Purpose: The purpose of this paper is to foster your synthesis of course content relevant to medical liability concepts. You should complete the learning materials before completing the case because important background information is included in these resources.
About the Patient
Name: Rafael
Age: 31
Gender: Male
Other details: Family history of cancer
Visits
1October 2001
Rafael was seen by the nurse practitioner with complaints of abdominal burning
and cramping, abdominal pain and inability to eat for a few weeks, but incidentally
resolved as of the appointment. The nurse practitioner prescribed Zantac and set up
a complete physician exam for the next month.
2November 2001
During this visit the patient gave a history of chewing tobacco and heavy coffee
intake, occasional abdominal pain and increased in stool frequency. Rafael also
indicated a family history that his mother was diagnosed with colon cancer at the
age of 54. The nurse practitioner changed the medication regimen from Zantac to
Protonix and ordered an upper GI series with contrast to rule out gastritis or an
ulcer. The negative test results were provided to the primary care physician, who
never saw the patient or reviewed the patients chart.
3December 2001
The patient was seen by the nurse practitioner a month later, when he reported that
his symptoms were improved on Protonix, but he continued to have problems with
eating. The nurse practitioner continued with a diagnosis of gastritis and gave
instructions to call with any concerns and scheduled a follow-up visit in six months.
4April 2002
Rafael returned and reported worsening stomach cramps and burning to the nurse
practitioner. The nurse practitioner then changed the medication to Prevacid,
continued with a diagnosis of gastritis and arranged for an appointment with a
gastroenterologist for a possible esophagogastroduodenscopy in July.
5May 2002
Rafael returned for an appointment with the MD, complaining of increasing pain and
loose stools. The appointment for a GI consult was moved up after a discussion with
the physician, but Rafael went to an emergency room before the scheduled visit. A
work-up at the hospital, which included an abdominal CT scan and colonoscopy,
resulted in a diagnosis of near obstruction of the right side of the colon by a Stage IV
tumor and metastasis to the peritoneum and lymph nodes.
Treatments
Immediate surgery was performed, followed by chemotherapy, and more. Rafael
died about two years later, in December 2004.
Review the Case
Please review the listed questions.
1. Identify the defendants and the areas of negligence in this case.
2. Given the patient’s symptoms listed above, provide a comprehensive differential
diagnoses list (ONLY a list).
3. Reflect on this case and what you would have done differently as an advanced
practice registered nurse.
4. Review the risks that NPs face associated with practice identified in Buppert (2021)
p. 299 and identify which of these apply to the case. What strategies might have
reduced the risk of the outcome presented in this case? Refer to Buppert (2021)
Chapter 8: Risk Management.
5. What do you think the verdict was and why?
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