Mr J, a 27 year old man, was admitted to hospital on a Saturday afternoon via the emergency

Mr J, a 27 year old man, was admitted to hospital on a Saturday afternoon via the emergency
department of a small rural hospital with a diagnosis of acute appendicitis. He underwent an
emergency appendectomy. Post-operatively he became unwell with an elevated temperature and
heart and respiratory rate. He was complaining of severe abdominal pain. The nurses contacted the
medical officer who reviewed Mr J, and ordered an abdominal x-ray, urine for micro and culture,
urea and electrolytes, FBE, and C reactive protein. The medical officer also ordered further pain
relief for the patient.
The x-ray was normal but the blood results were delayed due to technical issues. The blood results
were returned to the ward in the early evening after the medical officer had left the hospital. The
results showed a significantly elevated white cell count, and C reactive protein level. The nurse on
duty in the evening wasn’t sure about the results so she filed the pathology results in the patient’s
history and did not attempt to contact the medical officer. The results were not reported to any of
the other nurses. Brief verbal handovers were given to the other RN’s who came on duty over the
weekend, because on the weekends it is normal practice for the nurses like to go home early. None
of the RN’s reviewed the patient’s notes or noticed the pathology results. The medical officer did
not contact the hospital to ascertain the results until the Monday morning. The patient was given
further doses of narcotic analgesia at regular intervals over the next day to control the pain.
On the Monday morning the patient’s condition was assessed and the blood results reviewed. On
review of the patient’s notes the nurse’s reports were limited in detail, the trend of the vital signs
indicated a gradual reduction in his blood pressure and increase in his heart rate, and his urine
output had not been recorded. The patient was immediately commenced on IV antibiotics, and
subsequently returned to theatre for an exploratory laparotomy, at which time it was identified a
leak of faecal fluid had given rise to peritonitis.
He died a few days later as a result of multiple organ dysfunction and profound septicaemia. How
would you have practiced differently if you were looking after Mr J?
Discuss this case with reference to the following:
• Identify any legal implications associated with Mr J’s treatment.
• In this situation was there any negligence, if so by whom and why.
• Are there any ethical issues associated with the care of this patient?