The U.S. District Court for the Eastern District of New York recently awarded over $400,000 to the widow of a deceased Veterans Hospital patient in her lawsuit against the U.S. government for her husband’s death stemming from substandard nursing care at the hospital.

   The Federal Tort Claims Act allows lawsuits directly against the U.S. government in Federal court for negligent acts or omissions by Federal employees (but not against Federal employees themselves), to the same extent that a private employer would be legally liable under state law.

   The patient had had several heart attacks. While being seen in the hospital’s outpatient clinic for his arthritis, he became dizzy, short of breath and could not walk. He was taken to the emergency room, admitted to intensive care and then transferred to cardiac telemetry.

   He had been taking digoxin, captopril, prednisone, Lasix, and Lopressor. On admission he was given some captopril and Lasix, and also Compazine, buspirone, Benadryl and a benzodiazepine.

   The court noted the sedative, hypotensive and diuretic effects of these medications would tend to make a patient unsteady on his feet, lightheaded and in need of frequent use of the restroom.

   According to the court, the nurses should have assess this patient as a fall risk on admission to telemetry. They should have noted the risk in the chart, placed a fall risk sign on the bed and expressly said something about the fall risk in nursing report at changes of shifts.

   In addition, the side rails should have been up, and the nurses should have gotten the patient up every two hours and assisted him to the bathroom, the court said.

   The patient was found on the floor by the nurses. The last staff person who had seen him testified the side rails were not up. It was not clear whether he fell trying to get up, or just slipped off the edge. But the court said that did not matter.

   Standard nursing practice, according to the court, is to log all patient care in the chart. If something was not written in the chart, it was not done.

   The nursing flow charts were missing for the day of admission and the next day, when he fell. There was no evidence of any nursing assessment having been done or fall risk precautions having been followed.

   After the patient fell he suffered malnutrition and developed bedsores, both of which the court related to substandard nursing care and both of which the court said contributed to his untimely death.

   The medical records were used as evidence in court. There were declining serum albumin levels in the lab results, and the patient progressively lost weight.

   However, although the patient’s nursing care plan called for feeding assistance, there was only sporadic flow-charting of feeding assistance being given. The widow testified when she visited she often saw that his meal tray had not been touched. She never saw anyone encouraging him or helping him to eat.

   The first medical note in the chart of Stage I and II decubitus ulcers on the heels and sacrum was two weeks after the fall. A physician ordered an aggressive skin care plan and an air mattress and foam booties.

   However, over the coming months the ulcers progressed to Stage III and IV, according to medical-staff notes in the chart. There was no nursing charting of proper skin care, or that the patient was being turned every two hours, or that his regular bowel and bladder program was being followed to keep him from soiling his bed, which exacerbated the progression of the decubitus ulcers, the court noted.

   The court said the bottom line was that this patient, although suffering from serious heart disease, rightfully should have lived another three or four years. Lamarca v. U.S., 31 F. Supp. 2d 110 (E.D.N.Y., 1998).