The wife contacted hospital administration as the patient's physician did not give her a satisfactory answer to her questions. The critical care nurse director was contacted and spoke with the patient's nurse. The nurse director contacted the risk manager for assistance, and the hospital defense attorney was contacted.
Christine assisted the defense attorney with the following: analysis of medical records and the nurse's statements, authoritative research, hospital policies and procedures, and standards of care. Christine educated the attorney regarding the procedure of carotid sinus massage, the indications for the procedure, its benefits and risks. Christine's investigation report to the attorney included an opinion that the nurse was negligent by performing carotid sinus massage, a procedure to be done only by a physician and with prior informed consent, as the procedure has the risk of stroke and is contraindicated in a person with a recent myocardial infarction. Not only did the nurse violate the standard of care by performing a procedure to be done by a physician, she implemented the procedure incorrectly. Christine's investigation revealed that the nurse did carotid sinus massage by pressing on both sides of the neck at the same time; when done correctly, the massage is done only on one side of the neck. The nurse's negligent conduct, deviation from acceptable standards of care, more than likely caused a poor patient outcome with long term deficits. The evidence for causation was strong.

Outcome: The nurse resigned after she was disciplined for failure to follow hospital policies and procedures and acceptable standards of care, and for initially giving false statements to the hospital attorney. Christine's legal nurse consulting expertise assisted the hospital defense attorney to settle the case promptly for an undisclosed amount.