Background of the Case

Question:

Discuss about the Case Study of Albert Eric Bruce Biffin.

The following case study is about Albert Eric Biffin, who lived in Camden New South Wales. It was reported, that he had died unexpectedly at a health care setting that has a low nursing care facility. A residential health care setting is a system of care given by skilled doctors to patients in a home like surroundings. It was mentioned that the Mr. Biffin was under the care of his general practitioner, Dr John Lambie, for about 25 years. It was reported that the cause of death of Mr. Biffin was unclear and therefore it was reported to the coroner. A full internal autopsy had been done by the forensic pathologist Dr Terry, and it was reported that he had an incarcerated umbilical hernia containing an ischemic small bowel. It was also reported that he had bronchopneumonia and cardiomegaly; which is hypertrophy in the left ventricle and dilated ventricular chambers. He had moderate to severe coronary artery disease that required a pacemaker. It was also found that he had benign nodular hyperplasia of the thyroid gland and benign cortical adenoma; he was also suffering from early cirrhosis of liver. Mr. Biffins death raised questions on the efficiency of the health care professionals as well as the nursing home care provided. It was found that he was staying at a low nursing care facility residence. A home health care setting differs from the hospitals, in a residential health care setting the nurses work alone with resources got from a central office (McKenna, Hasson & Keeney, 2014). It was also provided in the case that the registered nurse that was appointed for him did not have any prior information about Mr. Biffins hernia. The registered nurse did not touch or examine the hernia, she did not know how long the hernia have been present and therefore prescribed him with just movicol. Another mistake from the staff’s side is that they did not understand the importance of the situation; therefore did not call for the doctors or the family members. The family should have been notified of his health status before calling a doctor. It can be understood from the case study that, the registered nurse would only attend Jacaranda, if called specially for urgent or specific reasons, since she had a patient load somewhere else.

It was not before the next morning when the staff reported the pain in Mr. Biffins hernia. Dr. Lambia was busy with other patients and did not find it of that much important; therefore it is clear from the given scenario that there has been negligence from the staffs of the health care setting, both the health practitioner and the registered nurse. The registered nurse in charge of Mr. Biffin did not find it necessary to call his family as she found that his vital signs were all within the limits, for a certain time. The registered nurse found it essential to inform the doctor, until an offensive discharge was coming out through the wound in his lower leg. It was until then that Dr. Lambie was unaware of Mr. Bruce’s hernia. It was also reported that doctor did not go through any medical history, and did not instruct the nurses about the treatment regimen for Mr. Biffin. He did not clearly document what the nurses would do after he had performed the procedure. It is the duty of the nurses to measure the quality of care systematically. Many residential care centers do not have public funding, managerial support to introduce new technologies to monitor improvement in their services (McKenna, Hasson & Keeney, 2014). The conversation between the doctor and the patient was very brief, therefore could not assess the problems faced by the patient, properly. After the surgery, Dr. Lambia did not instruct the nurses to identify the patient’s vital signs. The registered nurse reported that since she had patient load else where it was not possible for her to keep an eye on anything and everything. The clinical nurse reported that Mr. Biffin was suffering from short term memory loss, as per the cognitive test performed on Mr. Biffin. The nurse had a very brief entry records and she also admitted that Mr. Biffin was given unnecessary high doses of movicol without any improvement. The nurse was so careless that she was unaware of the pain and the signs of vomiting, which is a gross negligence on her part. Prolonged pain and vomiting are the clear signs of patient deterioration; therefore she should have been much careful in treating these. She even admitted that she did not suggest the enrolled nurse to call Dr. Lambia if emergency situation arises. She even did not hand over to the other registered nurses on the closure of her shift, but just told the enrolled nurses. She would have been alert to the signs and symptoms but she did not.  It was a total failure in the organization that led to Mr. Biffin’s death. Normally a registered nurse holds a high esteemed position than the normal enrolled nurses, therefore it is her responsibility to involve directly with the care regimen, which she did not.

Negligence and Failure of Health Care Professionals

It is the duty of a registered nurse to provide a holistic care to the patient (McKenna, Hasson & Keeney, 2014). It is the duty of a lead nurse to teach the junior nurse, how to monitor and assess a patient’s condition and start practicing the evidence based practice. A verbal guidance can never impart proper holistic care to the patient. Both verbal handover and written notes are required to ensure patient safety. Direct involvement with the patient, discussion with other clinical nurses regarding the care plan is required, which was lacking in this case (Haakestad, 2014). It was reported that the enrolled nurses who came to examine Mr. Biffin, was meeting him for the first time, therefore it is difficult for her to assess the whole condition at a go. It was found from the report that the enrolled nurse had mentioned in her records that the patient’s vital signs were normal, which was actually not. She seems to have been influenced by the report provided in the handover of the previous nurse and overlooked the low blood pressure. The enrolled nurse has admitted that the patient deteriorated during her shift and she regrets that she would have shifted Mr. Biffin to the hospital on time. The clinical staff load of the Jacaranda Place was also not very impressive to provide appropriate care to the elderly patients. The registered nurse was informed that Mr.Biffin was continuously having dry retching, but the she did not record about how long the retching had been going on. Furthermore Dr. Lambie claimed Mr.Biffin did not inform him about the continuous pain although Mr. Biffin reported that he was having prolonged pain around the umbilicus for the past few days.

It can be seen from the case study that there had been negligence on the caregiver’s part regarding administration of medicines. The nurses could have used broad spectrum antibiotics such as Cefoxitin, Gentamycin, Ampicillin , but the registered nurse continued to give him Movicol (McKenna, Hasson & Keeney, 2014).

The tort of negligence involves a person’s action that is less than the normal standard behavior and the duty of a person and the actions have caused serious damage. A tort is a civil wrong and tort of negligence can be applied in this study, as it can be clearly identified that the negligence of the involved doctors and the nurses lead to the deterioration of Mr. Biffin. Elements of negligence can be clearly seen in part of the doctor, the registered nurse and the clinical staffs. In a civil law it is the torts that can allow the advocates to claim compensations against the damage (Kitson, Marshall, Bassett & Zeitz, 2013).

Elements of Negligence

There are normally four elements to prove a negligence case.

• Negligence- The surviving members or the legal helpers of the deceased person should be able to provide appropriate proof of death of their loved ones due to the negligence of the defending party (Brenner, Brenner, Awerbuch & Horwitz, 2012). This does not only involve deaths and is applicable to other bodily harm to the patients.
• Breach of duty- It has to be proved that the defendant in the case owes a duty of care to the plaintiff. The health care professionals of a hospital have the duty to impart appropriate care to the patient according to their needs. It is up to the plaintiff to establish that the duty was being breached through negligent actions (Heaton, 2014).
• Causation- After proving how the defendant’s duty was breached, the plaintiff should also prove how the recklessness of the defendant actually took away the life of their loved ones (McDonald & Then, 2014).
• Damages- The death of the person should have brought quantifiable damages like admission to the hospital, medication costs, funeral, burial costs, loss of the potential earning members, pain and suffering brought to life due to the death of the loved ones (McDonald & Then, 2014). Mr. Biffin was an elderly person and his family might have been at a loss due to his death.

In order to prove these elements, the lawsuit requires relevant evidences and witnesses, and the whole procedure has to be done under the supervision of a specialized judge (Heaton, 2014). The patient’s family or the patient himself should be able to prove that the damages that had been done were foreseeable or avoidable.

A wrongful death is a civil wrong but not a criminal case. Therefore the burden of the proof is normally set a bit lower.  

Pursuing of the civil action in case of wrongful deaths can involve a number of steps like development of new strategies, communicating with the experts, investigating the claim, meeting the witnesses and researching about the tort law. The legal process related to wrongful deaths involves demands and possible settlement of the claim. A skilled attorney is required that can build a solid case in order to ensure that the proof burden has been properly addressed. Selection of an efficient lawyer is also required as the claim for the wrongful deaths which are complicated. A successful lawyer can communicate with the clients and work together to achieve a common goal off getting a good compensation (Heaton, 2014). In this report it can be seen that it is due to the organizational malpractice and the negligence of the nursing staff, that Mr. Biffin could no longer survive. In such a case legal actions can be taken against the health care settings. The inquest of Mr. Biffin’s death clearly provides with the idea that the total health care setting was responsible for providing a standard care to the patient, which they failed to provide (Brenner, Brenner, Awerbuch & Horwitz, 2012).

Ethical issues are one of the major challenges that are encountered by all professional nurses. In several cases, the nurses have to take critical decisions based on circumstances. Nevertheless, the lack of capability of the nurse and the Health Care workers, can we one of the major challenges that cause ethical concerns.

In the given case, of Mr. Biffin the major ethical issues are raised due to the fact that the patient family has not been informed about the cause of the death, which is believed to be one of the major ethical issues. According to the Coroners Act 2003, there are a set of rules that helps to identify the cause of death of an individual within the healthcare settings. It is also the ethical responsibility of the Healthcare organization to provide proper justification to the patient family for the cause of the death if it occurs immediately after receiving any health care treatment (Korhonen et al., 2015).

Legal Action for Wrongful Death

It is one of the major challenges of the Healthcare investigation team to evaluate the proper reason for the day of the patient in the given case.

According to McCarthy and Gastmans(2015), there are several ethical issues related to end of Life Care treatment. Due to multiple physical disorders that are encountered by an aged patient, there are several medical complications that are encountered by the General physician and nurses. Nevertheless, in the given case of Mr. Biffin, the nurse had not carefully attempted to fulfill the multiple needs of the patients. The nurses have also failed to deliver the exact care, as they were not properly able to diagnose the exact clinical condition Mr. Biffin. Hence, they have not been able to provide the correct forms of medical care that is needed in the case. It is also important to ensure that equal health care services are provided to every individual patient. It is essential from the nursing context to provide extra care to the aged patient that can help them in the process of recovery. In the given case of Mr Biffin, there has been clear breach of the ethical code of conduct for medical practice that has caused the death

References

Brenner, L. H., Brenner, A. T., Awerbuch, E. J., & Horwitz, D. (2012). Beyond the standard of care: a new model to judge medical negligence. Clinical Orthopaedics and Related Research®, 470(5), 1357-1364.

Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers. P.g.271-273

Coussement, J., De Paepe, L., Schwendimann, R., Denhaerynck, K., Dejaeger, E., & Milisen, K. (2008). Interventions for preventing falls in acute?and chronic?care hospitals: a systematic review and meta?analysis. Journal of the American Geriatrics Society, 56(1), 29-36.

Haakestad, A. (2014). Exploring the experiences of Enrolled Nurses regarding quality nursing care in general nursing units in the private healthcare setting (Doctoral dissertation, Stellenbosch: Stellenbosch University).

Hall, M. A., & Bobinski, M. A. (2014). Health care law and ethics. Wolters Kluwer Law & Business.

Heaton, L. (2014). Legal aspects of nursing. Kozier & Erb’s Fundamentals of Nursing Australian Edition, 3, 57.

Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.

McCarthy, J., &Gastmans, C. (2015). Moral distress: A review of the argument-based nursing ethics literature. Nursing Ethics, 22(1), 131-152.

McDonald, F., & Then, S. (2014). Ethics, law and health care : a guide for nurses ?and midwives. Australia: Palgrave Macmillan.

McDonald, F., & Then, S. (2014). Ethics, law and health care : a guide for nurses ?and midwives. Australia: Palgrave Macmillan.

McKenna, H. P., Hasson, F., & Keeney, S. (2014). Patient safety and quality of care: the role of the health care assistant. Journal of Nursing Management, 12(6), 452-459.

Shahriari, M., Mohammadi, E., Abbaszadeh, A., & Bahrami, M. (2013). Nursing ethical values and definitions: A literature review. Iranian journal of nursing and midwifery research, 18(1), 1. Jan-Feb 2013

Towsley-Cook, D. M., & Young, T. A. (2013). Ethical and Legal Issues for Imaging Professionals-E-Book. Elsevier Health Sciences.

Tune, M. D. (2016). Re: Aged Care Legislated Review.

Weiss, S. A., & Tappen, R. M. (2014). Essentials of nursing leadership and management. FA Davis.pg. 105,126.