The Somera Case

Jacob C. Reyes BSN 3-D Group 2

THE SOMERA CASE

Below are the case facts in condensed from which was published in 1930 from the International Nursing Review and it is read as follows: Sometime in May, 1928, one Pedro Clemente took his daughter, Anastacia Clemente, who was below fourteen years of age, to one Dr. Gregorio Favis of Manila for treatment. After examining her, the doctor decided that she should undergo a tonsillectomy, to which the father agreed. So she instructed the th

father and his daughter to go to the St. Pauls Hsospital on May 26 , where he would perform the operation at 7:00 oclock in the morning. Dr. Favis then called up Sister Mercedes of the St. Pauls hospital and requested her to have intended operation fixed on said date and hour. He also informed her that he would follow the same orders given in previous cases of tonsillectomy performed in the hospital. The Head Nurse in the operating room in the morning of May 26

th

was one Lorenza Somera.

Valentina Andaya and Consolacion Montinola were student nurses working in the operating room under Somera. Montinola was the sterilizing nurse and Dr. Armando Bartolome was the assistant surgeon. On the Day set for the operation, Dr. Favis arrived at the St. Pauls Hospital a little before 7:00 oclock in the morning. After scrubbing his hands and examining the patient, he asked for a ten percent Cocaine solution with Adrenaline and with it he swabbed the patients throat, and Miss Somera repeated and verified the order. The sterilized sterilized table was prepared, with solutions and other needed articles. articles. Dr. Favis asked his assistant, Dr. Bartolome, for the Novocaine/Procaine solution. Thereupon, Montinola handed to Dr. Bartolome a syringe filled with solution and in turn, Dr. Bartolome handed it to Dr. Favis, who then injected it to the patient. A few minutes later, Dr. Favis asked for more solution, which he injected again to the patient. After the second injection, Dr. Bartolome noticed that the patient became pale and acted as if she was dizzy, to which condition he called Dr. Favis attention. Dr. Favis said that the same was not unusual and he then asked for a third syringe of the solution, which he again injected to the patient. A few moments later, the patient showed symptoms of convulsion to which Dr. Bartolome again called Dr. Favis attention. Thereupon, Dr. Favis ordered adrenalin and then injected it to the patient. A second injection was administered and the patient again showed signs of convulsions. After a few moments, the patient died. Dr. Favis then asked if the Novocaine/Procaine was fresh. Somera replied that it was not Novocaine/Procaine but a 10 percent solution of cocaine. At the trial before the court of first instance of manila, Consolacion Montinola, when questioned by the prosecution on direct examination, affirmed that she did not know who prepared the drug; that she heard Dr. Favis ordered cocaine with adrenalin for injection; and that likewise, she heard Somera verified the order. When questioned by the defense, Montinola Again testified that she heard Somera verified the order was given and verified. Even on the part of the prosecution, the evidence had brought out the fact that Dr. Favis ordered 10 percent Cocaine Solution for injection and that Somera verified said order. The autopsy report and testimony of the Medico-legal Officer showed that the patient was suffering from status lymphaticus and that such patients were known to die even with so slight an injury as a needle-prick.

Jacob C. Reyes BSN 3-D Group 2

The decision on the case was rendered by the trial Court on May 7, 1929. in its decision, the court absolved Dr. Favis and Dr. Bartolome of the crime of which they were accused, but declared Somera guilty of the crime charged in the complaint and condemned her {a} to suffer imprisonment for one y ear and one day, {b} to indemnify the heirs of the deceased Anastacia Clemente in the sum of one thousand {1000} pesos, with subsidiary imprisonment in case of insolvency, {c} to suffer further the accessories provided in Article 61 of the Penal Code, and {d} top pay one-third of the costs, Somera then appealed to the supreme court. She was accused of homicide through reckless imprudence. In court, Ms. Montinola testified she heard Dr. Favis order cocaine with adrenalin for injection and heard Ms. Somera to have verified the order. Facts not brought in the trial were 1) that Ms. Somera. Had finished her training only on May 20, 1929; 2) that she had not received her registration certificate and was not an experienced graduate as states in the prosecution; 3) that Dr. Favis had performed tonsillectomy but once previously in St. Pauls and that no order from Dr. Favis was given before his arrival. The two accused doctors were absolved of the crime but Lorenza Somera was condemned to suffer one year and one day imprisonment and to indemnify the heirs of Anastacia C lemente the sum of P1, 000.00 with subsidiary imprisonment in case of insolvency and to pay one-third of costs. On December 20, 1929, the Supreme Court affirmed the aforesaid decision, stating as follows: Wherefore finding the decision of then lower court to be in accordance with the facts and the law, it is confirmed in all respect, with costs against the appealant. In view of the recommendation of two of the justices of the supreme Court who reviewed the case

upon

the appeal of the counsel of the defense, the unanimous recommendation of the Board of Pardons, and the petition of the Philippine Nurses Association for executive clemency, the Governor-General remitted the part of the sentence which called for prison confinement provided that Lolrenza Somera would not, in the future, violate any of the penal laws of the Philippines.

REACTION: In my ruling, both Nurse Somera and Dr. Favis are responsible Anastacia Clementes death. First in line, Dr. Favis flaw in this case was that he ordered the wrong medication. And as testified by student nurse Montinola, he aggravated his error by confirming his wrong order after being asked by Ms. Somera. Though Ms. Somera followed her nursing responsibilities by the book, she still lacked something. Obviously the order was questionable, and she did her role by confirming the order; which at the time was the right thing to do since they were n ot allowed to question orders then. But as someone who took up years to gain the title nurse, she had a lot of OR experiences, as well as theoretical inputs, in the past and surely, none of them involved cocaine used as a local anesthetic. She should have at least commented to Dr. Favis something like Ive never seen cocaine used as an anesthetic in the OR before. Is this a new addition doc? or This is a commonly abused drug

Jacob C. Reyes BSN 3-D Group 2

right doc? I should be careful. to gain the physicians attention and to wake him up from whatever he was so busy thinking about that he articulated the wrong medication name. Plus, she should not have carried the orders unless they where written in the chart. That way she could have her proof and defense. Of course, Dr. Favis cannot escape the blame, being the one who made the order. He should have written the order in the chart. Besides being the proper thing to do, that way he would have seen what he was writing. And if he had written cocaine then he could have changed it easily to procaine. I wasnt with them during the event so I dont know what was wrong with Dr. Favis or what he was so preoccupied with. But the thing is, when we, health professionals, talk, order, confirm information in the field, we must LISTEN and listen well. When we do something, we should focus on the job at hand and leave all worries and preoccupations behind. In terms of the court ruling, I dont think, I know that it was very unfair. In the first place, it was Dr. Favis who gave the order. If you were to stick to the rules and leave out the fact that the order was only verbal, the nurse had done her job of receiving the order and confirming it. Thus the main culprit is the surgeon. The court should have sentenced both persons, with more weight to the surgeon. Whats frustrating about this case is the fact that it was not mainly Ms. Someras fault, she had much lesser salary, she had just started her career, but she gets all the blame while the surgeon goes free unscathed. As several believe, bad things can produce good things. In Ms. Lorezas case, the whole nursing, as well as the medical profession, was benefitted. Because of the event, the eyes of nurses around the globe were opened. It became clear that the Victorian image of nurses as subservient to physicians needed to be changed. Instead, physicians and nurses should be treated as equals tending to the patients needs in different aspects- the physician being the one to diagnose, operate, decide appropriate medications and the nurse the one to give care and emotional support, ensure religious adherence to treatment regimen, prepare and give medications, and prepare and assist in operations. Because of the case, nurses were empowered; to have the right to question doubtful orders and even report physician misconduct or malpractice to the proper authorities. Several lessons can be made in this case. One, there should always be a written order. Two, focus on the job at hand and leave all preoccupations behind. Three, be knowledgeable about drugs, practices and procedures. Four, always clarify (and even challenge, if appropriate) a questionable order. Five, most importantly, nurses and physicians are equa ls.