It is both shocking and sad when obvious nursing negligence occurs in Maine. For almost every nursing procedure, there is a standard way of performing the procedure that every Maine nurse is expected to know.

Take, for example, the common nursing procedure of placing a feeding tube in a patient’s stomach. If a patient cannot eat, the doctor will often write an order in the hospital chart telling the nursing staff that the patientis to receive nutrition by a tube that goes in through the nose, down the back of the throat and into the stomach.

Placing the tube is a nursing function that takes place on a routine basis. Sometimes the tube goes in easily, other times it can be difficult to pass the tube into the stomach easily due to the patient’s condition or because the tube gives the patient the feeling of gagging during the insertion and causes the patient to thrash. It is important for all Mainers to know that even if placing a tube is “challenging”, there is not a hospital in Maine that is allowed to deviate from the standard of care in nursing as it relates to insertion of a feeding or “enteral” feeding tube. In fact, if placing a tube is especially difficult in a particular case, it is all the more reason for the nurse to be especially careful.

The most serious potential misadventure of a feeding catheter or nasogastric tube is placement in the lung. If not recognized in time, lung collapse and death may result from placement of a feeding tube in the lung.

This x ray shows a feeding tube in the lung of a 64 year old woman recovering from spinal surgery. ( There is also a nasogastric tube properly positioned in the stomach.) This case illustrates the importance of looking at the lung bases where a feeding catheter is seen passing through the bronchial tree of the right lower lobe and extending well into the right pleural space.

There are simple devices that allow nurses to be 100% sure that the tube is in the stomach and not the lungs. One article describes some modern methods of checking for placement as follows:

Enteral feedings are an integral part of care for many hospitalized patients. Accessing the gastrointestinal (GI) tract safely and in a timely manner can be challenging. Various techniques and devices to enhance the safety of bedside feeding tube placement are available for clinicians. Three specific devices are highlighted, including the colorimetric CO(2) detector (CCD), a magnetically guided feeding tube (MGFT), and the electromagnetic tube placement device (ETPD).

The CO(2) detector is applied to detect the presence or absence of CO(2), thus assisting in correct placement of the feeding tube tip into the GI tract vs the lung. The MGFT uses a magnetic device to manipulate the feeding tube through the GI tract into the small intestine.

The ETPD provides real-time visualization of the feeding tube as it progresses into the small intestine. Training and repetition are essential for safe and successful feeding tube placement, and the highlighted devices can contribute to both of these goals.

As a Registered Nurse as well as a medical negligence lawyer, it is especially disheartening to hear when such a basic nursing procedures is carelessly handled.

Briggs & Counsel has successfully litigated numerous cases of medical and nursing malpractice on behalf of patients. Maine has very specialized laws and procedures for handling medical malpractice cases and few Maine law firms handle medical malpractice on a routine basis as we do.

If you or someone close to you has suffered from the careless actions of nurses at a Maine hospital, attorneys from our firm would be willing to meet with family members individually, or as a family group, to begin the process of sorting out what needs to be done to fix what can be fixed, and make up for the problems that can’t be fixed.

Copyright 2009 Briggs & Counsel

Maine physicians have a duty to direct patients to seek a second opinion when appropriate.  There are enough gray areas in medicine that it is often worth asking for a second opinion, but alarmingly, only three percent of patients ask for a second opinion!  What is the reason for this?

Could it be that Maine patients are simply lackadaisical about following a doctors clear statement that a second opinion is warranted? Or, given the insurance disincentive to provide more costly care, is it the case that doctors feel pressure to minimize second opinion referrals?

Medical test results can give conflicting information to a primary care physician, and in many cases, another physician’s opinion—perhaps even a specialist’s opinion- is warranted. Though patients may worry about what their primary care physician will think and how they will be treated in future visits if they do seek a second medical opinion, a physician’s attitude can reverse that fear.  It is medical malpractice for a Maine physician to fail to refer a patient for a second opinion in appropriate circumstances.

Maine doctors should

Elective surgery and diagnoses of cancer are two instances where second opinions could be very helpful.   This is particularly important in Maine for this reason:  If, for example, a doctor negligently overlooks a tumor on an imaging study, and three years go by before the medical mistake is caught, the patient cannot recover against the negligent doctor for the increased risk of death, payment of bills for costly treatments caused by the delay in treatment, or lost wages related to the delay in treatment.

Knowing how vulnerable Maine patients are to physical, emotional and financial injury caused by medical malpractice is reason enough to give second opinions a second look.

Copyright 2009, Briggs & Counsel