In this case, the patient received instructions to have her wound rechecked in 36 hours. She also received instructions to “return if pain, redness, or warmth developed.” The patient experienced only numbness in her finger, not pain, redness, or warmth. The discharge instructions also told the patient to return if her condition worsened or if any new problems developed, language that included the patient’s new complaints of finger numbness.

Discharge instructions do create a duty for patients to follow the recommendations contained within the instructions. While not germane to the standard of care, the Standard of Care Review Panel believed that it was important to note that a patient’s failure to follow discharge instructions does not prevent a patient from filing a lawsuit against the provider. Instead, failure to follow discharge instructions is an example of “contributory negligence” or “comparative negligence,” which are affirmative defenses to a lawsuit. Once an affirmative defense such as contributory or comparative negligence is alleged, a jury must then determine whether the patient’s negligence contributed to the patient’s injury and, if so, what percentage of that injury was attributable to the patient’s own negligence. In many states, patients who cause more than 50% of their injuries are prevented from recovering any damages in a lawsuit.

Conclusions of the Panel

The standard of care does not require that wound dressings be reevaluated on an hourly basis for rebleeding.

There is no reliable and readily available method to determine the pressure inside of a tube gauze dressing. According to literature on the subject, it would be quite difficult to create pressure sufficient to induce finger ischemia inside of a standard tube gauze dressing. The standard of care, therefore, does not require that physicians check the pressure of such dressings after they have been placed.

Placement of dressings is one of many duties that physicians may delegate to other qualified health care providers. While physicians may choose to observe other health care providers during and after performance of these duties, failure to do so is not a breach of the standard of care.

Patient understanding of discharge instructions is an important aspect of follow-up care and good outcomes. When discharge instructions are clear and unambiguous, and when patients have not voiced any questions regarding the instructions, it is reasonable for health care providers to assume that patients have understood those discharge instructions as written.