Severe Infection Due to Delayed Follow-up Treatment in Correctional Facility

Case Overview

This case study involves an incarcerated adult who underwent a decompressive laminectomy. A lumbar drain was placed by the surgeon during the procedure, with explicit instructions for a follow-up visit within 3-4 days to remove the drain. However, nearly three weeks later, no follow-up had been conducted or scheduled.

The patient subsequently developed a severe MSSA infection, necessitating emergency hospitalization for approximately six weeks. This case seeks expert insight from a family nurse practitioner specializing in correctional medicine to review medical records and opine on the standard of care.

Questions to the Nursing expert and their responses

How frequently do you evaluate and manage postoperative patients in a correctional facility setting?

As a board-certified family nurse practitioner, I regularly evaluate post-operative patients several times a month within the correctional setting. Many of these patients have undergone some form of spinal surgery.

What are the pertinent protocols that should be followed if a postoperative patient requires surgical drain removal?

The protocols for managing post-operative patients, particularly those requiring surgical drain removal, are primarily based on the surgeon's recommendations. These include dressing management, follow-up schedules, and overall post-op care.

Additionally, there are specific correctional protocols that need adherence concerning follow-up timeframes, drain management, and post-op care. For instance, if a patient has a drain, they should be placed in a medically supervised cell with round-the-clock nursing care due to the high risk of infection. Nurses would monitor the drain multiple times daily and document output until its removal.

Have you reviewed cases similar to this one? If so, could you briefly describe your experience?

I have previously reviewed a correctional case where the attorney needed to determine if the standard of care was met for their client who lost a limb while under the care of a nurse practitioner. In that case, I reviewed over 3000 pages of medical records and provided an executive summary. I am prepared to apply similar diligence to this current case.

About the expert

This expert is a highly qualified family nurse practitioner with an extensive background in nursing, holding degrees from California State University, Chamberlain College of Nursing, and Grand Canyon University. They have served in various clinical roles, including labor and delivery departments and high-risk obstetrics case management, and have held teaching positions at West Coast University and a university in Kentucky. Currently, they direct a primary care residency program for a corrections department in California, making them particularly suited to provide insight into this case involving postoperative care within a correctional facility setting.