Perioperative festers are familiar...

Perioperative festers are familiar with the importance of carefully cleaning and resupplying the OR after individual patient leaves and carefully preparing the scope for the next patient. Failure to attend to these seemingly minute details can proceed in cross contamination and infection; confusion of patient specimens; a perplexed sponge, needle, or instrument count; or administration of the guilty medication or wrong dose to a patient. Now what happens between measures in the OR has taken in succession a legal dimension as well.

AN EXAMPLE

A June 2002 Colorado superlative Court case, HealthONE v Rodriguez, ex rel Rodriguez (50 P3d 879 [Colo 2002]) held that a professional practicing in the OR has not alone a professional duty to his or her patient if it were not that also a common-law duty to succeeding patients. Traditionally, liability has required that a professional-patient relationship be established.

This case deals with anesthesia care providers and medication left in succession an anesthesia cart. It also provides a vivid example to all perioperative practitioners of the importance of adhering to any applicable facility policies related to provision of care.

The facts of the case. The plaintiff in this case had retroactive sympathetic dystrophy in his left arm caused at a work-related accident. He received guanethidine force block treatments to alleviate his discomfort from 1991 to 1995 when the marked occurrences that gave rise to this case occurred

In August 1995 the plaintiff instanted for a nerve block treatment. His anesthesia care provider mistakenly took a vial of phenol from the anesthesia cart instead of the vial of guanethidine he had ordered from the pharmacy. He then injected the phenol into the plaintiff intravenously. The vials of phenol and guanethidine were identical save for the names on the labels. the two were kept in clear glass vials, which were identical in size and shape. Each was sealed with identical verdant stoppers covered with a foil seal and had labels that were identical in size, shape, color, size of print, and background.

The vial of phenol had been left forward the anesthesia cart three weeks earlier by the agency of another anesthesia care provider who had used it to inject the force of a different patient. He kept the vial despite an alleged single dose policy at this facility. The first anesthesia care provider claimed he did not leave the vial upon the cart. He claimed he wrapped the partially used vial in aluminum foil, placed it in a plastic bag labeled with the patient's name and date, and secur it in a fasteninged compartment of the cart. There was no mention in the case about who maintained, restocked, or had access to the cart between uses.

This error station in motion a series of issues The phenol injection caused left arm compartment syndrome requiring that the plaintiff bear an immediate fasciotomy. Two days later, the plaintiff was sedated to change the dressing throughout the fasciotomy incision. He allegedly was throughout sedated and consequently suffered cardiopulmonary arrest with an ensuing irreversible anoxic brain injury. The plaintiff now is incapacitated distressingly and requires supervised living and attendant care for the cessation of his life. The plaintiff su the anesthesia care provider who left the phenol in succession or in the cart; the anesthesia care provider who injected the phenol, administered the sedative, and managed the resuscitation; and the facility where these conclusions occurred.

The rulings. The trial court dismissed the claim against the first anesthesia care provider because a professional-patient relationship did not exist between the provider and the plaintiff. A professional-patient relationship is required for a medical malpractice action to be maintained. The patient also su for common-law negligence, which does not require a professional-patient relationship. Common-law function requires everyone to behave reasonably in such a manner as not to injure others, regardless of whether they are professionals.

In Colorado, a common-law negligence claim requires the court to decide whether the defendant owed the plaintiff a impost based on

* the risk involved;

* the foreseeability and likelihood of injury weighted against the social utility of the defendant's conduct;

* the cargo of guarding against the harm; and

* the deductions of placing that burden in succession the defendant.

If the court finds that a service is owed, then the court must decide whether a breach of that impost caused the plaintiff's injury. In this case, the trial court plant the risk of harm (ie, from leaving the phenol vial upon the cart) was slight and the injury was unforeseeable. In addition, the trial court fix that the action of leaving the phenol in or upon the cart was not the proximate cause of the plaintiff's injuries.

The plaintiff settl with the treating anesthesia care provider, and because the claims against the first anesthesia care provider had been dismissed, the plaintiff be causeded to trial against the facility as the alone remaining defendant. The jury awarded $4950730 for past and that will be damages, found the facility 30% at fault, and attributed 70% of the fault to the treating anesthesia care provider.