Stroke Complications in Long-Term Care Lead to Fatal Infection
A patient in long-term care deteriorated due to an untreated chest wound, leading to an infection and subsequent death, prompting a legal inquiry into care standards.
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Case Overview
This case involves an adult female who, during childbirth, suffered a stroke that resulted in severe neurological sequela. Following her stroke, the patient was admitted to a long-term care facility, where she remained nonverbal. In June 2019, while under the facility's care, the patient developed a wound in her chest. Unfortunately, no interventions were made to address this issue for several days. Subsequently, the patient exhibited signs of deterioration, including fever, which prompted her transfer to a hospital. Upon admission, it was discovered that the patient's ventriculoperitoneal (VP) shunt had become infected. Tragically, the patient passed away less than a week later, with the cause of death attributed to the infected VP shunt. The legal inquiry seeks an expert in internal medicine with extensive experience in long-term care facilities, specifically concerning the development of Care Plans, to assess the standard of care provided in this case.
Questions to the Wound Care expert and their responses
Generally, when developing a Care Plan for a patient with a VP shunt and a history of a severe stroke, what aspects of the Care Plan are important in preventing VP shunt issues/infection?
The standard of care is for a facility to develop and implement a care plan that includes monitoring the VP shunt site for signs of an infection or other complications such as bleeding.
Generally, when developing a Care Plan for a patient with a VP shunt and a history of a severe stroke, what aspects of the Care Plan are important in preventing VP shunt issues/infection?
In the event that a VP shunt site is complicated by a wound, then topical wound care and a wound care service including nursing and physicians trained in wound care should address it. Antibiotics should be given to treat infection and referral to a higher level of care such as a hospital or wound care is warranted when the actual shunt is infected or there is extensive necrotic tissue.
About the expert
This expert has over 15 years of experience in internal and geriatric medicine, specializing in wound care. He earned his BS in biomedical engineering from the University of Pennsylvania, followed by his MD from the Duke University School of Medicine. He then completed a residency in internal medicine at Franklin Square Hospital Center and a fellowship in geriatric medicine at the University of Maryland. Today, this expert is board certified in both internal and geriatric medicine and is certified by the National Alliance of Wound Care and Ostomy. He was formerly an attending physician for hospital medicine at multiple hospitals in Maryland and Pennsylvania. He provided wound care and general geriatric care services as a geriatrician at Ellicott City Health and Rehabilitation Center, Collingswood Nursing and Rehabilitation Center, and Oakview Nursing and Rehabilitation Center. He has worked in ambulatory hospital-based wound care centers, including Doctors Community Hospital and Howard County General Hospital. Currently, he serves as an attending physician in wound care and general geriatric care at a number of nursing and rehabilitation centers in Maryland and Virginia. Additionally, he serves as a wound care physician at an ambulatory hospital-based wound care center and as the medical director of a home health agency, also in Maryland.
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About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
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