Negligence Paper
Jennifer Zuber
HCS/478
April 11, 2016
Susan Lawson

Negligence Paper
In 1711, Alexander Pope wrote in a poem, "To err is human." Errors happen in every walk of life and every career path, but there are some areas where and error could be the difference between life and death or profound injury. The healthcare field is one of those areas. Over time, health care has evolved. There are now so many practices and protocols in place so that errors may be avoided. It is understood that there are some errors that may occur due to being human, and then there are other mistakes that should never happen, such as surgically amputating the wrong limb. There are so many safeguards in place to prevent such errors from happening.

Negligence is a general term that denotes conduct lacking in due care (Guido, 2014).
Malpractice sometimes referred to as professional negligence, is a more specific term that addresses a professional standard of care as well as the professional status of the caregiver. To be liable for malpractice, the person committing the civil wrong must be a professional, such as a physician, nurse, accountant, or lawyer (Guido, 2014). Gross negligence is an act or omission “which when viewed objectively from the standpoint of the actor at the time of its occurrence involves an extreme degree of risk, considering the probability and magnitude of the potential harm to others; and of which the actor has actual, subjective awareness of the risk involved, but nevertheless proceeds with conscious indifference to the rights, safety, or welfare of others” (Thornton, 2006). Any surgical procedure can be considered high risk. Surgery requires a team of highly trained professions starting with the nurses caring for the patient pre-op and post-op, the surgeon, the anesthesiologist, and the operating room and circulating nurses. In my personal experience, every single one of the members of this team at some point ask the patient what kind of surgery they are having, what area of the body will the surgery be performed on, the surgeon initials the area that is to be operated on and the patient or family agrees to this and question and concerns are addressed. Conducting a "time-out" before beginning a surgical procedure is essential for preventing wrong-site, wrong-side, wrong-procedure or wrong-person surgery. Time-outs are short meetings with the entire operating team immediately before an incision to verify the patient's identity, the procedure and the site along with other pertinent information (Rodak, 2013).
In the article provided by the Neighborhood 2.0, “Amputation Mishap”, a very scary event occurred, where Mr. Benson, a 62-year-old diabetic man had the wrong limb amputated at the Neighborhood hospital. There is no information about Mr. Benson’s level of involvement before the surgery. The article paints a picture of a cognitively intact male status post surgery. Was he cognitively intact before surgery and was there any family present to advocate for him if he was unable to do so for himself? The article also depicts a hospital that is in a state of flux, with unhappy patients and staff and a significant nursing shortage. The hospital is responsible for this event.
Based on the information provided and the definitions alone, this incident could be classified as both negligence and malpractice. There are so many safeguards in place to prevent these types of events, such as time in and time out and marking the site before surgery while the patient or family can participate. If these processes were not done or not done with the care and accuracy that the patient deserved, the staff, surgeon, and hospital are negligent. Malpractice is based on the event involving a professional such as a physician. The doctor should have followed all his personal, professional and ethical protocols to avoid any such occurrence happening while he is operating on anyone. On all accounts, protocols, policies, and procedures were not followed by many individuals and a health care team as a whole, and should be held accountable. In an event such as this, a nurse may feel conflicted in how to document, as not to show him or herself in an incompetent light or because of fear of punishment. One of the cardinal principles of legally defensible documentation is strict adherence to organizational policy and procedure (DiLeonardi, 2009). A competent, professional nurse will document accurately and truthfully regardless of the circumstances. As per protocol, any incident that needs to be reported should have an incident report completed, and an event such as this, legal and the manager or director should be notified immediately. A wrong-site surgery would be considered a serious reportable event as well as sentinel event and is subject to review by the Joint Commission, which is why documentation needs to be accurate and complete. A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome (DiLeonardi, 2009). After the event is deemed a sentinel event, there needs to be a root cause analysis to determine what went wrong and how to prevent this from happening in the future, and without proper documentation, this would not be possible.

As healthcare professionals, nurses in specific, never want harm to come to our patients. The ethical principle of nonmaleficence was not applied by the nurses or staff that cared for Mr. Benson. Moral dilemmas of clinical medical practice can best be resolved within a framework of prima facie duties, and that the most stringent of these duties is nonmaleficence (Timko, 1995). After the event, the ethical principle that should be applied is fidelity. The staff needs to be truthful with Mr. Benson about what occurred, why it happened and what will happen going forward. Mr. Benson will still need the correct limb amputated, so his life will be drastically changed, even more than originally anticipated. Patients were unanimous in their desire to be told about any error that caused them harm. Patients believed such disclosure would enhance their trust in their physicians' honesty and would reassure them that they were receiving complete information about their overall care. However, patients believed that "human nature" might lead health care workers to hide errors from patients (Gallagher, 2003). The health care industry and their governing agencies have established guidelines, policies and procedures that are proven to prevent such incidents from occurring. As long as proper protocols, documentation, and ethical principles are applied while caring for patients, near misses, errors and sentinel events will be avoided, along with being accused of or worse, guilty of negligence or malpractice.

References
DiLeonardi, B. (2009, February). Professional Documentation: Safe, Effective, and Legal.
Retrieved April 10, 2016, from http://www.rn.com/
Gallagher, T. H., Waterman, A. D., Ebers, A. G., Fraser, V. J., & Levinson, W. (2003). Patients' and physicians' attitudes regarding the disclosure of medical errors. Jama, 289(8), 1001-1007.
Guido, G. W. (2014). Legal and ethical issues in nursing. Upper Saddle River, NJ:
Pearson/Prentice Hall.
Rodak, S. (2013, July). 5 Takeaways for Surgical Time-Out Success. Retrieved April 10, 2016, from http://www.beckershospitalreview.com/
Thornton, R. G. (2006). Malice/gross negligence. Proceedings (Baylor University. Medical
Center), 19(4), 417.
Timko, R. M. (2001). Clinical ethics: Due care and the principle of nonmaleficence. University
Press of America.