Can you be sued if you didn't provide direct care to the patient? Nowadays, just being the nurse in charge can make you liable. Increasingly, medical malpractice lawsuits are reaching out to name not only all who provided care to a patient, but also name those who had the power and authority to make decisions regarding that patient's care.

Such was the case of a woman admitted to the hospital for the birth of her son. Her primary nurse recognized ominous signs of fetal distress. Despite the nurses' calls, the obstetrician refused to do a cesarean section. The primary nurse repeatedly asked her charge nurse to call the chief of obstetrics to go over the head of the obstetrician. The charge nurse refused.

The baby was born later that day with cerebral palsy and spastic quadriplegia. In addition to the obstetrician, the charge nurse was found negligent for refusing to contact the chief of obstetrics. The baby's family made a claim of $8 million for future medical expenses and $3 million for future lost earnings.1

This is one example of a growing trend to hold nurses with authority legally responsible for safe care. In cases of healthcare malpractice, error investigation now involves scrutinizing to see if the proper chain of command was followed. In addition, consumers and lawyers want to know if those in charge or in managerial roles have followed proper policies and procedures, delegated tasks appropriately, and ensured that there are adequate numbers of qualified staff on each shift to care for the patients.

Healthcare quality improvement and risk management efforts today must take a systems approach that looks beyond direct patient care. Errors rarely happen in isolation. All too frequently, numerous steps along the way provide opportunities for someone to prevent an error. In this tragic example, we have to question what would've been the harm in calling the chief of obstetrics. What's the worse that could've happened? The chief might get upset. If the steps in the process of alerting healthcare providers had been carried out by each member of the team, errors like this one may be prevented.

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