Skilled Nursing: Court Examines Allegations of Negligence Leading to Death of Patient
Legal Eagle Eye Newsletter for the Nursing Profession
June 1999
Quick Summary: The patient entered the facility for rehabilitation of a fractured femur. She was to receive physical and occupational therapy as well as nursing and personal-care services.
She was continent of bowel and bladder and her skin was free of pressure sores. Nevertheless, on the first day she was catheterized for urinary incontinence without assessment of her ability to use the bathroom with assistance.
Then she was mishandled, that is, a two-person assist was not used to transfer her to her wheelchair. She sustained a new spiral fracture of the same femur.
She kept complaining of pain in the leg and was given large doses of morphine, which did not diminish the pain and which caused decreased mental functioning, lethargy, incoherent speech, delirium and hallucinations.
She also developed pressure sores, electrolyte imbalance, urinary tract and upper respiratory infections and lost weight due to a general lack of attention to her needs.
After she died, the family had grounds to sue.
APPELLATE COURT OF ILLINOIS, 1999.The Appellate Court of Illinois recently reviewed the multiple-count civil lawsuit filed against a county-operated skilled nursing facility.
A nurse, the agency for which she worked, several doctors and their professional corporation were named as co-defendants along with the county itself.
The court said in so many words the care of this patient was so negligent it caused her greater harm than the injury with which she came into the convalescent facility in the first place.
She became incontinent as a result of being catheterized when her own needs did not require her to be catheterized. She was injured in transport. She developed pressure sores and infectious processes and lost weight.
She also developed hallucinations and delirium as a direct result of over-medication with narcotics for complaints of pain that should have been heeded and attended to, the court believed.
The court ruled all of the following were valid allegations of negligence in the family’s wrongful death lawsuit:
The defendants carelessly and negligently failed to implement necessary precautions in transporting, bathing and providing personal care to the deceased. Despite being aware that the deceased had decreased cognition with clear deficits in self-care skills, mobility and safety, she did not receive appropriate assistance such as two person assist for care and transfers.
The defendants carelessly and negligently failed to assess, evaluate and manage significant changes in the deceased’s mental condition, such as changes in level of consciousness, delirium, hallucinations and changes in respiratory function as potential adverse drug reactions.
The defendants carelessly and negligently, following an accident, and upon the significant change in the deceased’s physical and mental condition, failed to obtain treatment plans and/or consultations with other appropriate healthcare professionals, including, but not limited to failing to respond to abnormal radiologic films.
The defendants carelessly and negligently failed to institute a program to prevent the avoidable development of pressure sores on the deceased’s right knee and leg.
The defendants carelessly and negligently failed to identify and address the causes of the deceased’s decreased mental and psychological functioning.
The defendants carelessly and negligently failed to identify and address a treatable cause of the deceased’s incontinence and failed to document an appropriate medical explanation for worsening incontinence which appeared to be iatrogenic, leading to an inappropriate and unnecessary insertion of a urinary catheter on the day of admission and thereafter.
The defendants carelessly and negligently failed to implement physician’s orders to arrange for and transport the deceased to her treating physician for post-surgical exams (i.e., the surgery for initial repair of the first femur fracture.)
The defendants carelessly and negligently failed to properly train, supervise, instruct and observe its employees and agents so to insure that the deceased was not involved in an accident causing injury to her person.
The defendants carelessly and negligently failed to respond to and appropriately seek an evaluation and treatment of the deceased’s complaints of pain during the period of her stay at the facility.
The defendants carelessly and negligently failed to insure that the deceased received nursing home services to attain or maintain the highest practicable level of physical and mental well-being on and after the date of admission.
The court also considered at great length but dismissed the facility’s claim of governmental immunity under the Illinois Tort Immunity Act. The court’s opinion on that issue is pertinent only in the State of Illinois. Lloyd v. County, 707 N.E. 2d 1252 (Ill. App., 1999).
More references from nursinglaw.com
http://www.nursinglaw.com/catheter3.htm
http://www.nursinglaw.com/catheter.htm
http://www.nursinglaw.com/urinary-catheter-sepsis.htm