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Broehm v. Rochester1/20/2005
and discovered a "9x1cm reddish-purple area" across Broehm's forehead. Triple antibiotic ointment and "Elastogel" were then applied to the area and the restraint was "redone to remove pressure from site."
In his deposition, Dr. Pairolero stated that he believed it was during his rounds on Monday, December 20, when he first became aware of Broehm's injury and inspected the restraint and wound. He later stated that he was disappointed at the development of the wound because such a wound was unexpected and had never occurred in the dozens of times he had previously used that kind of restraint. He contacted Mayo's plastic surgery department for further consultation and assistance in treating the wound. Dr. Phillip Arnold, a plastic surgeon , examined Broehm on Tuesday, December 21. Dr. Arnold observed what "look like a partial thickness defect." Dr. Arnold prescribed additional ointments and gels to be applied to the wound and noted it "should heal without much difficulty."
Other than the injury to her forehead, Broehm's tracheal resection surgery was successful. Broehm reported being able to breathe better than she had ever remembered. However, as the majority notes, the skin on her forehead did not heal properly and a scar developed across her forehead above her brow line. The record shows that this scar is clearly visible in a March 2001 photograph of Broehm.
In September 2000, Broehm, acting through her attorney, requested a certified copy of her Mayo medical records. Broehm commenced this action in Saint Louis County District Court by mailing a summons and complaint to Mayo and Mayo acknowledged service of the complaint on July 31, 2001. Broehm's mailing to Mayo included an affidavit from her attorney stating that he had reviewed Broehm's claim with a qualified expert and, in the opinion of the expert, Mayo deviated from an applicable standard of care and such deviation resulted in Broehm's injury . This affidavit is required by Minn. Stat. § 145.862, subd. 3 (2004). On August 14, 2001, at Mayo's request, the case was transferred to Olmsted County District Court.
In an interrogatory answer submitted on January 21, 2002, Broehm disclosed to Mayo the identity and opinion of an expert witness--registered nurse Linda Wick. See Minn. Stat. § 145.682, subd. 4(a) (2004) (permitting disclosure in the form of interrogatory answers in lieu of an affidavit). As required by section 145.682, subd. 4(a), Broehm's disclosure of Wick as an expert witness was signed by both her attorney and Wick. Wick's signature acknowledged that she certified the contents of the disclosure and adopted the testimony it summarized. See id.
Wick first summarized her credentials. She has baccalaureate and master's degrees in nursing and is a certified geriatric nurse practitioner. She has worked as a nurse since 1984 and, at the time of the disclosure, she worked at St. Mary's Duluth Clinic, principally in the nephrology department. Wick then summarized her opinion regarding Broehm's wound. Wick agreed with the "description and diagnosis" in Mayo's records that the probable cause of the wound "was a pressure necrosis." Pressure necrosis describes a condition where pressure sores occur in immobilized patients due to chronic pressure on tissues overlying bony prominences. Josef Feit, et al., Atlas of Dermatology, 2.3.9 Pressure Necrosis, available at http://atlases.muni.cz/atl_en/main+nenadory+scratch.html (October 2004). She noted that general hospital policy would require documentation of skin integrity at least once during each eight-hour nursing shift "whenever a dressing or equivalent foreign material has been applied to a patient's skin." She presumed this to also be the policy of Mayo
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