This story portrays the real-life experience of an anonymous post-kidney transplant nurse, as shared with and compiled by Margarita David, DNP, BA, RN, PCCN.
It used to be that every day I looked forward to going to work to help patients with recent kidney transplants, preparing them for what would be the first days of their new healthy lives.
Now, going to work scares me to death.
First, a little background.
As a post-transplant nurse, I’m responsible for:
- Providing post-transplant care
- Monitoring labs and medications
- Preparing patients for follow-up appointments
- Arranging the discharge process with specialty medications for the patient
Although my team does about 4 to 5 kidney transplants a month, each post-transplant nurse has a caseload of over 60 post-transplant patients who require follow-up care throughout the year.
The days can get very long and overwhelming, as we’re also expected to:
- Assist with other patients who come for post-transplant appointments
- Attend a weekly team meeting to discuss new potential patients to place on the transplant list or to discuss those who are either admitted for transplant-related complications or have already been transplanted
- Provide patient call-backs at the end of the day to answer questions and call in medication refills
As has become common with healthcare systems, the hospital faced staffing issues, resulting in long shifts for staff, which can lead to mistakes.
I would know.
A mistake caused me to experience the devastation of being sued and to almost lose my nursing license as a result.
Here’s what happened.
After a long week of continuous patient visits, follow-up calls, and meetings, I had to prepare the discharge instructions for a new kidney transplant recipient. The patient, who received a kidney from his wife, was super excited to go home and start his new life.
On the Friday afternoon of discharge, I gathered all the information the patient needed, including:
- Discharge instructions
- Information on the specialty pharmacy responsible for providing the immunosuppressant medications
- A list of any potential complications that might occur in the coming weeks
- A schedule of follow-up appointments, as patients are seen frequently during the first year post-transplant
- A list of telephone numbers for reporting any issues
The discharge instructions also included a list of the patient’s post-transplant medications, which would prevent the patient from rejecting the new organ. These medications are titrated according to the patient’s medication blood and how they are feeling.
That is where the error occurred.
I wrote down the patient’s medications and dosages, not realizing I had recorded the wrong dose for his anti-rejection medication.
If the patient takes the wrong dose of the anti-rejection medication, the necessary level of the medication in the body is not reached, which can result in the risk of losing the new transplanted kidney.
Unfortunately, that was exactly what happened.
On the following Monday (three days after the patient was discharged), the patient’s wife called the office stating that her husband had a fever and was not feeling very well.
It was not a good sign.
Immunosuppressant medications shut down the immune system, which means that patients will not have the regular fever response as others who are sick. Therefore, if the patient had a fever, it meant that the immune system was not suppressed, which can be a sign of organ rejection.
We admitted the patient to the hospital, and lab work showed that the patient’s creatinine level was 1.9 (normal is 1.1). This indicated that the patient was experiencing kidney rejection, and as a result, the transplant team needed to act quickly to reverse it.
The patient spent 45 days in the hospital and received numerous treatments to help prevent the rejection. Although kidney rejection was ultimately prevented, the patient’s creatinine level ranged between 1.6 and 1.8, never returning to normal.
My mistake caused this patient’s “new life” to be delayed 45 days. That was 45 days he was not able to work and spend time with family. And he will never get those days back. What’s more, he’ll have to be monitored for many years to ensure his donated kidney works to its highest potential.
I didn’t realize the medication error until months after, when our director at the time called me into her office and informed me of what had happened.
In that precise moment, I realized my career could potentially be over.
She told me that I would probably be hearing from the legal department as the patient had requested an investigation on what had happened that caused him so much physical and mental pain.
A few days after our meeting, a legal representative from the hospital reached out to me and advised me to get legal representation. Frightened, I asked, “Am I getting sued?” The quick response: “We believe so.”
I was left with a feeling of doom and paranoia as a few weeks passed.
The day I had dreaded finally arrived as I was served with legal papers in the hospital parking lot after leaving work. I remember the embarrassment of others watching, but, at the same time, I felt relieved because I no longer had to wait for something to happen.
This is when I realized I didn’t have medical malpractice insurance through my employer, as only hospital employees were covered, and I was an independent contractor working for a nurse staffing agency.
I knew I’d never bought malpractice insurance myself, as I incorrectly believed that I didn’t need it since I was in an office setting most of the time, caring for patients before surgery and months after. I was not a bedside nurse. (Now I see that doesn’t make sense. All nurses should have malpractice coverage.)
Once I was able to calm down, which took a few days, I met with a lawyer. It took a few months to prepare for my deposition, which was taken over a three-day period.
The entire legal process took about a year, but after about four months I learned the full impact of my mistake on the patient. It was never my intention for this to happen, and although I can easily blame the nursing shortage or being overworked, I still should have double-checked everything. If I had, I would not have been sued for a staggering amount – $1.5 million.
Because I did not have medical malpractice insurance through my employer, I was on my own.
My employer did help me obtain legal representation, but this did not cover their expenses. I was glad, however, that I was able to keep my job, which I needed to afford mounting legal bills.
I had a lot of legal costs, but thankfully my lawyer was lenient with fees and allowed me to pay over time. I was hoping to settle the case out of court and avoid going to trial, which would be even more costly.
Finally, after nearly two years of back and forth between depositions, review of records, and meetings with the hospital’s legal team, some additional information changed my case just a bit.
Although I had made the medication error, the day after the patient was discharged, he had called the transplant surgeon’s answering service. He stated that he was not feeling well and needed the doctor to call back. He never received a call back.
If the doctor had called the patient, the patient’s medicine likely would have been adjusted. The doctor would have asked what medications and dosages the patient was taking; and the patient would have gone to the hospital sooner for treatment, which would have resulted in a shorter hospital stay.
This discovery shifted some of the potential responsibility for the patient’s condition to the physician and hospital. As a result, my potential liability decreased, as did the amount I ultimately had to pay.
In the end, we settled the lawsuit before trial, and I was responsible for 33% of the $1.5 million lawsuit, or $495,000. The doctor who stated he never received the page about the patient call was responsible for 33%, and the hospital paid the remaining amount.
I had to arrange a payment plan to cover my 33%, and eventually I took out a home equity loan to pay the remaining balance. I just wanted to be done with the whole situation.
Lessons Learned by This Nurse
I learned so many lessons from this incident, but the biggest ones are:
- If you need a mental health break, take it!
- Ask your employer the following questions regarding its malpractice insurance (because even if your hospital says it has malpractice insurance for employees, it might be beneficial to have your own supplemental policy to cover any gaps in your employer’s policy and give yourself more protection):
- Who is covered?
- What is covered, and to what extent is it covered?
- Is there a monetary limit to the coverage?
- As an independent contractor, you should always get your own malpractice insurance, even if you feel you mostly focus on paperwork.