Penal Institution Expert Witness Evaluates Medical Neglect Suffered by Inmate

This case involves a 25-year-old man who died while in prison. The decedent was confined to a half-way house after completing drug abuse treatment. The decedent had been constipated for several days, and was described as being so weak he couldn’t pick up his 3-year-old daughter who was visiting him at the halfway house. The next morning he was still weak, constipated, had vomited all night, and couldn’t sleep. He was transported in a wheelchair to the Correctional Center medical infirmary from the halfway house, where an RN performed an exam. There was no documented abdominal exam, and they prescribed him a drug to treat constipation. The next morning the decedent was completely disoriented, weak, unstable, and was found sleeping in the wrong bed. An ambulance was called, and en route to the hospital they performed an emergency re-route to the nearest hospital. His blood glucose was very high at the time. At the ER, he rapidly deteriorated, and expired within the hour. Lab results taken at time of death showed he was severely dehydrated. The medicine he was prescribed was name-stamped by the MD, who never actually saw the patient. According to the attorney handling this for the State, the doctor would have been called in only if the LPN saw something significantly wrong with the patient. The facility policy is to have the patient examined by the RN, and if the nurse feels that the inmate is too sick for them to treat, they put the inmate on a sick call list. The nurse in this case did not feel that this was called for, thus it was not done.

Question(s) For Expert Witness

1) Do you routinely treat patients similar to the one described in the case? What is the standard workup when presented with a patient with symptoms as described in the case summary? 2) Have you ever had a patient develop the outcome described in the case? If so, please explain. 3) Do you believe this patient may have had a better outcome if the care rendered had been different? 4) Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.

Expert Witness Response E-009311

I have a great deal of experience in this field. As director of nursing at a state correctional facility, I routinely treat similar patients. This is a very unfortunate case. I have never had a patient develop this outcome. When a patient presents complaining of these symptoms, a through examination should be performed, including a full abdominal exam. In order to give an accurate determination as to whether or not this was preventable, it will be important to determine the actual cause of death.