Not reporting neglect of adult patient lands home health agency in court

Several of my past blogs have covered the obligation of nurses to report child abuse and neglect to designated authorities. But not reporting neglect of an adult patient, even if it’s “self-neglect” is just as critical.

State statutes vary, but most include the nurse having a “good faith belief” or “reasonable suspicion” that sustained injuries are a result of abuse or neglect; the nurse has immunity from civil, criminal, and professional licensure actions if reported this way. “Good faith” is assumed unless the family or others allege otherwise; and the report is deemed confidential so the nurse’s identity is not made public.

In the following 2019 case against Healing Hands Home Health Care, the Kansas mandatory reporting statute was interpreted after the death of an adult patient with diabetes and “chronic, severe” paranoid schizophrenia, who was receiving twice-daily in-home nursing visits.

The patient’s schizophrenia resulted in “forgetfulness,” poor hygiene, “daily hallucinations and delusions,” and a potential for self-harm — despite being “alert and oriented.” Clozapine was prescribed for his schizophrenia, with side effects including an increased heart rate and a decreased ability to tolerate heat.

The patient’s psychiatrist ordered nursing visits twice daily and the patient’s care plan was reviewed every two months. The care plan included:

  • Daily evaluation of the patient’s cardiopulmonary status
  • Setting up the patient’s medications and reminding him to take them
  • Evaluating the patient’s blood sugar on Monday, Wednesday and Friday
  • Evaluating patient’s eating, hydration and restroom habits, as needed

Did not reporting neglect contribute to death?

From May until the end of June 2013, nurse’s notes indicated that the temperature in the patient’s apartment was very warm. The nurses attempted to intervene by instructing the patient to turn on his air conditioning, but to no avail. In addition, his personal hygiene habits deteriorated.

The patient’s blood pressure during June also increased from the previous 60-day period of 70-80 beats per minute to as high as 118 beats per minute on several occasions during the evening.

On June 26-27, 2013, the county in which the patient resided was under a heat advisory, with a high temperature of 101 degrees and 117 respectively. The patient died some time in the night between June 27 and June 28, 2013. His family found him. The cause of death was listed as “probable hyperthermia.”

The patient’s mother brought a wrongful death and survival action against Healing Hands, alleging that its negligence caused her son’s death. Healing Hands filed a motion for partial summary judgment, alleging that it legally had no duty to inform the patient’s mother about her son’s condition and that Kansas’ mandatory reporting statute did not require it or its employees to report his condition to law enforcement or state authorities.

The trial court granted the home care agency’s partial summary judgment, ruling that the mandatory reporting statute did not require the agency to report the patient’s condition. The jury also found that the agency “bore no fault for [the patient’s] death.” This ruling was based on many legal and other arguments proposed by the home …read more

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