Malpractice

Brief Overview

Downes v. Eileen Carpenter CRNP

In Downes v. Eileen Carpenter CRNP et al, nurse practitioner misdiagnosed cancerous breast lump as a benign fibrocystic lump that led to a lawsuit. Kerri Downes sought care at Axia Women’s Health after discovering a lump in her right breast while showering. After a comprehensive breast exam, NP (Eileen Carpenter) diagnosed the lump as fibrocystic breast changes and scheduled an appointment with the patient for follow-up breast exam. The NP performed another breast exam during the follow up appointment and confirmed fibrocystic changes (CPH Insurance, 2023). 8 months later the patient returned to the hospital with complaint of intermittent burning and itching in the right breast. The OB/GYN physician noted a lump in the right breast and that Downe’s right breast visibly larger than the left, and ordered a breast ultrasound. An ultrasound resulted in a diagnosis of stage II breast cancer and the physician referred Downes to a surgeon who performed a bilateral mastectomy with axillary node dissection and reconstruction. Downe sued the NP, her employer and the OB/GYN for improperly treating her for a lump on her right breast. The court awarded her $18 million (CPH Insurance, 2023).

Present Elements of Malpractice

All the four elements of malpractice are present in this case: duty, breach, causation, and damages. Regarding breach, the NP failed to meet the standard of care when treating Downe. The NP made incorrect diagnosis, misdiagnosing cancerous breast lump as fibrocystic breast changes. Additionally, the NP failed to perform ultrasound and mammogram, which are necessarily to confirm the diagnosis (Buppert, 2020). In regard to duty, the NP failed to adhere to a standard of reasonable care, which includes diagnosing Downe’s condition. The breach of duty harmed the patient in form of late diagnosis (Buppert, 2020). The failure to order necessary tests caused an injury to Downe. Downe sustained emotional and physical damages due to wrong diagnosis. This caused suffering and pain and diminished quality of life.  

Unmet Standards of Care

The NP deviated from the standard of care in several areas. The NP failed to recognize and diagnose the patient’s breast cancer, leading to delayed diagnosis. The delayed diagnosis denied Downe of a better chance for cure by deriving her of a chance to have lumpectomy rather than a bilateral mastectomy (CPH Insurance, 2023). The failure to meet the standard of care caused significant suffering and pain and prolonged treatment. The nurse was negligent also for delaying treatment for 9 months. Thus the NP is in breach of her duty of care by failing to adhere to the standard of care. The NP had failed to use the same degree of care and skill that a competent NP with the same qualification would use in the same situation. The NP also did not conduct medical evaluations such as performing necessary diagnostic tests (Azizian et al, 2021). Additionally, the NP caused harm by making wrong diagnosis that aggravated the patient’s condition (CPH Insurance, 2023).

Risk Management Strategies to Prevent Future Risks

Based on the current case, several risk management strategies should be applied to prevent such future risks. The nurse should have adhered to the protocol of accepted standard of care. First the NP could have ordered necessary diagnostic tests and analyzed the results to confirm the diagnosis during the follow-up appointment (Raveesh, Nayak, & Kumbar, 2016). The nurse could have documented the findings of the initial breast exam including breast diagram and pain scale. The NP did not give proper follow up instructions or patient education. In addition, the NP could have paid attention to client’s symptoms and concerns and change diagnostic test preferences. This includes putting oneself in the patient’s shoes. More importantly, one should pursue continuing education and maintaining competencies consistent with the needs of assigned patient and clinical setting.   

Lessons Learnt from the Case

The NP should not rely on applicable recommendations and guidelines when making clinical decision in totality while disregarding clinical judgment and critical concerning. Carpenter relied on guidelines developed by the American College of OB/GYN for breast imaging for females under 30 years of age for any nurse concentration.

The case also highlights the importance of documentation of any patient care including diagnosis, treatment, and follow-up (Azizian et al, 2021).

References

CPH Insurance. (2023). Nurse practitioner misdiagnoses cancerous breast lump as a benign fibrocystic lump. Retrieved on October 16, 2024 from https://cphins.com/np-misdiagnoses-cancerous-breast-lump-as-benign/

Azizian, J., Dalai, C., Adams, M. A., & Tabibian, J. H. (2021). Medical professional liability risk and mitigation: an overview for early-career gastroenterologists. New Gastroenterology,

Buppert, C. (2020). Nurse Practitioner’s Business Practice and Legal Guide. United States: Jones & Bartlett Learning.

Raveesh, B.N., Nayak, R.B., Kumbar, S.F. (2016). Preventing medico-legal issues in clinical practice. Ann Indian Academic Neurology, 19(Suppl 1):S15-S20. doi: 10.4103/0972-2327.