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Legal Review and Commentary
Newborn baby is burned in scalding water at hospital
News: A nurse at a hospital severely burned a newborn baby while giving her a bath. The parties reached a settlement shortly after the suit was filed, including periodic payments to a trust fund for the girl for 12 years.
Background: A 19-year-old woman gave birth to a healthy baby girl. Twelve hours after the delivery, the new mother was holding her baby. She handed the girl to a nurse for a bath, but the nurse placed the baby in water that was so hot that it caused first- and second-degree burns to the baby's back, buttocks, and toes.
The woman filed suit against the hospital and alleged negligence. Two days after the lawsuit was filed, the parties settled for $130,000, plus $62,000 in attorneys' fees, $1,400 in settlement expenses, and nearly $1,000 per month to be paid to a trust fund for the girl every year from her 18th birthday and continuing until age 30.
What this means to you: As sad as this scenario is, it is not as uncommon as one might think. In a 2006 case reported from England, for example, a 3-day-old baby had his foot burned after a nurse held it in scalding water for three minutes. The nurse, who was trying to soften the child's foot for a blood test, had failed to check the temperature of the water before immersing the boy's foot in the water. The nurse apparently did not realize that the baby was being burned because he was wearing gloves. The baby's foot was red, and the skin was peeling off. What made matters worse in that case was that the nurse apparently didn't even treat the horrific burn after realizing his mistake, instead proceeding with the blood test by switching to the other foot. The boy, whose wound was not dressed for two hours, luckily avoided any permanent scarring or other damage.
The case we are examining raises a couple of issues important for risk managers, the first of which is whether it was a nurse, a nursing assistant, or a medical assistant who bathed the infant. "Often we make references to nurse, when in fact it was an aide or medical assistant," says Leilani Kicklighter, RN, ARM, MBA, CPRHM, LHRM, consultant/principal with The Kicklighter Group, Tamarac, FL, and past president of the American Society of Healthcare Risk Management. "The reason this is important is that there is a different standard of practice and expectations from each." A nurse, of course, is a licensed professional who has graduated from an accredited school of nursing, passed his or her state's board, and maintains his or her licensure through continuing education. A nurse's aide, however, does not have such stringent requirements. It used to be that nurse's aides required no special certification and that they would be trained on the job, although some states now give nurse's aides the option to become certified nursing assistant (CNA) by going through training and passing a CNA exam. Medical assistants also are usually not as highly trained as nurses. Depending on the state, they typically work as physicians' agents but are unlicensed. Because a medical assistant works under a physician, the physician would retain full liability and responsibility for the medical assistant's acts. Although some states do not license medical assistants, they can take the certification examination offered by the American Association of Medical Assistants to become a certified medical assistant or seek credentialing by American Medical Technologists to become a registered medical assistant.
Kicklighter would advise the risk management department of this facility to conduct a root cause analysis to assist in determining how this event happened and to prevent a recurrence. As part of this process, policies and procedures should be reviewed against actual practice related to bathing newborns, and it should be modified as needed. "Often times we assume that what we have written in the procedures is how things are actually being done," says Kicklighter. "Observing how processes are actually being done may reflect 'work-arounds' or error-prone deviations. On other hand, observation may reflect that the actual written procedure is error-prone, necessitating written procedure practice modifications."
Finally, Kicklighter notes that as part of the life safety code standards, hospitals have master mechanisms to monitor and control the temperature of water in the facility to prevent such a situation. She recommends that the organization's plant operations document periodic monitoring of the water temperature and that this information, along with other routine monitoring, should be reported to the Safety Committee on at least a quarterly basis. The bottom line, notes Kicklighter, is that this was a preventable event.
Because a baby's skin is so sensitive, it is important that any burns be treated immediately. Professionals recommend quickly cooling a mildly burned area by submerging it in cool water or applying cool compresses for 10-15 minutes, followed by drying the area with a clean towel and covering it with a sterile bandage. Burns that start to blister can be treated with an antiseptic ointment and covered loosely with a clean, nonstick bandage. In the health care setting, the physician should be contacted immediately and orders implemented. A prompt visit by the physician or a consultant ordered by the attending would be most prudent.
The only good news from this scenario is that the baby's first- and second-degree burns were not any worse. In a first-degree burn, the mildest kind of burn, only the outer layer of skin has been damaged, which results in redness and sometimes slight swelling. A second-degree burn is one in which the second layer of skin has been damaged, which results in blistering, swelling, and varying degrees of pain. A third-degree burn, which is the most serious, results in damaged skin well below the surface, and it may be characterized by skin that appears white or charred. Third-degree burns often are not painful because the nerves have been damaged. A first-degree burn may heal in a few days, but a second-degree burn can take a couple of weeks. If the burn damage in this case had been more severe, the settlement amount likely would have been even higher.