Inadequate Care, Negligence, and Failure to Address Comorbidities Alleged for Patient’s Death

Allegation

The patient’s son sued the medical director of a rehabilitation center alleging failure to address the patient’s comorbid conditions and inadequate care and negligence—among other allegations—led to the patient’s death.

Case Details

An 88 YOM patient with a complicated medical history was admitted to a rehabilitation center after falling at home and sustaining a head injury. He had multiple comorbidities, including dementia, cardiomyopathy, and urinary retention, and was diagnosed with hydrocephalus. Due to his cognitive deficits, the patient was moved out of the Alzheimer’s unit at the request of his son. Over the course of several years, the patient had multiple falls and developed pressure ulcers that were believed to be inadequately managed. The medical director responsible for the patient’s care was accused of failing to address the patient’s comorbid conditions and inadequate care and negligence, among other allegations. The death certificate listed the cause of death as dementia and cerebrovascular disease, which was disputed by experts’ testimony.

Expert Testimony

The plaintiff experts testified that the medical director failed to address the patient’s nutritional status, independently assess ambulation and mobility, and ensure staff and physicians were implementing policies and procedures at the facility level. A plaintiff nurse expert also testified that the care plan was confusing, there were multiple care plans with different interventions, and the updated nursing interventions were not added to the care plan. The defense countered the allegations by stating that the medical director ordered appropriate interventions to reduce the patient’s fall risk and ordered frequent turning and toileting of the patient as well as daily cleansing of the wounds.

Risk Reduction Strategies

The medical liability concerns in this case highlight the need for proper medical care and management, especially for patients with multiple comorbidities and those at risk of falls and pressure ulcers. The confusing care plan and poor documentation of assessment and interventions also underscores the importance of clear and accurate documentation, effective communication among healthcare providers, and timely consultation with specialists as needed.

To mitigate such risks, healthcare providers should perform a thorough history and physical assessment of the patient prior to administering any medication to identify risk factors or potential contraindications. Ensuring that the patient’s current medication list is accurate and up to date can help prevent drug interactions and adverse reactions. Additionally, clear communication among healthcare providers and timely consultation with specialists as needed can help ensure proper patient care and management.

Effective communication among healthcare providers is crucial in identifying and addressing falls and changes in patient status. Here are some specific communication practices that can be used by healthcare providers—especially staff at long-term care facilities—to improve their ability to communicate about falls and changes in patient status:

• Create and maintain effective policies and procedures:
  • Emphasize the importance of compliance with policies and procedures and the potential risks associated with noncompliance.
  • Regularly review and update policies and procedures to address any gaps or emerging risks.
  • Encourage staff involvement in the policy development process to enhance ownership and compliance.
• Use standardized communication tools:
  • Standardized tools such as SBAR (Situation, Background, Assessment, and Recommendation) can help healthcare providers communicate effectively about falls and changes in patient status.
  • By using a common framework, healthcare providers can help to ensure that all relevant information is communicated to all team members.
• Document clearly and consistently:
  • Accurate and consistent documentation is essential for effective communication.
  • Staff should document all falls and changes in patient status, including the time and circumstances of the event, any injuries sustained, any interventions that were taken, and changes to the plan of care as a result of the fall.
• Conduct regular huddles:
  • Regular team huddles can be used to discuss falls and changes in patient status, share information, and identify any trends or issues that need to be addressed.
  • Huddles should involve all members of the care team.
• Use technology:
  • Technology such as an electronic health record (EHR) can help healthcare providers communicate more effectively about falls and changes in patient status.
  • An EHR can enable real-time updates, alerts, and reminders to ensure that everyone is aware of any changes in the patient’s condition.
• Provide training:
  • Healthcare providers should receive regular training regarding communication skills, including how to communicate about falls and changes in patient status.
  • Training can help improve staff confidence, reduce errors, and improve overall patient safety.

By adopting these communication practices, healthcare providers can help to improve their ability to communicate about falls and changes in patient status, leading to better risk mitigation for patients and improved overall quality of care.

In conclusion, healthcare providers should be vigilant in providing proper care to patients with complex medical histories and multiple comorbidities. They should also ensure that their documentation is clear and accurate and that they are communicating effectively with other healthcare providers. Taking these steps can help mitigate the risks associated with inadequate care and negligence, falls and fractures, pressure ulcers, and other medical liability concerns.

Resolution

Despite the defense team and defendant believing that, based on currently available information, the medical care provided by the defendant met the standard of care, the case was settled for a reasonable amount.

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