Norton Vs Argonaut Insurance Case Summary

The Plaintiffs of the case are Glynace H. Norton and his wife, Anne Graves Norton, The defendants of the case are the insurer of the Baton Rouge hospital: Argonaut Insurance Company, Mrs. Florence Evans R.N,,ADON (Registered Nurse/Assistant Director of Nursing services) whom had administered the fatal medication; and Aetna Casualty & Surety Company, that covered the liability insurance for Dr. John B. Stotler, who delivered the negligent order.
In the case of Norton vs Argonaut Insurance Company there are many factors which impacted the court’s ruling as to the parties who were responsible resultant wrongful death of the infant Robyn Bernice Norton. The nurses, doctors(independent contractors) and the the hospital though not formally charged

all played their parts that led to the events that transpired in a fatal medication error that terminated the life of the infant.
Two months following her birth, the Norton infant was diagnosed with a congenital heart disease by her pediatrician Dr. Charles N. Bombet. In response to her medical condition, Robyn was later placed on the medication Lanoxin. This medication is used to strengthen her heart and reduce the pulse rate to prepare her for a planned surgery. This case highlights the importance of egregious medication errors that can occur in a hospital setting.
Upon discovery of the baby’s heart problems, Dr.Bombet consulted with the specialists Dr. John B. Stotler, Cardiologist, and Dr. Charles Beskin who is a heart surgeon. All the physicians agreed upon the eventual need for heart surgery to correct her congenital malformation. Prior to the decision for surgery, Dr. Stotler needed further testing to make the final decision. Baby Norton was admitted to Baton Rouge General Hospital, December 15, 1959 for further evaluation and observation. When Dr. Stotler admitted Robyn upon admission, he wrote the orders for medication and treatment. The initial order was "Elixir Pediatric Lanoxin 2.5 cc (0.125 mg) q6h X 3 then once daily".
"Lanoxin" is a derivate of digitalis. It is a medication known for it’s potency and poisonous potential to overdose. It requires a need for caution and care with its administration. There are many different routes of administration for digitalis(lanoxin). There are three forms of “Lanoxin”. The elixir, given orally uses a calibrated medicine dropper. The second form is a pill that is also to be administered orally. The third form, injectable liquid form, in 2cc sealed ampules. The ampules are given with the use of a hypodermic needle into the muscle or vein. Dependant upon the route, the medication has differences in absorption time. The intravenous injection absorbs directly into the bloodstream. Another route of administration is by intramuscular injection. It is faster than the oral route, but not as rapid absorption as intravenous. The medical experts on the case testified that patients on digitalis should be "digitalized". This is a process in which a series medication doses given at timed intervals. The intervals are six hours apart to accustom a patient to the drug, and build a blood level. Once this desired reaction of the dose is achieved, then reduction to a single daily "maintenance” dose is then administered in oral form. Manufacturer advice is not to exceed .01 milligrams per pound of body weight every six hours. During this digitalization process, the third dose was not delivered by the nursing staff in timely manner. Having been there by her child’s side, Mrs. Norton then requested to be the one to deliver the medication to her child. Dr.Stotler consulted with the mother Mrs.Norton, and agreed she could deliver the maintenance dose of 2.5c.c. daily.
Soon after discharge from the hospital baby Norton had a cough, fever, and weight loss.

Dr.Bombet soon after readmitted her to the hospital. While in the hospital Dr. Stotler determined an increase the maintenance dose of Lanoxin would be adventitious to treatment. Mrs. Norton was told to increase the dose for that day only to 3 c.cs. He then ordered with the instructions only the following, "Give 3.0 cc lanoxin today for 1 dose only". Due to the ambiguity of the order and lack of knowledge by RN Florence Evans, Robyn was given an injection of Lanoxin intrader-muscularly, in both buttocks, which proved fatal. Nurse Evans Claimed to be lacking the knowledge of the oral form of Lanoxin other than through injection.

The defendants were Dr. Stotler along with Aetna, provider of professional liability insurance for Dr. Stotler, and the hospital along with Argonaut Insurance Co., the insurer of the hospital. The first court affirms the jury’s verdict and the defendants were found liable for the death of the infant.
The issues are: (1) whether Dr. Stotler wrote an ambiguous order that led to the administration of fatal dose of Lanoxin and (2) whether negligence occurred as a result of not following standard of care by the nurse who misinterpreted dosage administration directions of the medication leading to fatal

overdose.
There are quite a few legal principles surrounding this case of wrongful death. For example, negligence is a failure follow the accepted standard of care/behavior or a failure to adhere to to best practice. There are four elements to negligence: duty, the breach of duty, Injury, Causation. The outcome of the potential negligence needs to speak for itself(Res ipsa loquitur).
The Negligence of Dr.Stotler was a duty to provide detailed orders, the breach of duty was he failed to specify on the order the route for a dangerous medication. The injury is this lack of specificity led to a nurse delivering the medication intramuscularly leading to the death of the Norton infant. He was Negligent to document that the mother, Anne Graves Norton, was to administer the medication. This action might have lead to double dosing the Norton infant.
The Negligence of Mrs.Florence Evans was she failed to follow the standard of care when in question of a doctors order which a prudent RN person would contact the ordering physician. There was a duty to follow common sense dictated that the dose was too high for an infant in her “gut”. If she knew there was a problem with the order she should have called. She ignored common sense which led to the breach that inturn fatally injured the Norton infant. Florence RN also had a duty to be knowledgeable as to current practices, even though a nurse is not as knowledgeable as a physician. She needed to follow the five rights of medication. The five rights of medication are pertinent here in this case: right medication, right dose, right time, right route, right patient.
The Negligence of these parties combined led to the lethal injury of the Norton child, Robyn Bernice Norton, and there represented insurers who are then at fault.

The hospital under vicarious liability is based on Respondeat Superior (let the master answer) for the negligence actions of its contractors/employees. This is the responsibility of physicians for negligent actions of hospital employees ranging from nurses to x-ray techs. Through Corporate Liability the hospital itself is liable for the negligent actions of its workers.
Outcome
The court ruled in favor of the Norton family, in the amount of 10,807$ for the mother, and 13,000$ for the father in wrongful death of the daughter, baby Robyn Bernice Norton. The court ruled against the nurse, physician and hospital all of whom were found liable for the death of the infant. The awards to the family was later reduced to $5,807 and $5,000. The reason being that the Norton family already had three children and Robyn was only with them for three months so the attachment was low. This being said the courts found the Nortons were more than capable of have more children in the

future.

In this day and age pharmacies have taken the lead for medication conversion through the use of prepackaged single dose single route medications. The doses are precalculated to avoid medical errors. Systems such as PIXAS have been instituted using barcodes to monitor and control medications. Before prescribing medication medical professionals check your records to make sure that a prescription is right for patient depending on age, gender, allergies, their weight and presesitistn medical conditions.Pharmacy and health insurance company’s computer systems checks automatically to reduce medical errors. In the identification purpose in hospitals ID bracelets are used to ensure the right patient gets the right drug. Clinical decision support exists now to prevent mistakes such as the wrong medication or type. Not that this is a direct result of this cause but now warnings are placed on drug bottle labels. This case highlighted the need for better training of the medical staff in communication and knowledge of medications.