Lack of Timely Intervention Leads to Tragic Outcome in Nursing Home Resident
An elderly COPD patient’s ignored oxygen drop leads to fatal cardiac arrest; the case probes care standards for timely intervention in nursing homes.
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Case Overview
This case revolves around an elderly nursing home resident with a medical history of dementia and chronic obstructive pulmonary disease (COPD). After residing in the nursing home for approximately one year, the individual presented with an oxygen saturation level of 93%, indicative of declining respiratory function. Despite this significant drop, no immediate action was taken by the nursing home staff. Later that same day, the resident was found in cardiac arrest. Although CPR was administered and emergency medical services were summoned, the individual was ultimately transferred to a hospital where they passed away later that day. An autopsy determined the cause of death as respiratory failure and myocardial infarction. This case seeks to understand the standard of care in managing a nursing home resident with COPD, particularly in response to critical oxygen saturation levels.
Questions to the Geriatrics expert and their responses
What are some measures that should be taken if a nursing home resident with COPD has a significant drop in their oxygen saturation with decreasing respiratory function?
The standard of care for a nursing home to treat a patient that is declining in the setting of a low oxygenation reading is respiratory clinic assessment, cardiac evaluation, and early transfer to the ER to prevent advanced cardiopulmonary complications.
What are some measures that should be taken if a nursing home resident with COPD has a significant drop in their oxygen saturation with decreasing respiratory function?
In this case, it is apparent that the patient allegedly suffered from hypoxia which contributed to myocardial infarction via respiratory failure. A medical expert witness review of this case entails assessing for whether the nursing facility breached the standard of care through neglect by failing to prevent this hypoxia. To decipher any of the breaches of the above, I would undertake a utilization review of the nursing facility records which includes looking at MDS, care plans, orders, hospital records, nutrition, nursing notes, provider notes, etc. to evaluate any such breaches by the nursing facility from a multidisciplinary point of view.
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 several nursing and rehabilitation centers. He has also worked in ambulatory hospital-based wound care centers. Currently, this expert serves as an attending physician providing wound care and general geriatric care at several nursing and rehabilitation facilities across Maryland and Virginia. Additionally, he works as a wound care physician at an ambulatory hospital-based wound care center and serves as the medical director of a home health agency 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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