COMMENTS BY A NURSING HOME SPECIALIST
Home Director from Connecticut
A recent example of a case of nursing home care in which the standard of care was violated, resulting in injury to the patient, is that of a 64 year old man who was admitted to a nursing home following a surgical revascularization to his right (and only) leg. He had a past history of Diabetes Mellitus, Hypertension, s/p left AKA (above the knee amputation), renal insufficiency and peripheral vascular disease of the leg. He also had a persistent non-healing (ulcer of the foot from which MRSA (a resistant Staph bacteria) was cultured out in the hospital, and he was put on IV Vancomycin, the only antibiotic to which this highly resistant bacterial strain was sensitive, 4 days prior to leaving the hospital. On admission to the nursing home, he was seen by both his PCP (primary care physician) and an Infectious Disease consultant. The consultant ordered a tenday course of the IV Vancomycin which the patient received, and dressing changes to the foot ulcer every shift, which the patient received only once a day (one third of the dressing changes were ordered). In addition, the consultant returned 2 weeks later to check on the leg, found it worse, so reordered the IV Vancomycin for another 7 days. This order was not picked up or given by the nursing staff until the patient’s PCP made his visit a week later. Because both worsening infection and condition of the ulcer, it became necessary for the patient to undergo a right BKA (below the knee amputation) 5 days later.
As an expert witness in this case, I concluded that the failure of the nursing staff to carry out the orders of the physician resulted in persistent MRSA infection, lack of healing of the foot ulcer, and ultimately in the patient needing his BKA. In this regard, the nursing home and its nurses deviated from the acceptable standards of care, and infringed upon the patient’s nursing home resident right to adequate and appropriate health care as set forth in a state statute. This case was settled without going to trial.
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