IDPH has cited and fined Avantara of Long Grove nursing home due to a failure of the staff to monitor and obtain treatment for worsening signs of congestive heart failure, leading to the the wrongful death of this nursing home resident.
One of the basic roles that a nurse in a nursing home setting plays is to serve as the eyes and ears of the resident’s doctor. When a resident shows signs of a change in condition, has a nursing home fall, or is demonstrating some other condition of ill-being, it is the nurse’s job to notify the doctor. The doctor then can issue orders over the phone for treatment to be delivered at the nursing home, go into the nursing home to see the resident himself, or order the resident sent to the hospital for examination and treatment there. What is never acceptable is to have the resident suffer a significant change in condition and have the nurse fail to notify the doctor.
Federal regulations require each resident to have an attending physician. This is the doctor who is managing the care of the resident. Doctors are required to see the resident at least every 30 days during the first 90 days of an admission to the nursing home and at least every 60 days thereafter.
Both of these things were serious issues which contributed to the death of this nursing home resident.
The resident at issue suffered from congestive heart failure. This is a condition which is usually managed with medications, including a diuretic, or “water pill” because one of the symptoms of congestive heart failure is increased edema or swelling in the lower legs and ankles. If a resident is suffering from an exacerbation of or worsening of congestive heart failure, that is one of the signs of that and is something that would require physician notification. Monitoring for signs of congetsive heart failure including edema in the legs and feet were a part of this resident’s care plan.
On May 12, a CNA told the nurse that the resident was having a hard time breathing. Shortness of breath is one the signs of congestive heart failure. The nurse on duty that day went to his room, pulled back the covers and saw that his legs were red and swollen. The resident was brought to the hospital where he died the following two days later due to septic shock from lower extremity cellulitis, acute hypoxic respiratory failure due to septic shock, and acute kidney failure. Edema from congetsive heart failure can cause cellulitis which in turn will lead to sepsis if not treated properly.
The investigation into this resident’s death showed that a nurse on duty two days earlier saw that the resident’s lower legs were stretched and hard to the touch due to there being so much edema present. However, she did not think try to notify the doctor because she considered it his “normal.” And to some extent, she was right, as the resident’s skin inspection sheets recorded that for six weeks prior to the resident being taken to the hospital, the skin of his lower legs was described as being red and swollen, all at least potential signs of cellulitis – yet no one tried to notify the doctor during that interval.
And what of the resident’s doctor? The doctor hadn’t seen the resident since November 29 the previous year, nearly five and half months earlier. When contacted by the surveyor regarding this incident, he advised that the resident was no longer under his care because he was no longer seeing patients at that nursing home. In other words – the resident had a doctor on paper, but not in reality.
The fact that the resident had no actual attending doctor is fascinating for a couple of reasons:
- Doctors often see several patients at each nursing home they go to, which means that there were likely multiple residents who had this physician taking care of them. Assuming that the nursing home knew that he was no longer seeing patients there, what did the nursing home do to facilitate transition in care and how did this resident end up with no one?
- It was not clear from the citation when the doctor stopped seeing patients at this nursing home, but the fact that no one recognized that this resident was without a doctor means that no one from the nursing thought to contact the doctor about this resident at any time about this or potentially any other resident he cared for after that or paid attention to the fact the doctor listed as the attending physician for this resident (a) was no longer seeing patients there and (b) hadn’t been in to see the patient in months.
This is a case where it seems that no one was minding the store, so to speak. This resident was demonstrating changes in condition which required notification of the doctor, but no one thought to do so and no one was paying attention to the fact that this resident didn’t actually have a doctor. This was a series of catastrophic failures which resulted in the death of this resident.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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