Elder abuse claimed in treatment of 80-year-old in poor health. Defense. Los Angeles County.

Facts and Background

• Facts and Background:

  On March 15, 2016, one day prior to his 81st birthday, plaintiff was admitted to Hollywood Presbyterian Medical Center ED for a right humeral fracture that had occurred at home. Plaintiff lived with his daughter and son-in-law. He was admitted to the hospital with acute renal failure, dehydration and respiratory distress. He had a long history of medical conditions, including end-stage chronic obstructive pulmonary disease, Parkinson's disease, diabetes mellitus type 2, benign prostatic hypertrophy, obesity, moderate Alzheimer's dementia, coronary artery disease, and a pacemaker.

  Two days after admission a closed reduction was performed on the plaintiff, but his respiratory condition and renal function continued to worsen. He was placed in BiPAP therapy on March 18, after no response to progressive respiratory therapy and oxygenation methods were unsuccessful. His perfusion was poor. Intubation was recommend but refused by the family until March 22 in the late afternoon. It was noted when the patient was intubated and the BiPAP mask removed that the plaintiff had developed deep tissue injury on his nose. Further, on March 19, it was noted that the patient had some areas of deep tissue injury and excoriation on his lower back and sacral area.

  He was in the ICU at the hospital for two months, and during that time required a tracheostomy. He remained in the care of Hollywood Presbyterian Sub-acute Care Center ventilator dependent at the time of trial.

• Plaintiff's Contentions:

  That the deep tissue that developed on plaintiff's nose was the result of not properly monitoring the BiPAP mask by respiratory therapy. The respiratory therapists were employed by a subcontractor, GEM Medical Management.

  That a protective barrier should have been placed when the mask was initially placed, and was not. Further, that the mask was not properly removed for "rest" periods, and that records which reflected mask changes were fraudulent or erroneous.

  As to the sacral/back wounds, plaintiff contended that nursing staff failed to properly assess (pursuant to the Braden Score) plaintiff's potential for development of skin breakdown and therefore failed to institute appropriate preventative measures, failed to timely reposition the plaintiff every two hours, and failed to keep the plaintiff clean. That all of these failures in care were not only negligent, but constituted elder abuse/neglect.

• Defendant's Contentions:

  That both the skin injuries to plaintiff's nose and sacrum/back were the result of unavoidable medical conditions which pre-existed plaintiff's hospitalization, including his end-stage COPD, which ultimately required a tracheostomy and his ventilator dependency to survive.

  That all appropriate measures were taken by both respiratory care staff and nursing staff to prevent skin breakdown, but in order to save the plaintiff's life, he had to be placed in a position in bed (bed raised – known as semi-fowlers) which caused additional pressure to his lower back and sacrum in order to prevent him from decompensating. Offloading was done to alleviate pressure and mask changes were done, as well as routine skin checks on the nose in relation to the BiPAP mask. A protective barrier was placed the day following placement of the mask to prevent skin breakdown. Ultimately, the wounds developed despite the best of care. As the plaintiff's medical condition ultimately stabilized as his oxygenation was able to be sustained after the tracheostomy, the wounds were healed by June of 2016.