Legal Nurse Consultant Opines on Patient’s Damaged Voice Box From Endotracheal Tube

This case involves a patient who was admitted to the hospital ICU after an unintentional drug overdose. The patient had shallow breathing. The emergency room physician inserted an endotracheal tube to aid the patient’s breathing because she was comatose and unable to breathe. Five days later the patient’s doctor told a nurse to remove the tube. The nurse told the doctor she was unable to remove the tube and he removed it himself. The patient later had trouble breathing the doctor ordered a tracheostomy. When the patient’s condition improved, she was discharged from the hospital. The patient began experiencing difficulty breathing and she had to undergo another tracheostomy. This caused her to have difficulty speaking and she later was only able to speak in a whisper and she breathed partially through her nose and partially through a hole in her throat created by the tracheostomy. The patient sued the hospital for negligence.

Question(s) For Expert Witness

1. Does a nurse meet the proper standard of care if she fails to remove an endotracheal tube and this causes injury to a patient’s voice box and throat?

Expert Witness Response

A nurse at a hospital has a duty to exercise reasonable care in administering services to patients in the hospital. If the nurse knows that an attending physician is treating a patient in a manner which is a substantial departure from accepted medical standards and this may endanger the health of the patient, then the nurse has a duty to perform all acts that are within their authority to protect the health and life of the patient. Since nurses who work in the ICU of a hospital are specially trained to handle patients who have endotracheal tubes inserted, they usually know that endotracheal tubes should not be left in a patient longer than three or four days. For the nurse to meet the proper standard of care in this case, she would have had to take steps to remove the endotracheal tube because it had been left in the patient’s throat longer than the customary three to four day period. The nurse in this case would have had to inform the doctor that the tube was being left in longer than usual in order to meet the proper standard of nursing care in this case.