Disabled Patient Dies from Dehydration


Internal Medicine Expert WItnessThis case takes place in Massachusetts and involves a patient in a nursing home, who passed away due to complications from dehydration. The decedent was physically disabled and required close supervision and care. She was living at the defendant nursing home required contact supervision by staff at all times in every area of the nursing facility. On one occasion, the decedent and a staff member were sitting in the common area of the home. According to the defendant’s notes, the staff member stepped outside for a brief period of time. When the staff member came back in the decedent was slumped over in the chair and was unresponsive. According to the notes of the nursing home, lab reports were sent to the nursing home which revealed elevated sodium and chloride levels some time before the patient’s death. The group home files do not contain any further notes concerning the lab results. The autopsy report lists elevated sodium and chloride levels consistent with severe dehydration.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients similar to the one described in the case? Please explain.
  • 2. Have you ever had a patient develop the outcome described in the case? If so, please explain.
  • 3. What measures should be in place to ensure you receive critical lab values?
  • 4. Are you able to review the records on behalf of the plaintiff and opine on, potentially testify to, your findings?
  • 5. Have you ever served as an expert witness and testified on a case similar to the one described above?

Expert Witness Response E-025173

I routinely treat patients similar to the patient in this case. I do not recall having treated a patient who specifically died from hypernatremia. Patients with hypernatremia are at significant risk for death and require prompt evaluation and treatment, usually in a hospital. Critical lab values should be communicated directly to the patient’s physician or covering physician if not available. I am available and interested in providing an opinion regarding this case. I have not provided expert witness testimony on a patient with hypernatremia and an adverse outcome. I have reviewed a case of death from electrolyte abnormality, without deposition in that case.

Expert Witness Response E-007326

The patient was severely hypernatremic which requires many days to occur and a lack access to water. There are many causes which can contribute to this condition. It is not uncommon in medicine to have patient such condition and for physician to treat electrolytes imbalances as describe with this patient. Because of the earlier lab results which also indicated an electrolyte balance, it seems likely that this individual had been receiving negligent care for some time. Yes I can review the records. I have reviewed many cases over the past 10-15 years and have given expert testimony at three deposition and one trial (won)

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