Facts

On March 2, 2005, Julius Speiginer, 91, was admitted to Community Care and Rehabilitation Center (CCRC), from Riverside Community Hospital (RCH). Prior to his hospitalization, the patient had virtually no medical history, having avoided doctors and hospitals throughout his life. He was initially admitted to RCH due to increasing lower back pain and urinary incontinence. RCH discharged him to CCRC for rehabilitation and physical therapy, indicating the back pain was the result of a prior motor vehicle accident. The patient's laboratory data from RCH revealed poor nutrition and possible dehydration as well as elevated Alkaline Phosphatase marker, an indicator of bone disease.

Within two weeks of his admission, the patient had developed multiple Stage IV pressure ulcers on his sacrum, buttocks and ischium. Over the first two weeks, the patient's pain intensified drastically.

On March 8, an MRI of the spine and back was completed. The patient's treating physician received the results on March 10, which revealed a metastatic disease process throughout the spine. The patient was diagnosed with metastatic prostate cancer. The family demanded aggressive treatment. An oncology consultation on March 15 resulted in an order discontinuing physical therapy due to the risk of paralysis from the possible fracturing of the spine. The patient developed skin breakdown on his coccyx, thigh, elbow, buttocks, ear and toes.

On March 31, the patient became unresponsive; he was transferred back to RCH. Though his condition initially improved, his health continued to decline. He was placed on a ventilator and possibly suffered a stroke that rendered him comatose. The patient died on May 8, 2005.

The initial cause of death was determined to be complications of prostate cancer. The autopsy ruled the cause of death was sepsis caused by pneumonia caused by undiagnosed heart disease with his prostate cancer listed as a significant factor.

The plaintiffs brought suit against the hospital, managed care organizations, and the skilled nursing facility. The causes of action against the defendants included elder abuse, negligence per se, fraud, negligent infliction of emotional distress and wrongful death. Before trial, however, the plaintiffs entered a settlement with the hospital and HMO/managed care organization.

One year prior to trial, the defendant filed a motion for summary judgment on the issue of ratification of neglect. In opposition to the motion, the plaintiffs filed DPH records concerning the defendant's nursing home and related testimony concerning the administrator's and director of nursing's knowledge of those records. The motion for summary judgment was denied. One year later, the plaintiffs moved the court to admit the records and testimony at trial. The motion was denied.

At the conclusion of the plaintiffs' case in chief, the defendant filed motion of nonsuit as to the elder abuse, fraud and negligent infliction of emotional distress causes of action. The court granted defendant's motions as to the fraud and negligent infliction of emotional distress causes of action. The defendant's motion in regard to elder abuse as to the alleged corporate ratification was granted as to the elements of oppression, fraud and malice, though the jury was ultimately instructed on the element of reckless disregard. With the granting of these motions, the case was limited to reckless neglect under elder abuse and wrongful death. The court bifurcated for bench trial the statutory-based causes of action.

The court denied the plaintiffs' request for negligence per se instruction. The court also denied defendant's efforts to put forth evidence of the HMO managed care organization's failure to provide a continuity of care to the decedent. The court similarly denied the defendant's request for a comparative fault instruction as to this entity. The court did allow a comparative fault instruction as to the decedent's failure to comply with medical advice while at the defendant's facility.

PLAINTIFFS' CONTENTIONS:
The plaintiffs contended that the nursing staff failed to provide proper custodial care including food, water and modalities to prevent skin breakdown; and that these failures resulted in dehydration, malnutrition and the development of multiple Stage IV pressure ulcers. The plaintiffs alleged that the decedent's skin breakdown was caused by CCRC's failure to turn and reposition him regularly as indicated by his care plan; that CCRC failed to provide a waffle mattress or low air mattress as ordered by the decedent's physician; and, that CCRC failed to monitor his nutrition and hydration. The plaintiffs pointed to charting, that the decedent was not turned and not given the mattress ordered by his doctor, testimony of family members and prior facility staff as evidence of the alleged lack of care, and testimony of the director of nursing regarding patterns of prior neglect of other residents. The plaintiffs further claimed that sepsis from an avoidable Stage IV decubitus ulcer on the coccyx materially contributed to their father's death. The plaintiffs contended that the DPH records and related testimony of the administrator and director of nursing demonstrated a pattern and practice of neglect over a period of years.

The plaintiffs argued that the trial court improperly excluded the DPH records and related testimony from evidence. The plaintiffs contended that, following the denial of the defendant's motion for summary judgment, the court entered an order under C.C.P. 437c(g) that the records and testimony were admissible evidence on the issue of ratification. As such, the plaintiffs argued, the court violated its own order when it excluded that evidence on the basis of the same objections overruled a year earlier.

DEFENDANT'S CONTENTIONS:
CCRC contended that the decedent's multiple medical issues were the expected result of the natural course of the underlying disease process, which was accelerated by the decedent's failure to comply with medical advice and refusals of care. The skin breakdown was unavoidable given the decedent's metabolic decline, intense pain and refusals to be re-positioned. The care and treatment provided the patient was within the standard of care and did not cause or contribute to the patient's death. The defendant also contended that the decedent's managed care organization (HMO) failed in its duty to provide a continuity of care by not communicating an earlier finding of potential metastatic cancer to the decedent's care providers or the defendant prior to admission.

Settlement Discussions

The plaintiffs offered to settle for $850,000 at mediation, one year prior to trial. According to plaintiffs counsel, at that time, the defendant offered to settle for $5,000. According to defense counsel, the plaintiffs offered to settle for $1,600,000 six months before trial. CCRC issued a statutory offer to compromise for $2,000 on the wrongful death claim; $40,000 on the personal injury claim, $1,000 each to Gary and Rennae Speiginer on the negligent infliction of emotional distress claim. According to plaintiff's counsel, the defendant offered $1,000 with attorney fees to be decided by the court. At trial, the plaintiffs initially demanded $1,700,000, later reduced to $1,250,000. The defense offered $300,000 during trial.

Result

The jury found in favor of the defense on wrongful death. On the elder abuse cause of action, the jury found that the decedent was harmed by both CCRC's failure to provide reasonable care and the decedent's own refusal to comply with medical advice of CCRC; and the decedent was 50 percent responsible for his injuries in comparative fault. The jury also determined that plaintiffs did suffered pre-death pain and suffering and non-economic damages in the amount of $25,000 subject to 50 percent comparative fault. However, the jury did not find the essential element of reckless disregard for probable harm to the decedent nor did it reach the question of corporate ratification. Without these findings, the plaintiffs were not entitled to recover heightened remedies in elder abuse, including pre-death pain and suffering, thus rendering a verdict in favor of the defense. The plaintiffs' statutory-based claims are pending before the court.

Other Information

FILING DATE: Feb. 10, 2006.

Deliberation

one day

Length

20 days