Respiratory therapists: Scope of practice and medical malpractice
Respiratory therapists are an important part of the healthcare team for patients with breathing problems
I am currently working on a wrongful death medical malpractice case involving the death of a patient who had breathing issues after a minor surgery for hemodialysis access placement at Cypress Fairbanks Medical Center.
Cypress Fairbanks Medical Center is located at 10655 Steepletop Dr., Houston, Texas 77065. It is part of the HCA mega-chain of hospitals, based in Tennessee. Cypress Fairbanks Medical Center has a total of 181 licensed beds, including 22 intensive care unit (ICU) beds.
This patient went into the operating room with the full use of her arms and legs. After surgery, she was quadriparetic, meaning that she had weakness in all four limbs. There is nothing in the medical records from the hospital to suggest what caused her quadriparesis. This new neurological injury also caused her to experience severe breathing problems after surgery, which ultimately led to her death.
Shortly after the surgery, she was admitted to the hospital’s ICU, where she was followed by two critical care physicians.
As part of our investigation of this case, we hired a board certified critical care physician expert to review the medical records and provide us with opinions of what happened.
The expert was critical of the fact that the critical care doctors involved with this patient’s care in the ICU undertook inadequate efforts to investigate her breathing problem and why she was unconscious.
According to the expert, one of the first things that the intensivist physicians should have done upon admission to the ICU is order a blood gas test, which would have likely shown that the patient was hypercarbia. Hypercarbia means that the patient has abnormally elevated carbon dioxide levels in the blood. Her hypercarbia, in turn, was caused by hypoventilation, which means that the patient had insufficient breathing and air exchange.
When a patient is unconscious and having difficulty breathing, it requires prompt medical intervention. The expert pointed out that the critical care physicians taking care of this patient at Cypress Fairbanks Medical Center did not order a blood gas test until around 50 hours after the patient was admitted to the ICU. If it had been done earlier, it should have led to intubation, or insertion of a breathing tube down the patient’s throat, to secure her airway.
Throughout the patient’s stay in the ICU, her respiratory status continued to go downhill, until she eventually went into respiratory arrest. Only after that point did the physician team intubate her, but by then it was too late.
One of the issues that we are looking into in this case is the role of the hospital’s respiratory therapist staff. We believe that the respiratory therapists should have been communicating with the physicians about her deteriorating status and advocating for appropriate medical treatment.
What are respiratory therapists?
Respiratory therapists are non-physician healthcare providers who take care of hospitalized patients who have trouble breathing.
According to the American Association for Respiratory Care, based in Irving, Texas, respiratory therapists have a scope of practice including patient assessment, disease management, diagnostic evaluation, management, education, and rehabilitation and care of patients with deficiencies and abnormalities of the cardiopulmonary system.
The diagnostic activities and responsibilities for respiratory therapist include obtaining and analyzing physiological specimens; interpreting physiological data; performing tests and studies of the cardiopulmonary system; performing neurophysiological studies; and performing sleep disorder studies.
The therapy provided by respiratory therapists includes application and monitoring of medical gases and environmental control systems; mechanical ventilator management; insertion and care of artificial airway; bronchopulmonary hygiene; administration of pharmacological agents; cardiopulmonary rehabilitation; hemodynamic cardiovascular support; and sleep support.
In my experience as a Houston, Texas medical malpractice attorney, both respiratory therapists and registered nurses have an important role in monitoring patient status and communicating findings to physicians, including advocating for appropriate orders and medical intervention. When these health professionals fail in this role, their negligence can contribute to adverse patient outcomes, including death.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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