Below is a nursing home negligence case we handled for a resident who suffered multiple and repeated falls. He suffered a fractured leg in his last fall which led to complications. He developed a pulmonary embolism and died. At the time of his hospitalization, the severely infected wound was also discovered on his heel. This case demonstrates how the failure by the nursing home to carry out the most basic care can have tragic results.
PATIENT’S COMPENSATION FUND STATE OF LOUISIANA
PCF NUMBER: 20XX-00294
VILLAGE NURSING HOME
POSITION PAPER ON BEHALF OF DL
KENNETH D. ST. PÉ KENNETH D. ST. PÉ, APLC
La. Bar Roll No. 22638
311 W. University Ave., Suite A Lafayette, Louisiana 70506
Plaintiff alleges three (3) separate incidents of substandard care and damages caused by defendant, Village Nursing Home. The first arises out of a fall and fractured hip which occurred on May 9, 2012. The second occurred August 7, 2012 when the plaintiff again fell and fractured his left leg. Thereafter he developed a serious wound on the ankle of the injured leg (left) requiring extensive treatment.
The evidence to be discussed below will demonstrate that Village Nursing Home breached the standard of care in failing to take appropriate measures to prevent Mr. C’s falls. He had four (4) falls in five (5) months. The dates for these falls were March 17, 2012, May 9, 2012, June 9, 2012 and August 7, 2012.
The fall on May 9, 2012 occurred when Mr. C fell while ambulating with his walker. At the time of this fall he was a known higher fall risk, and required assistance with ambulation. He was not being assisted at the time of his fall, however, and this failure to provide assistance was a breach of the standard of care.
Mr. C’s fall on August 12, 2012 occurred when according to him, he reached for a remote control on the side of his bed and fell out the side of it. At the time of this last fall, Mr. C was a known high fall risk with his mobility status severely compromised due to the hip fracture he suffered in the May 9, 2012 fall. His family specifically requested bed rails and a bed alarm for his safety. The family’s request was ignored. Village Nursing Home breached the standard of care in failing to provide the bed rails and bed alarm Mr. C’s family requested and these items clearly would have prevented this accident.
LEFT HEEL INFECTION
Mr. C developed a severe left heel wound which was originally treated by the Village nursing staff. Without explanation, however, the staff charted that the wound was resolved on November 6, 2012. The wound was not resolved. Instead it became grossly infected, developed an abscess and required surgery after Mr. C’s admit into the hospital on November 22, 2012. Senior Village Nursing Home breached the standard of care in failing to properly treat Mr. Colomb’s left heel wound.
SUBSTANDARD CARE REGARDING FALLS
Attached herewith as Exhibit A are incident reports regarding Mr. C’s four (4) falls at Village Nursing Home. Again, these occurred March 17, 2012, May 9, 2012, June 9, 2012 and August 7, 2012. Attached herewith as Exhibit B are Fall Screening Reports performed for Mr. C by Village. These evaluations were conducted once a month. For the panel’s convenience I have only attached the screenings for April, May, June, July and August, 2012. The panel will see that they are all virtually identical with the exception of the August screening. They note that Mr. C is mobile with assistance, requires minimum assistance with transfers but has an overall fall risk score of 13 placing him in the high fall risk category. This panel is no doubt familiar with the federal OBRA Regulations which require a nursing home to take proper measures to prevent accidents/falls. In particular, 42 CFR 483.25(h) requires in part that “each resident receives adequate supervision and assistance devices to prevent accidents.” The regulation specifically requires that, “The intent of this provision is that
the facility identifies each resident at risk for accident and/or falls and adequately plans care and implements procedures to prevent accidents.”
The duty to prevent falls was acknowledge by Village Nursing Home, DON, M. Aucoin, RN. Mrs. Aucoin’s deposition is attached herewith as Exhibit C. Mrs. Aucoin acknowledged the nursing home’s duty to try and prevent falls at page 17 of her deposition. In discussing some of the measures the nursing home must take in order to carry out this duty, she noted the requirement to properly care plan.(Aucoin depo. p. 25) She noted specifically that the care plan should be updated (written on if necessary).(Aucoin depo. p. 25/26)
Nurse Aucoin discussed the nursing home’s fall prevention program which included meetings and documentation regarding the residents who had had falls and were at a high fall risk.(Aucoin depo. p. 27)1 Attached herewith as Exhibit D are Village Nursing Home’s “Restraint Necessity/Positioning Device Worksheet”. This document is produced for the months of April, May, August and September. It is significant in that it states that bedrails were never used at the facility for Mr. C. However, attached herewith as Exhibit E is an Affidavit from Mr. C’s sister and primary family caregiver, DL Mrs. L has stated under oath that she made repeated attempts to Village Nursing Home to use
bedrails and a bed alarm for Mr. C. Village promised to address the issue but nothing was ever done. Plaintiff is not attaching a complete copy of Mr. C’s chart. This will be provided by Village’s counsel. This panel is directed to the Physician Orders and telephone orders. It will see that no requests for bedrails were ever made.
1 Senior Village has answered in discovery that they do not have and/or cannot locate any fall prevention minutes or meetings regarding Mr. Colomb.
Attached herewith as Exhibit F is a “Plan of Treatment for Outpatient Rehabilitation” dated May 17, 2012. This document was completed by one of Mr. C’s therapist shortly after his May 9th fall and hip fracture. The panel will note the debility Mr. C was suffering relative to his recent injury. This panel should contrast this document to the fall risk screen documentation maintained by the facility.(Exhibit B) It will see that as could be expected, Mr. C’s ability to function independently decreased substantially. Naturally, he was at a much greater risk of falls. This decrease was never charted by Village Nursing Home. Their fall risk screening simply charts the same conditions over and over again in a boilerplate fashion. It was not until after his fourth and final fall in August that any significant change was made.
SUBSTANDARD CARE REGARDING HEEL WOUNDS/ INFECTION
Village Nursing Home records reflect that on or about October 11, 2012 Mr. C developed a left heel wound. “Wound/skin management documentation records” for Village are attached herewith as Exhibit G. As was mentioned above, the nursing home’s records reflect treatment for the wound until November 6, 2012 when it was charted to be “resolved”. Attached herewith as Exhibit H are “ETARs” which are excerpts from Village’s electronic treatment administration records for Mr. C’s left heel ulcer treatments. These exist only for the month of October 2012. The undersigned can find no treatment records for the month of November. The documentation to be discussed in the next section of this paper will demonstrate that the wound was not “resolved” but instead had abscessed and became grossly infected with the MSRA virus.
Attached herewith as Exhibit I are physician record excerpts from Mr. C’s admit to Opelousas General Hospital following his hip fracture May 9, 2012. These documents are self-explanatory and cover the details of his injury.
Attached herewith as Exhibit J similarly are Mr. C’s physician record excerpts for his August 7, 2012 admit.
Attached herewith as Exhibit K are the Opelousas General physician record excerpts from Mr. C’s treatment from his left wound. (November 21, 2012)
SUBSTANDARD CARE/SUMMARY OF ARGUMENTS
Mr. C’s May 9, 2012 fall and hip fracture was easily preventable. He had fallen in March in a very similar manner. Despite this fact, Village Nursing Home took no further measures to prevent another fall. Moreover, despite requiring assistance with ambulation, none was being provided at the time of this fall. Defendant breached the standard of care in failing to take affirmative measures to prevent Mr. C’s fall.
Of Mr. C’s four (4) falls, his August 7, 2012 fall was the most easily preventable. The family had requested bedrails and a bed alarm for his safety. This request was ignored and none was provided. Village Nursing Home’s records are devoid of any further measures taken after his three (3) prior falls in March, May and June. Certainly the standard of care required that they investigate and take action to prevent further falls. This is the requirement under the federal regulations. Good nursing standards demand that affirmative measures be considered at the very least. The family requested bedrails and a bed alarm. Other measures could have included a mat on the floor next to his bed, or simply placing the remote control
within easy reach. Any of these measures, bedrails, a bed alarm, a floor mat, or having the remote within reach would have prevented Mr. C’s fall and leg fracture.
The serious wound infection Mr. C suffered is inexcusable. Without rhyme or reason the nursing home records reflect all treatment for his wounds stopped on November 6, 2012. Unfortunately, that wound not only continued but abscessed and became severely infected eventually requiring surgery. Failing to properly treat Mr. C’s heel wound is a breach of the standard of care.
RESPECTFULLY SUBMITTED, KENNETH D ST. PÉ, APLC
KENNETH D. ST. PÉ
La. Bar Roll No. 22638
311 W. University Avenue, Suite A Lafayette, Louisiana 70506
GLOSSARY OF EXHIBITS
- Incident Reports;
- Fall Screening Report;
- Deposition of Aucoin, RN;
- Restrain Necessity/Positioning Device Worksheet from Village Nursing Home;
- Affidavit of DL;
- Plant of Treatment for Outpatient Rehabilitation dated May 17, 2012;
- Wound/Skin Management Documentation Records;
- Physician Record Excerpts from Opelousas General Hospital for May 9, 2012;
- Physician Record Excerpts from Opelousas General Hospital for August 7, 2012;
- Physician Record Excerpts from Opelousas General Hospital for November 21, 2012;