A patient was hospitalized before admission to the defendant’s nursing home. During the hospitalization, the patient had a PEG (percutaneous endoscopic gastric) feeding tube put in place. The patient was discharged to the defendant’s nursing home after surgery within one week of the surgical feeding tube placement.
Several days after admission to nursing home, the patient was observed with the PEG tube lying in his bed with the bulb deflated. When the patient’s PEG tube was noted to be displaced, the nursing home re-inserted the tube manually at his bedside without taking proper steps to ensure that the tube was returned to a safe location within the patient’s stomach. The nursing home improperly inserted the tube into the patient’s peritoneal cavity, not his stomach, and continued providing feeding formula, medication, and flushes through the misplaced feeding tube.
One-in-one half hours later, the nursing home received an order from the patient’s physician to verify PEG tube placement by x-ray. The nursing home delayed obtaining x-ray confirmation of the feeding tube placement for hours and hours, during which time the nursing home continued to provide the patient with tube feedings, medications, and flushes. The patient began grunting and was observed to express pain by grimacing. The patient’s blood pressure dropped at the nursing home and he became cool, clammy and sweaty. Fifteen hours after the PEG tube was re-inserted and feeding formula, medications and flushes resumed, the nursing home finally transferred the patient to the hospital.
On admission to the hospital the patient was noted to have shortness of breath and a painful abdomen. He was further noted to be hypoxic with a rapidly declining mental status and rapid respirations. He also demonstrated an elevated temperature, elevated heart rate, elevated blood sugar level, abnormal creatinine and acute kidney failure.
A CT scan of the patient’s abdomen at the hospital revealed that the PEG tube had been improperly re-inserted into the patient’s peritoneal cavity. The CT scan further revealed free air and tube feeding in the patient’s peritoneum. The patient declined rapidly at the hospital and, based on the severity of his peritonitis, he was a poor candidate for surgery. The patient’s family placed him on comfort measures and he died at the hospital eleven days later.
We obtained copies of the nursing home’s policies and procedures and discovered that the nursing home had been instructing staff to verify proper PEG placement by auscultation (listening for a “gurgling sound” in the stomach when air is placed through the feeding tube and aspiration (withdrawing) fluid through the feeding tube and examining fluid). We determined through a literature search that auscultation was a notoriously unreliable method of confirming proper PEG tube placement, that a “gurgling sound” can just as easily reflect a tube in a improper position as a properly placed tube, and that a “gurgling sound” alone never indicated correct placement such the feeding, medications and flushes should never have been resumed.
With respect to aspiration, the nursing home’s policies and procedures falsely provided that PEG tube placement could be verified merely by aspirating the feeding tube contents and examining those contents visually. Unfortunately, the nursing home’s policies and procedures, which were used to train staff responsible for the care of patients with feeding tubes, contained no discussion about the use of x-ray to confirm proper PEG tube placement or the use of pH paper to test tube contents to verify proper placement, both of which were reliable and inexpensive methods identified in medical literature as early as ten years prior for determining proper PEG tube placement.
We requested compensatory damages as a result of the patient’s wrongful death. We also requested punitive damages because the nursing home’s antiquated policies and procedures, inadequate training, and negligent care of the patient represented conduct the nursing home knew placed the patient at a grave risk of harm. The nursing home settled the case before trial for a confidential amount.
Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia.
Posted on Tue, July 26, 2011
by Kristie Pierce