Legal Review and Community-Subdural hematoma causes death: $1 million
News: A Florida nursing home reached a $1 million settlement with the family of a resident who died after sustaining a subdural hematoma in a fall. The resident did not receive medical attention until four hours after the incident.
Background: The woman was admitted to the nursing home after surgery for peptic ulcers. The goal was to keep her for seven to 14 days of rehabilitation, after which she would return home to live with her daughter. On March 4, 1996, 2½ months after her admission, the resident fell, sustaining a subdural hematoma to the right occipital portion of her skull. Her neurologic condition deteriorated, and she exhibited slurred speech, elevated blood pressure, and sluggish pupils.
The plaintiff alleged that the resident did not receive any medical or emergency care for more than four hours. The charge nurse testified that the resident's attending physician was called at home but would not authorize her transfer to the emergency room until he saw her. Other nurses testified that her condition did not warrant the transfer. However, two certified nursing assistants (CNAs) who had observed the resident two hours after she fell told the charge nurse that the resident was unresponsive, her vital signs were grossly abnormal, and she had vomited. The charge nurse went to check on the resident, who was unresponsive and had fixed or dilated pupils as well as abnormal vital signs. The charge nurse allegedly started shaking the patient, telling her to "wake up" and "stop faking it."
Florida home violated resident's rights
The patient's attending physician arrived and ordered the resident transferred to the emergency room. She died the next day as a result of the injury sustained in the fall. Her family filed suit, alleging wrongful death and violation of her resident's rights under Florida law. The plaintiff claimed that the resident received substandard care, causing her mental and physical condition to deteriorate significantly.
The complaint alleged that despite the resident's request for assistance to go to the bathroom, she was told to urinate and defecate in her bed and wheelchair and would be cleaned later; that she suffered a 19% weight loss because the home failed to provide her with appropriate nutrition; that the home failed to obtain an order for antidepressant drugs despite knowing of the resident's admitting condition of depression and anxiety; that the resident developed a urinary tract infection because the staff failed to properly clean her Foley catheter, and that she developed a stage II pressure ulcer on her coccyx.
What it means to you: The first red flag in this case is the fact that this patient was still in the nursing facility 2½ months after she was admitted for what was planned as two weeks of rehabilitation, says Betty Svoysky, JD, director of risk management for Medical Mutual Liability Insurance Society of Maryland in Cockeysville. "Why was she still there? The answer might be found in the daughter's allegations that her mother was not given adequate nutrition and not properly cared for as far as her personal needs were concerned."
Svoysky says the patient's urinary tract infection and pressure ulcer probably were left to fester because of the lack of any kind of treatment or rehabilitation plan. If the woman was elderly, those conditions put an added strain on her recovery and possibly increased her depression and anxiety, for which she received no apparent medical attention, she adds. Svoysky attributes the patient's fall to a combination of factors, including the allegedly poor nutrition and the failure to maintain her on her antidepressant medications, which probably made her weak and unsteady.
Also, there appeared to be no orders for her to be restrained, monitored, or accompanied to the bathroom. "If the daughter's allegations are true, the staff at the facility probably spent more time cleaning her up than assisting her in either getting to the bathroom or to rehabilitation," Svoysky says.
Where was the on-call physician?
The staff's reaction to the fall was inappropriate, Svoysky says. "Apparently the nursing staff believed the patient was all right, while the CNAs reported a significant change in her vitals and mentation. I sincerely hope the vast differences in opinion were not based on turf battles but merely represented folks looking at her at different time frames. However, I find it hard to believe that a patient can 'fake' abnormal vital signs and fixed or dilated pupils. What about a coma score?" she points out.
That the patient's physician refused to have her transferred to the emergency department because he wanted to examine her first also is a red flag, she says. "Didn't the facility have a doctor on call for just such an emergency? Also, where patient welfare is concerned, can't a charge nurse or nurse administrator, who is on the premises, overrule a physician who is off-site?"
Finally, Svoysky says the $1 million dollar settlement the facility paid should serve as a warning to other nursing and extended-care facilities that this kind of patient abuse and neglect will not be tolerated.
Reference
Anonymous settlement, Pasco County (FL) Circuit Court.
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