ALN was presented with a long term care case with allegations related to respiratory failure and death. At the time of the events in question, the plaintiff, Ms. Maggie White, was an 84-year-old female with a past medical history of coronary artery disease, chronic obstructive pulmonary disease, hypertension, anxiety, Alzheimer disease, chronic low back pain and lumbar disc degeneration. Ms. White was admitted to the defendant facility, a skilled nursing center, for rehabilitation after receiving epidural steroid injections for chronic low back pain.
Upon admission, care was implemented to include physical therapy and occupational therapy. During the course of residency, Ms. White developed a cough which progressed to chest congestion with decreased breath sounds. Prescribed treatment included cough suppressants, antibiotics, nebulizer treatments, and steroids. Ms. White’s chest x-ray was clear; her respiratory symptoms improved with treatment, but subsequently developed edema of the lower extremities bilaterally. Lasix was prescribed which resolved the extremity edema. Three days later, Ms. White was again found to have diminished breath sounds and labored respirations requiring a hospital admission. Admitting diagnoses included congestive heart failure (CHF) and cardiomegaly with respiratory failure. Ms. White was intubated and placed on ventilator support. Despite multiple consultations and treatments, Ms. White’s CHF worsened and she expired three days later.
Plaintiff’s counsel alleged that the defendant facility failed to properly assess Ms. White’s respiratory status and failed to provide timely treatment for shortness of breath, alleging the symptoms existed for days prior to transfer. Plaintiff’s counsel further alleged her respiratory failure and death were caused by the defendant facility’s negligence.
False Allegations Identified With Legal Nurse Review
Upon review of the facility records, ALN’s nurse reviewer was able to refute allegations of inappropriate assessment, as well as the existence of respiratory distress in the days prior to transfer. The investigation confirmed that the facility staff properly assessed, reported, and monitored Ms. White’s clinical status per facility protocol and long-term care guidelines. Although it was believed this information was enough to present an adequate defense, the ALN nurse reviewer dug deeper into the hospital records, striving to ensure the best possible defense was developed for the client.
Further investigation into Ms. White’s condition and circumstances surrounding her death revealed a myriad of possible contributing/causative factors. Ms. White had a recent diagnosis of possible heparin-induced thrombocytopenia (HIT). Research revealed that the most common complication of HIT is venous thromboembolism, including pulmonary embolism. Subsequent to Ms. White’s hospital transfer, the nurse reviewer’s investigation revealed that the physician consultants had conflicting opinions related to the cause of Ms. White’s respiratory deterioration. One theory the consultant considered was that Ms. White’s respiratory deterioration was possibly caused by a pulmonary embolism. In spite of this, Ms. White was never evaluated or treated for a pulmonary embolism or HIT. Although the resident was admitted with CHF, Ms. White was never adequately treated for the condition. Diuretics, a staple in CHF treatment, were discontinued – quite possibly contributing significantly to Ms. White’s declining heart function. Of further consideration was the fact that records indicated Ms. White had a probable new diagnosis of lymphocytic leukemia, which was never fully evaluated or treated. Investigation into Ms. White’s history revealed previous chest x-rays with evidence of pulmonary nodules which were never evaluated or treated. The cause of Ms. White’s death was listed as respiratory failure. As the ALN reviewer determined, the etiology of the resident’s respiratory failure was never confirmed and could have been the result of any number of conditions diagnosed after her rehabilitation stay at the defendant facility, which were not adequately evaluated or treated.
On initial review of the defendant facility records, the ALN reviewer was able to produce evidence showing the facility met the standard of care for evaluation and treatment of the respiratory symptoms Ms. White developed while a resident at the Defendant facility. The ALN reviewer’s in-depth investigation into Ms. White’s comorbid conditions and history revealed a myriad of possible sources for Ms. White’s respiratory failure and death – greatly expanding the client’s ability to argue against the facility’s liability and help mitigate possible damages.
In this case, the expertise of the ALN nurse reviewer was crucial in identifying possible contributing factors and raising questions regarding causation and mitigating factors – factors which would have gone unnoticed by a non-clinical professional. ALN Consulting’s team of nurse consultants are in a unique position to build the strongest, most manageable court case for their clients. We find the root issue by digging deeper.
ALN Consulting is a national provider of medical-legal consulting services, founded in 2002. Our expertise includes, yet is not limited to, medical malpractice, long-term care, product liability, class action/mass litigation, and toxic tort. Contact Us to put our legal nurse consulting experts on your case.