This case takes place in Washington and involves a male patient who was admitted to a residential care home as an in-patient resident following a heart attack. The medical records show that the patient was a vulnerable adult who required total assistance with all activities of daily living. The patient was due to receive occupational therapy and therapeutic exercises as part of his rehabilitation. The patient’s medications were also to be monitored closely. In spite of these orders for close supervision, the staff at the nursing home failed to feed the patient for extended periods of time. Eventually, a member of the nursing home’s staff walked by the patient’s room and noted that he was lying face down on the floor, and he was subsequently taken to a hospital. The patient was diagnosed with pressure sores, severe dehydration, and malnutrition. Following treatment and discharge, the patient was returned to the nursing home, where staff again failed to properly document the patient’s condition. The patient suffered from continued neglect for several weeks until nursing home staff found him dead in his room.
Question(s) For Expert Witness
- 1. Do you have experience in running a residential nursing home?
- 2. What is the standard of care for a vulnerable patient?
- 3. What protocols are in place to prevent neglect or abuse of residents in these types of facilities?
Expert Witness Response E-007898
This is certainly a case of neglect. The physician noted improper nutrition. I wonder if the physician ordered a dietary consult with a registered dietitian. The case summary mentions that the man has a dementing illness. This brings up questions about his level of dementia. I personally use the GDS or FAST scale. If he was in the later stages, he most likely would have lost the ability to swallow and the decision would be made to either let him die naturally or place a feeding tube. Was the resident placed on hospice or comfort care? Was he offered meals or perhaps a high calorie high protein nutritional supplement? I’m very interested in this case and would like to know more.
Expert Witness Response E-005614
I do not have experience running a nursing home. The standard of care for a vulnerable patient is to provide care for them which they cannot do themselves, including nutritional service, skin care, fall prevention, rehabilitation and safety measures for those in mental distress, with enough trained staff to accomplish these goals. The standard for a vulnerable patient assumes nursing care in all these instances that complies with nursing and medical standards. These standards are general and must be detailed in specific institution policies and procedures, all predicated on initial and ongoing assessments. These procedures and policies are designed to prevent neglect or abuse, if followed. This case is horrifying in the staff’s denial of basic care that spiraled into an untimely death.