What to Do????

What is the name of your state? Georgia
I guess I really have a couple of questions. First, to show Standard of Care, concerning an emergency room nurse, would a Professor of Nursing be considered an expert wittness? Next, consider this scenerio. The attorney pulls out of a Med Mal. case because he ran out of time to get an expert wittness. A few days before the statue of limitations are up the case is filed pro se, it is delivered to the defendants,( in an attempt to save the case, and on advise from a friend attorney), then the planintiff makes a motion to Dismiss Without Prejudice,(giving the plaintiff an opportunity to refile the case in six months)The motion was granted. I know this must be legal, but because this was filed pro se, an attorney will not touch it. Could this case be filed in small claims court, to recover medical bills, or does the six month refiling thing only have to do with the original filingin State Court. I know this sounds really off the wall, but there's a lot more to the case, it's hard to let go. Any advice is truley appreciated .

elm1949
Can a Professor of Nsg. provide expert testimony? Yes; but not necessarily in your circumstances. You need a testifying expert with the same qualifications as the ER nurse and with the same or similar practice and area of practice. You can not expect an RN with a Master's Degree in Nursing to perform at the same level as a Diploma RN or expect an RN with one year or less of clinical experience to perform at the same level as an RN with 10 years experience and numerous ER certifications. You also can not expect the same level of ER care at a rural hospital in GA, probably with a level III trauma ER, as you would find in the level I trauma center at the Medical Center of Central GA in Macon.

I'm afraid you've made a big problem for yourself by filing pro se. It would have been better to have your attorney or another attorney to file for an extension. I don't think you can simply go to small claims court and ask for resolution.

Care to tell us what happened? Maybe we can tell you if the general standards of care were met. Please, don't tell us the hospital's name or the nurse's name, but generalize by stating the level of trauma ER services by comparing to the levels stated in the first paragraph.

EC

What to Do???

The hospital I am refering to is one of three in Savannah, Georgia. If you are familar with these, you'll know that all of them indeed are trauma units. I went to the E.R.(my sister went with me) because I had a nose bleed off and on for about a week. My family dr. told me to go as their office was no experienced in nasal packing. When I entered the E.R., my nose was not bleeding , but as I sat in the exam room waiting, it did start to bleed(thru nose and down the back of my throat. I was put in a reclining position and watched as they hunted for a nasal pack. They found a Rapid Rhino Rocket nasal pack (size750) and proceeded to read directions, as the E.R. nurse, told the other hospital employee," she had never done this before" She reclined me almost in a flat position and proceeded to push the tampon up my nose. Of couse, it wouldn't go all the way in and by this time I was screaming bloody murder and they thought I had fainted. The pain was unbearable, she then sit me up, the tampon only halfway inserted, and inflated the balloon. You could hear my screams all over the E.R., as a crowd was gathering outside the door. A dr. then cam in and saw what she had done and instructed her to take it out. He then inserted another of the same kind, but he got it all the way in. I was given Vicodin&Demeral & Phen. and released in a wheelchair. What a nightmare. The pain that I have today on the left side of my nose, that gives me headaches and I cannot wear my glasses for any lenght of time, started when that balloon was inflated in the wrong position. One Ent told me I have scar tissue (from pressure necrosis) another ENT told me there could have been a bone fracture during the procedure, but no one will say for a certaintly, much less sign an affadavit. This is certainly not all, but you're probably tired of reading it, besides my nose is killing me! Thanks

You have not given enough informaiton to really refer you appropriately or answer your question. We just had another similar tale of a Rapid-Rhino and the poster thought thr ER doc was negligent but in fact if there was neglience it was by another provider.

What happened causing your nose to bleed?

Did you have any lab work, if so ,what? Results? ct or mri?

What did ent say? how long after injury?

Do you have a history of head injuries or blows to the face?

Are you on any medications?

Are you allergic to any medications?

Do you have a history of bleeding, nose bleeds, bleeding gums, easy bruising etc? Anyone in your family?

Your age?

Was the RR soaked in sterile water or saline? HOw long was it in? did it stop bleeding when removed?

What pressure?

This is a start

what to do???

I am 55 yrs old. I do not have a history of nosebleeds, nor my family. Only medication I was on was estrogen. My B/P has always been with in normal limits. Blood work was done & normal. The next day, I was still in so much pain, and the blood was seeping thru the packing, my husband took me to one of the other E.R., by this time my nose was flowing pretty good. They called an ENT and he admitted me and did surgery the next a.m., 9in surgery 4 hrs.,ligation of the sphenopalatina artery) No real cause for the breakage. The ENT noted in my records a tremendous amt of scarring and trauma to the septum from packing. I followed up with this ENT for 7 months after surgery, still compalining of the pain and headaches. He simply did not know what to do. I went to another ENT for a second opinion. He ordered a CT scan immediately. It showed scarring in that area. He offered me surgery with a 50/50 chance it would help. I did opt out on that decision. Both ENTs believe that my pain and trauma started with the intial packing with a nurse that had no idea how to do that procedure. But no one will swear to it. So I'm to live the rest of my life with an injury that could have been prevented.
No, I did not have any trauma to my nose before the bleeding occured. I think I have answered all the questions. Thank for listening.

elm1949
I suggest you speak with a medmal attorney in your area.

Scarring, actually significant scarring, is a known risk of this procedure; and, each patient develops scarring at his or her individual level of response/healing. You would need to prove that you would not have developed the scarring and required surgery except for the improper technique and, or that the damages are the result of the nurse's failure to follow the minimum standard of care by failing to get an experienced nurse or MD to perform the procedure. You don't have to prove it absolutely, just prove it 'more likely than not'.

Depending on the potential monetary value of the damages, your claim may or may not support the high cost of a medmal claim.

(Based on the location and the trauma center's level of acuity, it may have been appropriate for an RN to perform the procedure. In facilities with lesser levels of acuity, an MD may be required to perform the procedure. From your description of events, I'd wager the nurse was inexperienced; a more experienced nurse would have observed the procedure unless no one else was available. I have no problem with the nurse's reading of the instructions; products and suppliers are changed so frequently, I read the instructions on the packages!)

EC

ellencee said:

elm1949
I suggest you speak with a medmal attorney in your area.

Scarring, actually significant scarring, is a known risk of this procedure; and, each patient develops scarring at his or her individual level of response/healing. You would need to prove that you would not have developed the scarring and required surgery except for the improper technique and, or that the damages are the result of the nurse's failure to follow the minimum standard of care by failing to get an experienced nurse or MD to perform the procedure. You don't have to prove it absolutely, just prove it 'more likely than not'.

Depending on the potential monetary value of the damages, your claim may or may not be support the high cost of a medmal claim.

EC

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We still don't know how she got the bloody nose in the first place and she didn't answer the questions. the 750 model was the largest model of the RR, and that's two RR injuries in <1week, very strange. I think I'll stick to tissue, got the technique down to a science and DDAVP!

what to do!!!

rmet4nzkx said:

We still don't know how she got the bloody nose in the first place and she didn't answer the questions. the 750 model was the largest model of the RR, and that's two RR injuries in <1week, very strange. I think I'll stick to tissue, got the technique down to a science and DDAVP!

Click to expand...

I think I DID answer most of the questions...But I'll repeat a few answers for you.

The bleeding came from an artery, way back in my head. It was wintertime and the Dr. says it can happen for no apparrent reason.

I do not have a history of nosebleeds.

I do not take any medication (except my estrogen & pain med now) on a daily basis. Basically in good health. Raised 3 "strapen" boys, so I'm not a crybaby..

Basically, I went to an E.R. for a nosebleed and was not treated with the minimal standard of care that is demanded. The ANA supports the nurse's obligation to reject an assignment in situations where it puts the patient or themselves in jeopardy. She should have admitted she did not know the procedure.

Ever had your nose packed? There certainly is some discomfort. But there is a procedure and instruction for a good reason! First, I should have been in an upright position , not lying almost flat. That put everthing in my nose in a different position, therefore, putting the tampon and the inflated balloon in the WRONG position in my nose! Thats were the damage was done.
Thanks

what to do!!!

ellencee said:

elm1949
I suggest you speak with a medmal attorney in your area.

Scarring, actually significant scarring, is a known risk of this procedure; and, each patient develops scarring at his or her individual level of response/healing. You would need to prove that you would not have developed the scarring and required surgery except for the improper technique and, or that the damages are the result of the nurse's failure to follow the minimum standard of care by failing to get an experienced nurse or MD to perform the procedure. You don't have to prove it absolutely, just prove it 'more likely than not'.

Depending on the potential monetary value of the damages, your claim may or may not support the high cost of a medmal claim.

(Based on the location and the trauma center's level of acuity, it may have been appropriate for an RN to perform the procedure. In facilities with lesser levels of acuity, an MD may be required to perform the procedure. From your description of events, I'd wager the nurse was inexperienced; a more experienced nurse would have observed the procedure unless no one else was available. I have no problem with the nurse's reading of the instructions; products and suppliers are changed so frequently, I read the instructions on the packages!)

EC

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As I stated in my first post, my attorney quit, (because of frustration I think) He could not get an affadavit from my Dr. Even though they state in my records, they beleive my pain started with the intial packing. Therefore, I was advised the save the case, by filing pro se. I tried very hard to get another attorney to take over, but the statue was running too close for anyone to take it. So, Here I am. I have two weeks to refile. I would even go to small claims to recover the medical bills, But can I sue the nurse or Dr. in small claims court? ($15000.00 in Georgia) You see I'm not out to get rich, I really don't want this to happen to someone else. I actually have nightmares and crying spells remembering that night. The nurse needs to be held responsible for my pain.. Thanks

elm1949 said:

I think I DID answer most of the questions...But I'll repeat a few answers for you.

The bleeding came from an artery, way back in my head. It was wintertime and the Dr. says it can happen for no apparrent reason. This is true, however, something prevented your normal clotting in the first place leading to the the entire series of events, so it is not as simple as blaming it on the nurse, perhaps your doctor should have refered you immediately to an ENT. These are questions that will come up. That's why your Dr. can't say who is the cause. You really should have told us about your pro se law suit up front.

I do not have a history of nosebleeds. This is the first nose bleed you have ever had? Do you bruise easily? Heavy periods? any history of abnormal bleeding? I ask because most nose bleeds are easily controlled with presure this suggests something is affecting your ability to clot normally, this could be a medicaiton, some foods, a medical condition/bleeding disorder, what lab tests were done, were you tested for bleeding disorders?

I do not take any medication (except my estrogen & pain med now) on a daily basis. Basically in good health. Raised 3 "strapen" boys, so I'm not a crybaby.. Estrogen should help prevent excessive bleeding if your levels are adequate, pain medications including common otc can cause bleeding.


Basically, I went to an E.R. for a nosebleed and was not treated with the minimal standard of care that is demanded. The ANA supports the nurse's obligation to reject an assignment in situations where it puts the patient or themselves in jeopardy. She should have admitted she did not know the procedure. Go to the site for the Rapid Rhino, it has a link to the instructions for the doctor, see how complete those look to you. You are assuming the nurse didn't have training, she may have had training, not with this newer product but with older products.

Ever had your nose packed? YES and my son's There certainly is some discomfort. But there is a procedure and instruction for a good reason! First, I should have been in an upright position , not lying almost flat. That put everthing in my nose in a different position, therefore, putting the tampon and the inflated balloon in the WRONG position in my nose! Thats were the damage was done. That's why I specifically asked questions which you don't have answers to, such as the inflation.
Thanks

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I asked specific questions, the same questions you will have to have answers for later. Please ask you doctor to refer you to a hematologist to rule out bleeding disorders, you don't want something similar to happen in the future, a nose bleed can a very serious thing. There have been two Rapid Rhino questions this week, it could be a product problem.

In this thread, I believe the OP has reason to file a complaint because of the nurse's performing a procedure with which she was not familiar and with a product with which she was not familiar. The nurse's actions approach violation of the Nurse Practice Act (GA) and I am reasonably sure that the nurse's actions are in violation of the facilities policies and procedures by not performing the treatment under the direct supervision of a professional experienced in the procedure.

I don't think either complaint regarding the use of the Rapid Rhino will support a medmal claim because the damages are not of a significant monetary value to pay for the litigation.

In this poster's claim, I believe the hospital will provide some compensation due to the nurse's performing a procedure without necessary experience or supervision.

I researched the Rapid Rhino and found that the manufacturer paints a rosy picture of it's benefits, ease of use, etc.; however, ENTs and other physicians rate the product below average. I've been an RN long enough to believe this product is a new 'toy' in the ER department and, more likely than not, an incentive to use the product is being provided (low or no cost for the product for the hospital).

In this poster's situation, I believe 'regular' nasal packing should have been used and if not therapeutic, then to progress to a tamponade device.

This poster's situation does not lend itself to an easy defense; the other poster's situation lends itself to a relatively 'easy' defense.

EC

ellencee said:

In this thread, I believe the OP has reason to file a complaint because of the nurse's performing a procedure with which she was not familiar and with a product with which she was not familiar. The nurse's actions approach violation of the Nurse Practice Act (GA) and I am reasonably sure that the nurse's actions are in violation of the facilities policies and procedures by not performing the treatment under the direct supervision of a professional experienced in the procedure.

I don't think either complaint regarding the use of the Rapid Rhino will support a medmal claim because the damages are not of a significant monetary value to pay for the litigation.

In this poster's claim, I believe the hospital will provide some compensation due to the nurse's performing a procedure without necessary experience or supervision.

I researched the Rapid Rhino and found that the manufacturer paints a rosy picture of it's benefits, ease of use, etc.; however, ENTs and other physicians rate the product below average. I've been an RN long enough to believe this product is a new 'toy' in the ER department and, more likely than not, an incentive to use the product is being provided (low or no cost for the product for the hospital).

In this poster's situation, I believe 'regular' nasal packing should have been used and if not therapeutic, then to progress to a tamponade device.

This poster's situation does not lend itself to an easy defense; the other poster's situation lends itself to a relatively 'easy' defense.

EC

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I agree, there is certainally reason to make a complaint re what the nurse did and to keep that from happening to others. Perhaps against the hospital for not providing appropriate safeguards to prevent this from happening. A lawsuit against the nurse may not be the best approach especially when her own doctor won't say the nurse is the cause. Too many questions that cannot be answered. Granted this is a more difficult defense and we only have some of OP's perceptions of the evidence and they are proceeding in pro se.

Yes there are complaints about the RR on the internet and in articles that is why, including two within one week which make me believe there may be some product liability since these devices are routinely approved by FDA without extensive testing. I also agree that traditional packing would have been a good start, but there is so much we don't know and would have been better to know up front that she was suing in por se after her attorney got frustrated and quit.

What ti Do???

I sincerely thank you for your words of encouragement!!! Your thoughts are right on target. Your said everything I was trying to get accross about the nurse. You know, I really did feel bad for the nurse, as she was visably upset and embarressed, when the Dr. scolded her and she left the room.
In this hospital, the nurses and doctors are contracted and are not hospital employees. Therefore, I'm not sure where I go from here, for any compensation. Can you actually take them to small claims court?

Again, thank you for all your help!
elm1949

elm1949
No; I don't think you can take them to small claims court as you have no debt that is owed. Small claims court would have to rule as to whether or not you are owed the money because of damages sustained in a medmal claim that has not been heard in court and does not have a verdict. In GA, I don't think small claims courts can do that.

Keep looking for an attorney. There is one out there who will represent you; you may have to look outside of Chatham County to find one. Maybe look further south for an attorney so you can find one with some clout--like maybe some of the hot-shots that moved in with the Navy around Kings Bay and St. Marys area.

Best wishes,
EC

elm1949
You haven't asked about attorney malpractice. Based on the events in your claim, I think you would have won if the attorney had performed his or her duty and performed as required.

You may want to check into attorney malpractice.

EC