Commentary:
Conflicting Testimony and Documentation Left Room for Doubt for Defendant After Resident’s Death
Case Details:
The resident, a 67 YOWM (4’0", 112 lb), had a history of Korsakoff’s Dementia, nicotine abuse, insomnia, depression, anorexia, alcohol abuse, anxiety, and vitamin D deficiency. He also had a history of aggressive and combative behavior with other residents and staff. That behavior led to a previous behavioral health admission, and prescriptions for five different anxiety/behavioral medications, including Haldol and Ativan.
The resident was cold to the touch at 1:30 p.m. In an attempt to warm him, staff took him to the shower. He sat in the shower chair on his own and was responsive while in the shower. When the charge nurse arrived to the shower room approximately 30 minutes later, she noted the resident was cold and clammy, and that he was nonresponsive even with sternal rub. The nurse attempted to take vital signs; his temperature did not register on thermometers, and his blood pressure could not be obtained. Since the resident’s body temperature was not increasing, staff took him to his room, covered him in warm blankets, and called an ambulance. The EMT responding to the call was a disgruntled former employee of the facility.
Upon arrival at the hospital, the EMT falsely stated the resident was found in a cold room on the floor. Nursing notes indicated the resident’s body temperature was 85.6°F at 6:00 p.m. He was diagnosed with hypothermia, and was transferred to another hospital where he died the following day.
The nursing notes and staff testimony at deposition presented drastically different pictures of the timeline leading up to the resident’s transfer to the hospital. According to nursing notes, over 13 hours earlier at midnight, the resident’s skin was warm and his temperature was 96.1°F. He was resting in his room. At 5:54 a.m., he was in the day room, and at 7:45 a.m., he was in the dining room for breakfast. The notes indicated the resident ate half of his breakfast, which was a normal amount for him. At 9:00 a.m., it was noted he was resting in his wheelchair with his eyes closed.
Nursing notes further indicated the resident was back in the day room at 9:45 a.m. The nurse also charted the resident finished all of his Ensure and about 20 percent of his lunch. The chart revealed the resident pointed his finger at the nurse in a playful manner, indicating he was interactive and energetic. The next nursing entry was at 1:30 p.m. when the resident was cold and unresponsive to sternal rub.
Testimony from one staff member stated the resident was “ice cold” as early as 9:00 a.m. Multiple employees claimed they told the charge nurse the resident felt cold that morning. Testimony also indicated the resident did not eat at all on the day in question, though the nursing note indicated otherwise. Finally, testimony showed that the resident was extremely lethargic and did not “perk up” as the day progressed like he usually did. To further impeach the credibility of the nursing notes, his chart at the facility indicated his skin was warm and dry with good skin turgor and no edema the day he was transferred to the hospital and on the day of his death.
Expert Testimony:
The defendant facility’s expert witness testified the resident died from a rapid onset of pneumonia that led to sepsis causing hypothermia. He was of the opinion that the resident developed pneumonia the same morning he was found to be cold because his blood gases did not demonstrate acidosis which, if present, would have indicated a prolonged illness. He further testified the resident’s immune system was affected by his underlying medical issues, and by the multiple antipsychotic medications working against his body’s ability to fight infection.
The defense expert was concerned with claims of false charting. However, he had no medical reason to believe that the resident’s temperature at 7:00 a.m. was not 97°F, or that his temperature was not 85.6°F when he arrived at the hospital.
There was also concern by the defense expert and defense counsel that the plaintiff would argue environmental hypothermia, which would be the most common explanation for a rapid drop in body temperature. There was nothing to indicate that the resident was exposed to the elements on the day in question, but he had a history of attempted elopement. In one instance, the resident managed to open the back door when a Wanderguard malfunctioned and the alarm did not sound.
Due to conflicting testimony from the defendant’s staff, questionable charting, and the EMT’s false report to treating physicians, the case was settled with the defendant’s consent.
Resolution:
Accurate documentation and supportive testimony are critical to the defense of a malpractice lawsuit: in this case, questionable charting and conflicting employee testimony left room for doubt, leading to settlement as the best solution for the defendant.
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