Young residents' screams for help go unanswered resulting in her death
Alabama NewsChannell 19 had a horrendous story of neglect on their website. NewsChannel 19's Carson Clark reported that a Marshall County Nursing Home is in trouble with state and federal officials after a patient died there. A doctor says the Golden Living Center in Boaz allowed a young woman to scream for help for more than six hours, before finding her dead.
The patient, 20-year-old Felicia Ann Engle of Boaz, suffered from kidney disease. She had to be placed in Golden Living because her father was no longer capable of taking care of her needs.
According to state records obtained by NewsChannel 19, Engle began to yell for help around 3:00 p.m. on April 3, 2008. The records quote nurses at the facility, with one saying Felicia was, "...begging us to call her doctor that something was really wrong this time. She was hurting so bad it was unbearable."
The nurse tells investigators she went to another nurse to tell her of Engle's request. The nurse reportedly replied, "Yes, we know, we've heard all about it four times at least."
NewsChannel 19 contacted Dr. Tom Geary with the Alabama Department of Public Health in Montgomery. He says the way in which Engle was treated violates the law.
"If the patient requests to go to the hospital, [if] they say something is wrong, I need to go to the emergency room, they are supposed to take them to the emergency room. They are not supposed to make a judgment that the person is just trying to disrupt the normal services in the facility, close the door and leave them alone," he says.
The director of Golden Living, Kevin Cogan, refused an on-camera interview and asked NewsChannel 19 to leave the property when they visited.
One big problem is that in some states, a nurse is required to have a physician's order to send a resident to a hospital. Often the physician tells the nurse, "see what the family wants to do". Unless the facility has a strong DON or clinical coordinator who is willing to buck the physician and send the resident out, often the resident stays where he/she is. Most families will not challenge the physician, and have doubts when told that the decision is up to them. Unless the DON is willing to face a reprimand from the physician (or worse) for taking action without a physician's order, I'm afraid you will continue to see things such as this. I continually remind my staff that they are resident advocates FIRST.
Don't most nursing homes have standing orders allowing nurses to transfer residents when there is a significant change in condition or if they need emergency care?
Why would a family NOT want to send their loved one to the hospital to get checked out? Seems like if the doctor left it to the unexperienced family members that all, or almost all, would decide to transfer the resident.
Also, doesn't this come down to training of the staff, and managerial supervision. Often on the weekends and third shift, there is no RN at the facility for the LPN to seek advice.
Unfortunately, most standing orders, or symptomatic protocols, as they are now called, plainly state that a physician's order is required to send a resident to the hospital. Too many times, I have seen the physician pass the responsibility of making the call on to the families. Usually this comes after the physician has had a family conference detailing the resident's condition, and asking the family to make the resident "comfort measures only", meaning that the resident will not be sent out for any reason, and will be treated in the facility and kept comfortable. While this is an acceptable and even preferred treatment for most residents receiving end of life care, where do we draw the line as far as treatment? Do we not treat a UTI because the family has consented to a comfort measures only order? If a family has questions about sending the resident out for evaluation and treatment, and the physician suggests to the family that the resident should be kept pain free and allowed to expire in the facility, some families will elect to leave the resident in the building rather than challenge the physician. Many times, diagnostic tests have been run and are inclusive as to why a resident has specific complaints. Should the resident be allowed to stay in the facility even though he/she is still in pain? Staff must be sure enough of their assessment skills to be able to clearly present to the physician and family the exact symptoms the resident is presently, and leave the decision to the family members, not the physician.