Legal Review and Commentary: $340,000 verdict follows Alzheimer's patient's case
Legal Review and Commentary
$340,000 verdict follows Alzheimer's patient's case
News: An elderly man suffering from Alzheimer's disease was taken to the hospital for treatment of cough and body aches. When hospital staff completed their treatment of the patient and cleared him for discharge, the man learned that his ride home had left the facility. The man subsequently spent the night at the hospital. The man was wandering through the hospital's hallways during the night and ultimately wandered off the hospital's premises early the next morning. He was found several hours later by the side of a highway, and he had been caught in a brush fire. The man died the next day. The patient's surviving wife sued the hospital for negligently failing to monitor her husband, and a jury returned a verdict against the hospital for $340,000.
Background: A 73-year-old nursing home resident suffering from Alzheimer's disease was taken to the emergency department following complaints of coughing and body aches. By 1 a.m., the man was cleared for discharge. However, because his caregiver had left the hospital, the patient stayed the night in the emergency department. Social services personnel were scheduled to take the man back to his assisted living facility the next morning.
In the middle of the night, the hospital's nursing staff found the man wandering the hallways. Consequently, nurses moved the patient to an area where he could have the assistance of a technician outside his room. At 8 a.m. the next morning, however, the hospital's security surveillance video showed the man leaving the facility's premises. He was found several hours later by local fire department personnel in a gully off an interstate, where he had been caught in brush fire.
The man was transported by helicopter to another hospital for treatment of burn injuries to nearly 90% of his body, more than half of which were third-degree burns. Hospital staff attempted to save the man's life by removing nonliving tissue from his burns; administering full life support and full burn protocol treatment; intubating him; and cutting holes in the thick, rigid barrier of burn tissue from his ankles to his armpits to release swelling — a procedure known as an escharotomy. Nevertheless, the man died within 24 hours.
The man's surviving spouse sued the first hospital and alleged negligence for its failure to monitor her husband. She alleged that her husband should have been directly observed because he was an Alzheimer's patient who required a caregiver and because he was in a strange environment. She further contended that had her husband been appropriately monitored, he would have been seen trying to leave the hospital and brought back for safekeeping. As a result, he would have avoided the horrific massive burns and subsequent death. The wife brought claims for her husband's pain and suffering and economic damages as well as on her own behalf for loss of companionship.
The hospital disputed liability and claimed that its nurses were not required to monitor the man very closely, given that he had been cleared for discharge and was merely awaiting transportation back to his assisted living facility. After trial and four hours of deliberation, a jury returned a verdict of $340,000 for the plaintiff, awarding $300,000 to the man's estate and $40,000 to his wife.
What this means to you: "Upon admission, a hospital legally accepts responsibility for its patients until they are returned safely to their usual caregivers," says Lynn Rosenblatt, CRRN, LHRM, risk manager at HealthSouth Sea Pines Rehabilitation Hospital in Melbourne, FL. And the undisputed tenet of hospital care that "discharge planning begins at admission" applies to all services, including the emergency department and ambulatory surgery. This includes an affirmative duty to safely transition every patient to the next level of care, regardless of whether the transition is internal after being admitted as an inpatient or external to a subsequent discharge. Indeed, Rosenblatt notes, it is a requirement of the Centers for Medicare & Medicaid Services and is a long-held standard of The Joint Commission that once a patient is admitted, the facility has an undeniable obligation to ensure a safe discharge.
In this case, the staff were well aware that the patient resided in an assisted living facility and was cognitively impaired. As such, the patient could not get himself home safely and was likely incapable of understanding post-discharge instructions. "His Alzheimer's disease placed him in the same category of a minor child, requiring a health care surrogate to give consent, supervision to ensure he did not wander off, and a discharge plan to ensure someone assumed responsibility for his person," says Rosenblatt.
Upon the man's admission, the case manager should have entered into a dialogue with the patient's representative as to what supervision the hospital could provide and what was expected of the caregiver. When the hospital learned that the caregiver would be unable to remain in attendance, the hospital was required to find a suitable alternative. Although the hospital apparently argued that it had no responsibility for monitoring the man once it cleared him for discharge, Rosenblatt notes that the hospital's conduct actually constitutes patient abandonment.
Rosenblatt advises risk managers to implement a policy whereby patients, upon admission, are assigned a staff member who is responsible for developing a plan of care that includes a safe and executable discharge plan based on the patient's presentation and current medical condition. "In situations such as the [emergency department], a nurse case manager is the likely role to assume such responsibility. This individual would be responsible for overseeing the patient's movement through the various aspects of the emergency evaluation process and plan for the patient's ultimate disposition when the evaluation is complete and the patient ready to move on."
In this case, because the hospital failed to assign someone to be directly responsible for the patient, he would not have received any assistance unless he had affirmatively asked for it. The problem here also might have been exacerbated by the fact that a shift change likely occurred overnight, and no one informed the new shift that a patient was waiting for his ride and still required monitoring. "This hospital failed to realize that discharge actually occurs when a patient is deemed to be able to safely leave the premises and has the capability of assuming full responsibility for himself or having another do so. Had this rather simple but effective safeguard been in place, this patient would not have suffered as he did and would have been returned safely to his home."
Reference
- Baltimore County (MD) Circuit Court, Case No. 03-C-03-013966.
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