Legal Review & Commentary-Wrong patient gets insulin: $6.5 million settlement
Legal Review & Commentary-Wrong patient gets insulin: $6.5 million settlement
Nursing personnel had criminal background
News:
The family of a man who died in a nursing home after receiving an insulin injection meant for the resident across the hall has reached a $6.5 million settlement with the companies that owned and managed the home. The jury had returned a $13.4 million verdict in the December 1998 trial.
Background:
The 88-year-old man was placed in the nursing home on June 29, 1994. He suffered from hallucinations, dementia, and advanced Parkinson's disease, for which he was given three pills a day. The man was five feet nine inches tall and weighed 135 pounds.
His physician saw him on July 5. On the morning of July 7, the physician received a call from the home's director of nursing, informing him that the man was in distress. The physician advised the director to have the man taken to the emergency room.
The physician met his patient there, and found the man comatose. After having a blood stick done, he prescribed 50 ccs of D-50% glucose. The patient did not improve. A short while later, his blood sugar was a 2. More glucose was administered, but the patient died later that evening.
The physician attributed his death to profoundly low blood sugar. Lab tests indicated the insulin level was high, while the C-peptide level was .07. Tests of the thyroid and adrenal glands revealed they did not cause the excess insulin.
The physician suspected that his patient had been injected with insulin. A police investigation ensued. The patient's body was exhumed, and an autopsy was performed. A possible needle injection was noted on the upper left shoulder. Injection marks also were found on both forearms, which were attributed to possible IV insertion sites. The insulin level was 489.5. The death initially was ruled a homicide.
The home's director of nursing and its administrator were stunned to learn that the patient had died from an insulin overdose, because the patient was not on insulin. However, they informed the police that a female patient in the room across the hall from this man required insulin injections. Both rooms had two beds, and both patients were in bed "B" in their respective rooms. An examination of the insulin vials for the female patient revealed that one was 4 ccs short.
First, a nurse's aide was questioned. She said that during her shift on the day of the incident, she had been unable to locate her supervisor, a charge nurse, and finally found her asleep on the couch in the lobby. The aide passed a lie detector test, but was arrested after the police discovered that she was wanted in New Mexico on an outstanding forgery charge in a different name. By this time, the nursing home had fired her.
Inadequate background check alleged
The charge nurse, an LPN, was suspended by the nursing home on July 29 for excessive absenteeism, smelling of alcohol, breaking into a locked storage cabinet, and allegedly stealing insulin. The director of nursing told the police she suspended the nurse because "she needed to do something to protect the patients."
The charge nurse denied knowing anything about the missing insulin or how the patient was overdosed. She did state that she gave all medication injections. When the police went to her home to serve a grand jury subpoena that had been issued for her, she was gone. As the prosecutor could not establish a motive or prove intent to commit murder, the case was reclassified from a homicide to a sudden death.
According to the plaintiff's attorney, Robert Templeton of Temple ton Smithee Hayes Fields Young & Heinrich, LLP, in Amarillo, TX, the nurse had several convictions for writing bad checks. Her license had been suspended in Oklahoma, although it was reinstated before the home hired her. She had been terminated from her previous employment at a hospital.
Templeton alleged the home failed to perform an appropriate background check, among other things. He alleged negligence and gross negligence. The jury awarded the man's widow and son $13.4 million — including $10 million in punitive damages. The company that managed the home was found 70% liable, and the company that owned it was assessed 30% of the damages.
What it means to you:
The criminal histories of both the LPN and the aide as well as the LPN's Oklahoma license suspension suggest the facility failed to conduct sufficient background checks, says Kathy Connolly, RN, MSEd, assistant vice president of risk and safety management for PHICO Group in Mech an icsburg, PA. It is particularly disconcerting that both employees were on duty during the shift when the incident occurred, she says.
Role for national registry?
All nursing homes need to be reminded to do thorough background checks on their potential hires, Connolly says. Facilities need to find out whether the person's license has been suspended or revoked in any state in which the applicant has held a license. One problem in this case may have been that the LPN might not have indicated on her employment application to the Texas home that she held an Oklahoma license, she says. This is a common problem, and it is a reason behind the current push for a national registry of health care workers, Connolly adds.
Such a registry could work in a way similar to the National Practitioner Data Bank. Any suit or claim filed against a physician is entered into the data bank, and hospitals check the information during the credentialing process before they decide to grant a physician staff privileges. Connolly says she hopes this registry ultimately will be extended to other health care professionals such as nurses, physical therapists, and social workers. Had such a registry existed prior to the hiring of the LPN in this case, the employer could have checked it and discovered the Oklahoma license suspension, she says.
Out-of-state history a risk
Another problem for this employer was the fact that the aide used a false name when she was hired. A federal background check may have revealed her out-of-state convictions, but the expense of conducting such a thorough check for every employee is costly, Connolly says.
The overriding question in the case is how the patient received the insulin, Connolly says. "When administering medications, the staff needs to focus on the task at hand. They cannot function on autopilot. The nurse has to verify that it is the right patient, the right drug, and the right route. This gentleman had only been in the institution for a week, so they should have been still getting acclimated to him."
Confront impaired employees
Connolly's final concern is the LPN's alleged drinking problem. If an employer becomes aware that a staff member is working under the influence of alcohol, it needs to fully investigate the situation and confront the employee, she says. "Facilities are obligated to ensure the safety and well-being of their residents. The employer should not take this lightly if they are informed that a staff member may have a problem. They need to ferret out any allegations of negligence or abuse, which usually must be reported to the licensing authority. A full investigation goes a long way toward fulfilling their duty of maintaining a safe environment."
Reference
Trostle v. Comprehensive Healthcare Associates and Amarillo Health Properties, Amarillo (TX) District Court, Case No. 81,085A.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.