A Case Involving a Defunct Nursing Home Revealed Hidden Complexities

Since my nursing background consists of 15 years in gerontology and long term care nursing, I was glad my first case was a nursing home neglect case. One long term care facility in my hometown was known as the “place not to go” because of its substandard care. The facility had changed owners and names several times in the past few years. After receiving multiple citations from state and federal agencies, it lost its Medicare and Medicaid certification and closed down. I was hired to screen a case involving a male patient who had resided in this facility and eventually died in another nursing home.

The plaintiffs were the patient’s ten children and widow (the children’s stepmother). The man originally resided at the now-defunct facility, then he was hospitalized briefly for multiple infected wounds, pneumonia, dehydration and sepsis. He was discharged to another long term care facility, where he passed away. All three facilities were potential defendants. Although the substandard care at the first nursing home was thought to be the cause of the patient’s progressive decline and death, I recommended reviewing records from all three facilities.

The alleged deviations from the standards of care centered around the lack of skin care, resulting in extensive wounds to the left shoulder blade, bilateral heels, coccyx region and right hip. The wounds varied from superficial to non-stageable necrotic tissue. Other potential deviations from the standards of care included several falls, use of restraints and use of a catheter without a supporting medical diagnosis. The original long term care facility’s records did not reflect the severity of the impaired skin integrity. More important, these records did not agree with the hospital’s admission assessment documentation and pictures taken on admission.

I was excited to find what I thought was a strong case and was ready to discuss my findings with the attorney. Because this was my first case and I wanted to present my best work, I reviewed the medical records one more time. In the hospital records I found some dietary notes regarding the patient’s diagnosis of dysphagia secondary to end-stage Parkinson’s disease. Per medical recommendations, which were clearly documented, the patient could safely consume only thickened liquids and pureed foods. In the hospital records, but absent from the first long term care facility’s records, was a dietary waiver signed by the patient’s spouse, the acting power of attorney, stating she understood the risks of going against medical advice and chose to feed the patient all types and textures of foods and liquids anyway.

The hospital claimed the patient’s status was critical upon admission and they treated him per protocol. The second long term care facility claimed he was admitted for palliative care with death anticipated. The medical records clearly supported defense arguments for these facilities.

My $120/hr CLNC^® Consulting Fee Saved the Attorney Thousands of Dollars

Before the appointment with my attorney-client to review my findings, I ran over the case in my head again and again. Had I missed anything? Was the patient’s sepsis related to the pneumonia or to the wound infection? Was it aspiration pneumonia or bacterial pneumonia? And I wondered how the attorney would react – would he think the information I was providing was worth $120 an hour?

Finally, the morning of our appointment arrived. I presented my screening opinion supported by the facts of the case. I took the time to explain the relationship between the patient’s Parkinson’s-induced dysphagia and pneumonia, demonstrating aspiration with a drawing.

The attorney left the room and returned with a piece of paper, the patient’s death certificate, which had not been in the medical records. The cause of death was aspiration pneumonia.

This case was complicated by several issues. The patient’s spouse and the ten children from his previous marriage were in conflict over his care. The funds for potential liability settlements were limited because of the recent bankruptcy of the original long term care facility and the attorneys representing this facility were not interested in settling. That meant the case would have to go to trial to obtain any possible monetary award. In light of what I had discovered during my screening, the attorney had to discuss the case with the plaintiffs again.

He thanked me for my work and for what he called the “mini medical lesson,” and said he would inform me of any changes in the case. I took the opportunity to mention additional CLNC services I could provide on this case (if he chose to continue litigating it) or on any other medical-related cases.

Two weeks later the attorney called to tell me the family had decided not to pursue the case further. He thanked me again for my CLNC services, stating that I had saved him not only time but also money and added, “I look forward to working with you in the future.”

I know I will always remember this case because what I learned was priceless. I gained invaluable marketing experience, boosted my confidence and self-esteem and had my first exposure to providing CLNC services on an actual case. Most important, I now know that as a Certified Legal Nurse Consultant I can be a valuable asset to any attorney in a medical-related case.

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