Mr V, a 45-year-old teacher, went to see his GP surgery’s practice nurse because he had been bitten and scratched by a neighbour’s cat, 48 hours earlier. His left arm was ‘quite inflamed and puffy’ according to the notes of nurse P. She treated Mr V’s wound with Flamazine and an absorbent dressing.
Mr V, who lived alone, was unwell and off work for the following week. A colleague visited him and found him very unwell and delirious; she called an ambulance and Mr V was admitted to hospital. He was found to be suffering from meningitis due to Pasteurella multocida. Mr V was critically ill and managed on ITU.
He suffered a pericardial tamponade and myocardial impairment, taking many weeks to recover. He was left with disabling epilepsy and focal neurological deficits which prevented him from returning to work.
Mr V made a claim against nurse P and the practice that she worked for.
A nursing expert witness thought that because nurse P had noted that there were signs of inflammation in the arm, two days after an animal bite, her management was indefensible. The expert commented, ‘a competent nurse should have recognised this and taken immediate action, especially given the cause of the wound … she should have referred Mr V to the doctor with a view to him being prescribed antibiotics.’
It transpired that the friend who called on Mr V had done so earlier in the week and phoned the GP practice to express her concerns about him, suggesting he be visited at home. No GP had visited and general practice experts considered this contributed to the failure of duty of care to Mr V.
MPS contributed 25% to Mr V’s compensation, which was for a sum equivalent to £60,000 (US$105,000). Nurse P’s indemnifiers paid the remainder.
- Treating cat bites - NICE has produced evidence-based guidance on the management of animal and human bites, useful for practice nurses who manage this condition. See information for human and animal bites. A recent review paper from a predominantly nursing perspective may be of interest. See Bower MG, Evaluating and Managing Bite Wounds,Advances in Skin & Wound Care, 15(2):88-90 (2002).
- Nurse indemnity – In this case the nurse had her own indemnity in place, but if she hadn’t, things might have worked out differently. Nurses are professionally accountable for their own actions. However, when these actions are carried out as part of their nursing duties with the consent of their employer, the employer may also be held vicariously responsible for the nurse’s actions. You should make sure that nurses employed by your practice are properly indemnified.
- GP Practice Package – In the UK, the MPS GP Practice Package provides a simple way of giving peace of mind to your whole practice. When GP practices encounter medicolegal difficulties they often involve more than one member of the practice team. When you are all supported by one protection organisation these problems are resolved more quickly and efficiently. This greatly reduces the stress and inconvenience that invariably accompany such incidents. Phone 0845 456 7767 for more details.