crew member lawsuit medical malpractice

[pully8]

https://www.law.com/dailybusinessreview/2018/09/10/miami-attorney-helps-secure-3-3m-for-man-whose-arm-was-amputated-after-seeking-care-for-flu-like-symptoms/ Sad case treated on board by doctor and nurse for flu like symptoms, ending up needing his arm removed.

Medical care was inappropriate and negligent.

[noobcruiser]

Link to a different website that doesn't require an account to read the article: https://www.cruiselawnews.com/2018/09/articles/crew-member-rights/arbitrator-orders-ncl-pay-3337500-seriously-injured-crew-member/

[luvcruzing]

Holy crap! It really makes you hope you never need to use the ship’s medical center.

[PTC DAWG]

With all the workers on all the ships worldwide, I'm sort of surprised you don't hear of this more often. I have no expectations that health care on a ship is as good as I can find in my hometown, but it may be much better than is available in their hometowns. In this case, obviously, not so much.

 

These workers really do put it all on the line..

[300dtc]

Yikes, I hope that doctor is no longer on the breakaway!

 

 

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[dogboy]

Three mil is a lot of money. Still wouldn't trade for right arm... or would I?

[mdsgu]

Promethazine (Phenergan) would be appropriate treatment for nausea. It can be administered intravenously, but s l o w l y. Much easier (and safer) to give IM. However, ordering promethazine IV does not, in itself, constitute malpractice. Giving it IV push (which apparently the nurse did) could cause such problems. My question is: why was the physician found liable? The nurse, practicing under his or her own license, should be the culpable party for failing to give the medication correctly.

[All-ready2cruise]

Promethazine (Phenergan) would be appropriate treatment for nausea. It can be administered intravenously, but s l o w l y. Much easier (and safer) to give IM. However, ordering promethazine IV does not, in itself, constitute malpractice. Giving it IV push (which apparently the nurse did) could cause such problems. My question is: why was the physician found liable? The nurse, practicing under his or her own license, should be the culpable party for failing to give the medication correctly.

 

The Doctor is in charge and the nurse is to follow and carry out his/her orders. If the Dr. didn't stipulate the speed with which the med was administered, it's on him/her, not the nurse.

[mdsgu]

The Doctor is in charge and the nurse is to follow and carry out his/her orders. If the Dr. didn't stipulate the speed with which the med was administered, it's on him/her, not the nurse.

 

I am a doctor, and I order Phenergan pretty routinely in the ER. Nurses are trained on how to give medicines safely. I have never ordered medicine given at a specific speed -- except for fluids. If I order Phenergan IV (which is rare), the nursing staff knows it has to be infused slowly and not as a push. And if the nurse doesn't know, he/she should ask or look it up. The doc might have some liability if he ordered it IV push, but even then, the nurse should have said something and refused to administer it as such.

[All-ready2cruise]

I am a doctor, and I order Phenergan pretty routinely in the ER. Nurses are trained on how to give medicines safely. I have never ordered medicine given at a specific speed -- except for fluids. If I order Phenergan IV (which is rare), the nursing staff knows it has to be infused slowly and not as a push. And if the nurse doesn't know, he/she should ask or look it up. The doc might have some liability if he ordered it IV push, but even then, the nurse should have said something and refused to administer it as such.

 

I guess it comes down to a question of training, right? I mean obviously a nurse needs to have been trained on ER procedures along with regular training in health care and the DR. has to be licensed practitioner as a medical doctor.

 

I've heard and read that the medical staff on ships are not at the same level as doctors on land and NCL is not alone.

 

And if this doesn't explain what the arbitrator found significant then I don't know what would:

 

" Dr. Campuzano had no experience or familiarity with the drug which he ordered to be mistakenly injected intravenously in Mr. Loncar’s arm rather than intramuscularly in his buttocks; he first attempted to schedule a consultation via the internet with a medical facility in South Florida for advice but he gave up after he could not establish a connection; he didn’t read the relevant physician desk book, medical literature, package inserts or warnings for the medication; he never warned Mr. Loncar of the risks associated with the medicine or obtain his informed consent; and he didn’t consider ordering a lower dosage or other medicines available on the ship which did not contain the risk of such catastrophic injury."

[mdsgu]

Do you know where your doctor trained? Where they went to medical school? The vast majority of people do not, and you would be surprised at the number of doctors in the United States who went to medical school elsewhere but did their post-graduate training in the US. I don't know if this doctor is licensed in the US or not but he was apparently educated in Colombia. Having no experience with or knowledge of Phenergan is a stretch, though, because it has been around for eons.

 

As far as the nurse, in the olden days, yes, nurses carried out doctors' orders to the 'T' without question. Now, however, nurses are trained to ask questions and they can refuse an order that would be detrimental to the patient. Any nurse, ER or not, would (or should) know you cannot give Phenergan IV push.

[N&SCruise]

I'll chime in from a nurses perspective.

Phenergan IV is a *very well known* vessicant. It is a drug you learn about in nursing school, before you ever touch a patient - to be careful with.

I would only given phenergan IV in a large bore IV (18 gauge or larger), in the AC or higher, and mixed with MINIMALLY 10ml NS and slow push if you have no pump capabilities to drop it into a 50ml bag and infuse over 10-15 minutes. Why that nurse didn't - who knows.

 

I will agree with doc up there as well - when IV Phenergan is ordered it is never accompanied by "infuse over" or "slow IVP" directions. Same goes for many IV medications. There are exceptions of course - as doc mentioned - IVF, certain IV antibiotics, TPN, so on

 

That all being said - why isn't the nurse alone being targeted? Money. How much malpractice insurance do RN's carry these days? I'll venture to say the cap is far less than 3 million dollars - which is why the doctor alone wasn't named in arbitration and NCL as a company was.

 

Regardless all of this - sad story to hear.

[UnorigionalName]

Promethazine (Phenergan) would be appropriate treatment for nausea. It can be administered intravenously, but s l o w l y. Much easier (and safer) to give IM. However, ordering promethazine IV does not, in itself, constitute malpractice. Giving it IV push (which apparently the nurse did) could cause such problems. My question is: why was the physician found liable? The nurse, practicing under his or her own license, should be the culpable party for failing to give the medication correctly.

 

I don't think the physician was found liable for the order or administration. I think they (including most importantly the cruise line with deep pockets) were found liable in delay of management of the complication.

[Jana60]

I am a doctor, and I order Phenergan pretty routinely in the ER. Nurses are trained on how to give medicines safely. I have never ordered medicine given at a specific speed -- except for fluids. If I order Phenergan IV (which is rare), the nursing staff knows it has to be infused slowly and not as a push. And if the nurse doesn't know, he/she should ask or look it up. The doc might have some liability if he ordered it IV push, but even then, the nurse should have said something and refused to administer it as such.

 

 

I am also a physician. As to whether or not the physician would be liable, it is usually whoever has the deeper pockets. It is very rare for a nurse in a case to be sued without the physician also being named in the suit. It would also depend upon the training level of the nurse. If the nurse is a nurse practitioner she would be held to a higher level of care than if she is a nursing assistant. Ultimately the physician ends up being held at least partially responsible for the behavior of staff working under their supervision.

 

 

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[david_sobe]

Some of you guys are forgetting the most important part of the article. The injection by the nurse was wrong that indirectly led to losing the arm. However its the medical neglect afterwards by the doctor is the worst part. Keeping him on the ship and not getting him to a hospital led to him losing his arm. This was not an immediate process either. This got worse and worse every day before it was too late.

[$hip$hape]

Some of you guys are forgetting the most important part of the article.

The injection by the nurse was wrong that indirectly led to losing the arm.

However its the medical neglect afterwards by the doctor is the worst part.

Keeping him on the ship and not getting him to a hospital led to him losing his arm.

This was not an immediate process either.

This got worse and worse every day before it was too late.

I agree.

We call this "authorised practicing of medicine"

Nobody is perfect.

They did their best(?)

[kochleffel]

It's noteworthy that a case, Wyeth v. Levine, involving exactly the same issue -- IV push administration of Phenergan, leading to gangrene and amputation -- went to the U.S. Supreme Court in 2009.

 

The case itself was a legal thicket, because it was appealed from a state court and the major questions were whether Federal law pre-empted a state lawsuit, whether the FDA blocked Wyeth from making the warning label stronger, and whether the latter had any bearing. That IV push of promethazine was unsafe appears not to have been in dispute.

 

(Disclosure: I'm not a doctor, nurse, pharmacologist, or lawyer, nor do I play one on TV.)

[wonderland1]

On 9/11/2018 at 8:58 PM, noobcruiser said:

Link to a different website that doesn't require an account to read the article: https://www.cruiselawnews.com/2018/09/articles/crew-member-rights/arbitrator-orders-ncl-pay-3337500-seriously-injured-crew-member/

Thanks for sharing.

[newmexicoNita]

What a sad story. I think this was discussed here about a month ago. I am surprised we do not hear things like this happening more often. We have had a few visits to the medical center on ships, not just NCL either. Though the staff has always been friendly and caring I would never want any of the doctors to be my full time doctor. I think they also come and go, rarely staying with the same ship long. I don't know that for a fact, just an opinion. 

[TrumpyNor]

39 minutes ago, newmexicoNita said:

What a sad story. I think this was discussed here about a month ago. I am surprised we do not hear things like this happening more often. We have had a few visits to the medical center on ships, not just NCL either. Though the staff has always been friendly and caring I would never want any of the doctors to be my full time doctor. I think they also come and go, rarely staying with the same ship long. I don't know that for a fact, just an opinion. 

 

I actually agree with you, based on a personal experience with one of the NCL doctors on a cruise a few years ago. DH is the type who rarely goes to the doctor, and normally never feel ill or sick. But towards the end of this cruise, he starting feeling bad and complained about a very severe headache, being dizzy and throwing up and generally feeling very week in arms and legs, and staying in bed most of the day just wanting to sleep and sleep and sleep. When he asked me to contact the medical office on board it ws so unusual for him that I understood that he worried about something being seriously wrong with him. To make a long story very short; he had two trips to the doctors office on board, and after taking numerious blood tests both times the medical conclusion was "dehydration". So he was given IV fluids and some tablets to stop feling nausious/throwing up, told to avoid "fat food" and coffee on board and that was it (plus a medical bill of USD 2200 for two visits of 1 h duration each time - that was of course later covered by our travel insurance, but very happy I had brought an extra credit card for unexpected expenses...). 

 

A few days later the cruise was over and we returned home, and since my husband still was feeling very "strange" (his own description) we contacted our full time doctor. That ended in a trip to the ER where an IMR scan revealed that he had suffered from 7 (seven!) minor brain strokes during the last couple of weeks. So he was veeeery lucky that all the strokes were minor and didn't cause much damage - but I still get kind of upset when thinking about the doctor on board and his easy explanation of "dehydration". 

 

Both DH and I are mid-fifties and didn't know much about strokes and symptoms of this, so we had no idea the situation could be as serious as it actually was. I understand that we would have been "thrown of" the ship if the NCL doctor had suspected anything as serious as brain stroke and transferred to a hospital on land, and would be totally understanding about that knowing that they don't have equipment on board to deal with serious illness or injury. And even though this would have been "inconvenient" to put it mildly, it is still a better "option" than the risk of permanent damages and/or death caused by a large and unthreated brain stroke. 

 

In my husbands case, it ended as good as it possibly could have ended, and all the doctors he has been in contact with after this happened, say that he has been extremely lucky. And yes, both the doctor and the nurse on board the ship were very friendly - but for future references I would only "trust them" with minor things like the flu, sea sickness or tooth ache........

Edited December 7, 2018 by TrumpyNor

[Homosassa]

On 9/12/2018 at 7:20 PM, kochleffel said:

 

 

(Disclosure: I'm not a doctor, nurse, pharmacologist, or lawyer, nor do I play one on TV.)

 

But did you spend last night in a Holiday Inn Express?

[ONECRUISER]

On 9/11/2018 at 11:31 PM, dogboy said:

Three mil is a lot of money. Still wouldn't trade for right arm... or would I?

I'd give my Left Arm for $3 Million 

[kochleffel]

On 12/7/2018 at 9:56 AM, Homosassa said:

 

But did you spend last night in a Holiday Inn Express?

 

Not even that.