As a Houston, Texas medical malpractice lawyer, I have experience representing patients and family members regarding poor skilled nursing facility care.
What is a skilled nursing facility?
Healthcare providers often refer to skilled nursing facilities with the abbreviation “SNF,” which is pronounced “sniff.” A skilled nursing facility is a residential facility that provides on-site 24/7 health care.
SNFs are staffed with registered nurses, licensed vocational nurses, and physical, speech, and occupational therapists. This level of care is supplemented by occasional rounding by a physician, typically a hospitalist.
Quality of care concerns
In my experience, many skilled nursing facilities are under-staffed and ill-equipped to handle patient needs. Further, in many instances, the staff existing at SNFs is poorly trained, meaning that some facilities lack the “skills” suggested by their names.
One of the patient safety problems that I believe plague SNF care is the overmedication of patients. Sometimes this is because of poor staff training, meaning that the providers do not recognize that the medications they are administering are harming the patient. On other occasions, nurses and doctors over medicate patients to keep them quiet, which prevents them from requiring care, time, and attention.
Poorly trained staff
I handled a wrongful death/medical malpractice involving the eventual death of a woman in her early 70s. She was an active woman who was involved in a wreck and required neck surgery at a hospital. A few days after the surgery, she was transferred to a SNF facility in Sugar Land, Texas for skilled nursing care. This was intended to be a short-term admission to get her back on her feet so she could return home.
Although she was never seen by a physician during her admission, a hospitalist called in multiple medication prescriptions for her, including powerful painkillers. Before long, she began to have periods of confusion, was drowsy, and was found to be slumped over. On the third day of her SNF admission, she was transferred back to the hospital, where she died. Her death certificate reflected one cause of death, multi-drug toxicity.
The medical experts that we hired to review the case included an internal medicine physician and a toxicologist. They agreed that this patient was overmedicated during her SNF stay, as demonstrated by her altered mental status, drowsiness, and being found slumped over.
Both physician and nursing personnel are required by law to understand the rationale and effects for medications that are ordered and administered to patients. Part of the nursing process is to assess a patient, implement the treatment, and then reassess the patient to evaluate the treatment. If the patient has a negative response to treatment, like this patient did, the standard of care requires the nursing staff to discontinue the treatment and inform a physician immediately. Further, the physician would then be required to come in and evaluate the patient in person.
In this case, though, the poorly-trained nursing staff operated like an assembly line, without assessing and re-assessing the patient. Therefore, they did not notice—and did nothing about—the major neurologic changes in front of their eyes.
Another risk in some skilled nursing facilities is the deliberate overmedication of patients that require a lot of time, care, and attention.
Recent news reports reflect that Duncanville Healthcare and Rehabilitation Center is under investigation by Parkland Hospital for the alleged unnecessary use of powerful antipsychotic drugs to sedate or control patients.
An informant that works at the Duncanville facility told a news reporter that a patient who was awake and talkative was given antipsychotic drugs Risperdal and Seroquel. The patient was then placed in a bed and became nonresponsive, and within six hours was picked up by an ambulance and later died.
Patient advocates have referred to this growing problem all over the country as “chemical restraints.”
What you can do
In my view, the best thing you can do to keep a family member or friend safe in a skilled nursing facility or hospital is to visit frequently. In some circumstances, that may be 24/7.
People who know the patient well will often be able to identify changes in the patient’s baseline and mental status more quickly than healthcare providers. It is important to raise anything unusual immediately with the nursing staff and to request quick physician notification. Next, follow up. Ask what the doctor said and if the doctor will be coming to see the patient. Be assertive.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.