Nursing home expert witness links elderly woman’s death to deficient nursing home care

ByKristin Casler

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Updated onOctober 19, 2017

Nursing home expert witness links elderly woman’s death to deficient nursing home care

A nursing home expert witness advises on a senior care case involving a decedent who was 86 years old when she was admitted to defendant nursing home. Nearly 10 days passed before she underwent a pain assessment and received a pain care plan. Despite continued pain, and her inability to communicate her needs, neither the decedent’s family nor her physician were contacted. She suffered considerable weight loss and developed a bed sore on her coccyx that was not treated and became infected. Doctor’s orders for wound inspections on every shift were ignored. Despite several falls, no fall prevention plan was developed. She ultimately was transferred to a hospital, where she died from sepsis.

Her estate hired a nursing home expert witness and filed suit against the nursing home in the Pennsylvania Court of Common Pleas.

Question(s) For Expert Witness

1. What are the applicable standards for nursing home nurses?

2. Were the standards met in this case?

Expert Witness Response

inline imageThe required care plan must describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. This requirement was not met. The plaintiff, as a result of care planning that was not individualized or updated, suffered a decline in pressure ulcers, suffered a urinary tract infection, suffered multiple falls, suffered in pain, and failed to progress in her rehabilitation.

inline imageThe facility must maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete: accurately documented; readily accessible; and systematically organized. This requirement was not met as evidenced by the grossly inadequate documentation in medical records covering plaintiff’s residency. Records were inadequate or completely missing in areas including but not limited to nursing notes, medication administration sheets, treatment administration sheets, weekly skin investigation sheets, and wound assessment sheets. Lack of adequate medical records contributed to increased safety risks, hospitalizations and actual injury for lack of care planning; inaccurate information and lack of communication for and with family and other health care providers; and increase in pain and suffering.

inline imageFalse documentation was noted for one date, when the decedent already had been transfer the previous day.

inline imageA resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sore from developing. This requirement was not met as evidenced by decedent’s developing an infection in her coccyx pressure ulcer during her residency. The nursing home was cited for deficient practice in this area in February 2010.

inline imageThe facility must establish and maintain an infection control program. This requirement was not met as evidenced by decedent’s development of a UTI. Decedent, who was incontinent of both bladder and bowel, entered the defendant’s facility without a UTI, and was admitted to the hospital with sepsis from a UTI with possible contribution from a wound infection. This requirement also was not met as evidenced by decedent’s development of a wound infection. Her wound was found to be infected with Proteus mirabilis, bacteria found in the gastrointestinal tract, indicating that the wound was not protected from contamination with feces.

inline imageThere was also insufficient pain management and no notification of family members of changes to her condition.

inline imageIt is my considered opinion, rendered within a reasonable degree of nursing certainty, that the staff, as well as the facility's owners, managers, consultants and agents deviated from the standard of care and failed to adhere to federal and state regulations and state standards of conduct for registered nurses and nursing homes. The lack of care decedent received was outrageous and unacceptable. As a result, decedent was at an increased risk of harm and caused to suffer much unnecessary pain, humility and injuries, including poor wound healing, pain, weight loss, infections, and ultimately death.

About the author

Kristin Casler

Kristin Casler

Kristin Casler is a seasoned legal writer and journalist with an extensive background in litigation news coverage. For 17 years, she served as the editor for LexisNexis Mealey’s litigation news monitor, a role that positioned her at the forefront of reporting on pivotal legal developments. Her expertise includes covering cases related to the Supreme Court's expert admissibility ruling in Daubert v. Merrell Dow Pharmaceuticals Inc., a critical area in both civil and criminal litigation concerning the challenges of 'junk science' testimony.

Kristin's work primarily involves reporting on a diverse range of legal subjects, with particular emphasis on cases in asbestos litigation, insurance, personal injury, antitrust, mortgage lending, and testimony issues in conviction cases. Her contributions as a journalist have been instrumental in providing in-depth, informed analysis on the evolving landscape of these complex legal areas. Her ability to dissect and communicate intricate legal proceedings and rulings makes her a valuable resource in the legal journalism field.

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