This case involves a 92-year-old female patient with Alzheimer’s who was living in a long-term nursing facility. The patient was considered to be at high risk for aspiration and was always supervised during meals. While the patient was eating lunch, the supervising nurses changed shifts leaving the patient alone for a few minutes. While alone, the patient choked on her food. Nursing staff attempted revival but the woman eventually expired.
Question(s) For Expert Witness
1. What are the standards of care while working with a patient who has dementia and is an aspiration risk?
2. What precautions are in place to prevent an incident such as this?
Expert Witness Response E-005614
The standards for nutritional care and support of patients in a skilled nursing facility (SNF) are firmly set by CMS (Medicare). Patients' care must be supervised by an admitting physician, and include an admission assessment by a registered dietitian, with dietary needs set at this point. If swallowing problems are perceived, a speech therapist must be brought in to evaluate the extent. All information gathered on admission must be evaluated by the physician and a plan of care developed by him/her and the nursing staff. Nursing is then charged with preventative measures to be instituted, such as fall prevention, supervised meals, etc. Any difficulties with swallowing noted by the dietitian, the speech therapist, or nursing staff should be brought to the physician's attention. A change in method of nutrition might follow. A failure to bring this patient problem to the physician's attention and to address it proactively is a nursing breach of duty. I have served as a legal nurse consultant and expert since 2016 and have consulted on a similar case involving an SNF and its nursing staff's failure to correctly observe and report a problem with a feeding tube.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
