Surgical Procedure Leads to Allegations of Negligence in Skilled Nursing Facility

Case Overview

This case involves an elderly individual with multiple chronic comorbidities, including dementia and poorly controlled diabetes, who underwent a laparoscopic diverting sigmoid loop colostomy procedure with the placement of a PEG tube. Postoperative recovery appeared uneventful, leading to discharge to a skilled nursing facility (SNF). Approximately a week later, while recovering at the SNF, the individual developed diffuse abdominal pain and associated erythema. Imaging studies revealed that the PEG tube was not positioned correctly. The individual was readmitted for the management of an abdominal abscess but ultimately succumbed to septic shock. Allegations have been made regarding the failure of the SNF medical staff to appropriately evaluate and triage the patient, contributing to the poor clinical outcome. In this case, a medical director physician with expertise in skilled nursing facility administration has been engaged to review the relevant medical records and provide insight into the standard of care.

Questions to the Geriatrics expert and their responses

Please describe your experience as a medical director of a skilled nursing facility, including the implementation of patient care and safety policies and procedures.

I have been a medical director of five different skilled nursing facilities over the last 25 years. As such, my responsibilities have been to the monitoring of the medical care delivered by other physicians in the facility, as well as the development of patient care and safety policies and procedures in concert with the director of nursing services. Some of these policies address the nursing responsibilities of performing vital signs, doing rounds on the patients, and evaluating their overall status. This would include close monitoring of patients with foreign bodies, including feeding tubes for the evaluation of possible infections or complications.

What are some facility policies/procedures to ensure patients are appropriately evaluated and transferred to an acute care facility in cases involving abdominal abscesses and sepsis?

[This response was not provided in the expert's answer and has been omitted.]

About the expert

This expert has over 30 years of experience in the field of geriatrics. He earned his BA in biological sciences from Temple University and his DO from the Philadelphia College of Osteopathic Medicine, before receiving his MBA from the University of Washington School of Business. He completed an internship and a residency in internal medicine at the Detroit Osteopathic Hospital, where he was named chief resident, followed by a fellowship in internal medicine through the American College of Osteopathic Internists. He is an active member of several professional organizations, including the American Osteopathic Association, the Washington State Medical Association, and the American College of Physician Executives. He previously served as the chief of staff at Shorewood Hospital and as the director of medical education at Fifth Ave Hospital. Over the course of his career, this expert has also served as the medical director of several nursing homes, including Everett Rehabilitation Center, Aldercrest Nursing Home, Columbia Lutheran Nursing Home, Odyssey Hospice, Parkridge Care Center, and Issaquah Care Center. Currently, he serves as an adjunct professor of medicine at two universities, one in California and the other in Washington. Additionally, he is the regional medical director of a healthcare system and an attending physician of internal medicine and geriatrics at two hospitals in Washington.

E-087034

Specialties:

Geriatrics