcare services to maintain specific facilities and equipment to perform the procedures. Some states require, or at least recommend, that hospitals have the capability to perform open-heart surgeries in order to obtain certification to administer cardiac catheterizations. When a hospital is not equipped with the necessary facilities, nurses and hospital technicians should be acutely attentive to the patient’s condition in anticipation of the need to transfer the patient to a hospital qualified to perform the procedure.
Communication between and among nurses and physicians is also essential in providing adequate patient care. A New York jury found a hospital liable for a patient’s death when the nursing staff failed to notify the physicians of all of the patient’s clinical changes during her hospital stay.
In Keefer v. Ahmed, et al. (2011, New York), a nurse administered intravenous Cardizem bolus to a patient without informing the on-call cardiologist of the patient’s suddenly decreasing heart rate. The patient had also received a breathing treatment earlier in the day resulting in an erratic heart rate. In this case, the nurse failed to document the breathing treatment or relay this information to the cardiologist, resulting in the patient coding then dying immediately after the drug’s administration. As a result, the court found the hospital 75% liable for the nurse’s failure to communicate the patient’s changing condition with the doctors.
The performance of cardiac catheterizations and related procedures requires a team of medical professionals attending to each respective patient. In addition to the physician, other personnel, typically technicians and nurses, assist with the procedures and are responsible for observing and monitoring patients in the period following cardiac catheterization procedures.
Communication between nurses, physicians and hospital staff of a patient’s condition is critical in providing proper treatment and preventing patient injury. When assisting in cardiac catheterizations before, during or after a procedure, nurses and technicians are required to follow the standard of care. Deviation can pose devastating consequences to patients with liability falling on the healthcare providers.