Group Home Administration Expert Evaluates Fatal Lapse in Resident Care

This case involves a patient in a group home, who passed away due to complications from dehydration. The decedent required contact supervision by staff at all times both in the community and at home. On the day of the incident in question, the decedent and a staff member were sitting in the living room of the home, when the staff member stepped outside for a brief time. When the staff member came back in the decedent was slumped over in the chair and was unresponsive. According to the notes of the group home, lab reports from a medical facility were sent to the group home. The lab results revealed elevated sodium and chloride levels. It was alleged that the group home failed to properly monitor the patient, and that they were negligent in allowing him to become fatally dehydrated.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case? Please explain.

2. Was it unreasonable for the nurse to step outside, based on the fact the patient needed constant supervision?

3. What is the proper protocol when given the patient's critical lab values?

Expert Witness Response E-008120

I review lab values everyday and report abnormal values immediately to the physician. Lab values are monitored on a daily sometimes hourly basis by all nurses who care for any patient. I am well versed in hypernatremia and hyponatremia as well as other lab values. As a nurse you must know how to think critically and ensure the physician is informed immediately of critical lab values so he/she can instruct the nurse on the next course of action to ensure the patient's health is safely and effectively managed. This patient should have been in the hospital for care as I described above. Follow-up should have been immediate. If critical labs were reported, the responsible party receiving the results should have followed up the next day with PCP for further instruction and if PCP was unavailable the patient should have been taken to the nearest ER for treatment.