The Complexity of Gall Bladder Claims…
In most gall bladder surgery, thankfully, nothing goes wrong, the procedure is not easy though, it requires skillful blind operation techniques and it is therefore, never without risk. We have set out the basics of the procedure below.
It is interesting but demanding to read. You may not know yourself where things have gone wrong but we can talk to you and we usually judge wether there is a case to investigate or not.
Almost all operations, are completely successful. This is in no small part due to the skill of the surgeons, however, inevitably errors can occur. As a procedure there is a requirement to fit surgical clips, the surgeon clips the cystic duct in two places. One is near the cystic duct’s juncture with the gallbladder, and the second is at the cystic duct’s juncture with the common bile duct. The surgeon similarly also clips the cystic artery. The surgeon then transects (cuts) the cystic duct and artery between the two clips. By transecting the cystic duct and artery, the surgeon releases the gall bladder for removal from the abdominal cavity.It’s a lot easier to say than it is to do. It is plan which relies on all parts to go correctly or it will fail utterly. The surgeon must find and identify the cystic duct’s juncture with the gall bladder and the cystic duct’s juncture with the common bile duct before transecting the cystic duct.
The surgeon achieves this by finding the gall bladder and the cystic duct juncture; and then meticulously tracing the cystic duct to its junction with the common bile duct. The objective is to identify the cystic duct conclusively. The surgeon must not clip the cystic duct or transect it before making conclusive identification of the cystic duct.
The most common area for fault as you can probably guess, is that the surgeon clips or cuts the patient’s common bile duct instead of the cystic duct. This injury usually requires extensive, complicated and painful surgery to reconstruct the patient’s biliary system.
The biggest issue here is often the patient is actually discharged without a recognition that the injury has occurred. Once the injury is diagnosed, the patient is often in extreme pain and discomfort. Once the patient’s biliary anatomy has been reconstructed, there will be a long period of convalescence.
If the patient is not diagnosed quickly the results can often be fatal.
Often the gall bladder surgery litigation in which we are involved focuses on that one issue – that the surgeon failed to conclusively identify the cystic duct and or did not diagnose the injury caused by that failure. As a result, the surgeon may have placed clips across the common bile duct, obstructing the flow of bile or transected the patient’s common bile duct, resulting in the flow of bile into the patient’s abdomen with consequent sepsis.
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Nursing Negligence Example
Some examples of nursing negligence would be:
- Failing to refer a patient who is suffering from an open wound or pressure sore that is not healing.
- Failing to gaurd against pressure sores, ulcers and weeping wounds.
- Failing to lift a patient safely leading to fractured bones which can go unnoticed or untreated
- Keeping a patient on antibiotics for a urinary tract infection when the infection is not responding.
- Not keeping a patient hydrated or not noticing that a patient is dehydrated or undernourished.
- Administering the wrong medication or the wrong dose.
- Not reffering a patient who is not responding to medication
- Not taking a patients consent or ignoring a patients wishes
Nursing Negligence Consequences
The consequence of negligence for the patient is nearly always injury or harm, for the responsible nurse the consequences vary but could be:
- The Nurse will likley have to be questioned and a statment taken by the Hospitals legal department.
- The Nurse will likely have to given an account to thier manager or supervisor
- They may face and investigation by the NHS Trust or the Hospital.
- They may have to face an investigation by the Royal College of Nursing and Midwifery.
- They may have no conseqeunces at all.
Ultimately much depends on the degree of negligence or harm that has been caused.
Nurse Negligence Wrongful Death
FATAL ACCIDENT INQUIRY INTO THE CIRCUMSTANCES OF THE DEATH OF MR JAMES MCNEILL  FAI 50
In terms of section 6(1)(a) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976, the Sheriff found that Mr James McNeil (DOB 14th September 1935) died at 08:30 hours on the 22nd of October 2008 at Belhaven Hospital, Dunbar. The cause of death was (i) bronchopneumonia; (ii) pressure sores on back, ischemic heart disease, and dementia.In 1989, Mr McNeill was diagnosed with Alzheimer’s disease, and his condition eventually deteriorated in 2007. On 18th April 2008 Mr McNeill was admitted to Lennel House Nursing Home, Coldstream; Lennel House was a nursing home owned and operated by Guardian Care Homes (UK) Ltd. On admission to Lennel House an Admission Assessment Form was completed by the duty staff nurse. The assessment covered, inter alia, the risk of pressure sores; Mr McNeill was assessed as being at high risk of developing pressure sores.
On 19th May 2008 two blood blisters were noticed on Mr McNeill’s sacral cleft. These were the first manifestations of the early stages of pressure sores. In the course of the following days the blisters were treated with creams and dressings. However, the area of the wound, which was measured and recorded daily, increased. By 30th May 2008 the blisters measured 3 x 1.5cm and 1 x 1cm and were recorded as being necrotic and producing an odour, signs consistent with infection. By 9th June 2008 the measures put in place produced no improvement and the odour from the wound was now described as offensive. On 11th June 2008 the districtnurse visited Lennel House by prior arrangement. The wound now measured 13 x 4.5cm and was discharging thick yellow puss. A hole had appeared in the sacral cleft from which fluid leaked. The districtnurse arranged for Mr McNeill to be examined by a GP which examination was conducted on 12th June 2008. As a result of this examination the GP arranged for Mr McNeill to be admitted to the Borders General Hospital on 12th June 2008 in order to obtain a surgical opinion.
On 13th June 2008 surgical debridement of Mr McNeill’s pressure sore wound was carried out. The operating surgeon considered the wound to be serious and described the operation as a “planned emergency”. In his experience of having carried out 12 or so pressure sore debridements over the years, this was described as the worst which he had encountered.Mr McNeill remained at Borders General Hospital until 24th September 2008 when he was transferred to Roodlands Hospital, Haddington. On 20th October 2008 Mr McNeill was transferred to Belhaven Hospital in Dunbar. At about 06:00 hours on Wednesday 22nd October 2008 nurses attended on Mr McNeill to administer medication, including morphine sulphate, and prepare him for a bed bath. After about 30 minutes, when in course of being bathed, Mr McNeill’s condition deteriorated and he expired in the presence of nursing staff.
The Sheriff noted that from the evidence there could be little doubt that Mr McNeill’s care at Lennel House would have benefitted from better and more promptly implemented care plans and risk assessments; from being cared for by nursing staff who had the advantage of better managerial support; better induction procedures; better training especially in respect of pressure sores and the care of the elderly; better dissemination of information regarding policies and procedures; better access to specialist equipment; and from allocated time for communication as between staff on different shifts.
Focusing on Mr McNeill’s development of pressure sores, the risk of these developing would almost certainly have been reduced with earlier provision of special mattresses, cushions and organised and recorded positional changing. The Sheriff concluded from the evidence that the latest date when Lennel house nursing staff ought to have contacted the district nurse, or general practitioner, regarding Mr McNeill’s pressure sore would have been 4th June 2008. However, the Sheriff noted that in the interim period, key staff had changed at the nursing home and that following the death of Mr McNeill, procedures had been improved radically. For these reasons, the Sheriff considered it inappropriate to make any findings under the Act in terms of section 6(c) and (d).
FATAL ACCIDENT ENQUIRY INTO THE DEATH OF NASRULLAH KHALID, SHERIFF KENNETH ROSS, DUMFRIES SHERIFF COURT, 9TH MARCH 2011
In terms of section 6(1)(a) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976, the sheriff found that Nasrullah Khalid died within cell B/17 at H M Prison, Terregles Street, Dumfries on 23 November 2009 between the hours of 3.15pm and 4.55pm. In terms of section 6(1)(b), the cause of death was (a) Ischaemic Heart Disease (b) Coronary Artery Thrombosis and (c) Coronary Artery atherosclorosis. A formal determination was made under section 6(1)(c).
Background: Mr. Khalid had suffered from a heart condition since 1996 when he had had a heart attack. The symptoms of his condition were stable angina, hypertension and atherosclerosis. For the three years prior to his death the deceased exercised regularly in Dumfries Prison gym. There was no medical reason why Mr. Khalid should not have participated in the exercise regime.
At about 1.50pm on 23rd November 2009 Mr. Khalid attended the prison gym as usual. About five minutes before the end of his routine the deceased experienced nausea and pains in the centre of his chest. He was examined by the duty nurse who concluded that he had suffered an angina attack. He was returned to his cell at 3.15pm and advised to rest and take his angina medication. At about 4.55pm Mr. Khalid was discovered lying on his bed with his eyes open and with vomit on his face. Officers commenced CPR and continued to do so until paramedics arrived about ten to fifteen minutes later. They took over the attempts to resuscitate Mr. Khalid which continued for a further twelve minutes. Throughout the procedure there was no response from Mr. Khalid. He was pronounced dead when the prison doctor arrived at 5.45pm.
Under s.6(1)(c) the sheriff found that, in the examination of Mr. Khalid at the Prison gym, it should have been established if the chest pain of which he had complained had disappeared completely. In the absence of such a finding, the prison doctor should have been contacted and an ambulance called. However, to have done so would not have guaranteed Mr. Khalid’s survival. Nor would that survival have been a probability.
What is a community nurse?
Delivering care to the elderly, disabled and vulnerable patients who are unable to travel to a hospital or doctor’s surgery, community nurses are registered nurses who have undertaken degree level training as a specialist practitioner. This course focuses on four key aspects of nursing including clinical nursing, care and programme management, clinical practice development and clinical practice leadership.
Community nurse roles and responsibilities
A community nurse is responsible for performing many of the same duties as a district nurse. These include basic care (checking temperature, blood pressure and breathing), wound management, administering injections, setting up intravenous drips and assisting doctors with examinations and medical procedures. Community-based nurses are also able to provide vital information to clients, their families and carer/s, much in the same way as district nurses, while emergency support may also be required in cases when a patient is suffering cardiac arrest or a stroke. This demonstrates the many hats a community nurse must don in their line of care.
So what is the difference between community and district nurses?
In recent times, the terms district and community have become interchangeable as a way of describing areas of villages, towns and cities, meaning that there may be no difference between community and district nurses at all.
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