$220,000: Nurse Breaches Duty Of Care By Giving Patient An Injection In The Wrong Place

June 8, 2010

CASE DESCRIPTION: During a hospital stay the Plaintiff was given an intramuscular injection to relieve back pain. However, the nurse gave the injection subcutaneously causing necrosis of her skin located around the injection. Plaintiff brought suit alleging breach of duty of care and actual damages. The Defendant disputes what factually happened.

RESULT: $220,000.00 total verdict

Plaintiff was a patient at Defendant’s hospital, where she was being treated for low back pain. As part of her treatment, the physician prescribed intramuscular injections of memerol/Phenergan, to relieve pain. On November 10, 1986, while a nurse was inserting the needle for the injection into Plaintiff’s anterior thigh, blood came back into the syringe. The nurse forcibly completed the injection.

Plaintiff contended that the blood flowing into the syringe showed that the nurse had struck an artery, and the standard care required immediate removal of the needle. Not only did the nurse breach the standard of care in this way, but she also completed the injection into an artery located in subcutaneous tissue, also a breach of the standard of care. The medication is required to be injected intramuscularly. The result of Defendant’s negligence was necrosis of skin and subcutaneous tissue in the Plaintiff’s anterior thigh, down to muscle fascia. There is some dispute as to whether the Plaintiff factually caused the injection in the wrong area. Plaintiff’s stance on this issue is that Plaintiff hit the nurse’s arm, knocking syringe and needle after injection was given.

Experts for the Plaintiff testified that given configuration of the scar, this injury is consistent with an injection of this medication into an artery located in subcutaneous tissue. Plaintiff can have reconstructive surgery to lessen the depth of the scar, which will cost between $50,000-$65,000. She will always have some scar in her leg. Plaintiff’s nursing expert testified that this injection is required to be given deep in the intramuscular area. However, from the testimony of the Defendant nurse, it is clear that the injection was given subcutaneously. The discrepancy between where the shot should have been given and was given is below the standard of care. The standard of care also requires immediate withdrawal of the syringe, if blood comes back into a syringe during an injection.

Plaintiff’s experts also gave testimony as to her damages. They testified that the burning of skin and subcutaneous tissue on anterior thigh resulted in tissue necrosis. In order to fix her injury she would require debridement and a skin graft, in addition to a second procedure to remove residual dead subcutaneous tissue. However, she would retain a permanent depressed scar of 5” X 6” on anterior thigh that would extend down to muscle fascia. Plaintiff is a candidate for scar revision surgery but, even with good results she will have a permanent scar on her leg

At trial the Defense argued that Plaintiff caused this injury to occur when she hit the nurse’s arm while the nurse was giving the injection, causing the needle and injection to go into subcutaneous tissue. Alternately the Defense argued that the intra arterial injection never occurred.

The Defense had an expert witness testify as to their theory of the case. An Orthopedic surgeon testified no functional problem with the leg as a result of injury. A plastic surgeon testified the cost of scar revision was much lower than cost estimate provided by Plaintiff’s expert and that cost should be between $7,000 – $20,000. A defense nursing expert testified that there was no breach of the standard of care and that Plaintiff caused her own injury.

Defense experts gave testimony that rebutted expert testimony by Plaintiff’s regarding damages. The experts claimed that the Plaintiff’s injuries were a cosmetic defect and there is no functional damage to the leg. Cost of future surgery is much less than Plaintiff alleges and given time delay from injury there is little likelihood that she will ever have surgery.

TYPE OF CASE: Medical Malpractice

INJURIES: Necrosis of skin and subcutaneous tissue in the Plaintiff’s anterior thigh, down to muscle fascia.

DATE & LOCATION OF INCIDENT: On 10/10/86 at Defendant’s Hospital.

PLAINTIFF’S AGE: 42 at time of incident

OCCUPATION:  Housewife

PLAINTIFF’S ATTORNEY:
David P. Crandall
AITKEN * AITKEN * COHN
For Plaintiff – Susan W.

DEFENDANT’S ATTORNEY:
NEIL, DYMOTT, PERKINS, BROWN, & FRANK
For Defendant – Kaiser Foundation Hospital

DEFENDANT’S INSURANCE CO.:  Kaiser Foundation Hospital