The patient’s urinary tract infection called for antibiotics to be started right away.  Then when the nurse practitioner was informed the patient was diaphoretic, had lost his balance and fallen and had vomited brown emesis, she should have advised the assisted living staff to call 911.  Telling staff simply to continue to monitor his condition was wholly inadequate. CALIFORNIA COURT OF APPEAL August 3, 2018

  A nurse practitioner worked for a medical practice that, among other services, provides medical care to residents in assisted living.  When not on site the nurse practitioner communicated primarily by fax with the staff at the assisted living facility where her eighty-two year-old patient resided.

  Personnel at the facility believed the patient had a urinary tract infection.  They faxed the nurse practitioner asking if a urinalysis was needed.  She phoned the next day and said she would fax an order for that.  That afternoon more faxes started back and forth for several days about the patient’s deteriorating condition.  He began having severe abdominal pain, became incontinent, fell several times and vomited dark brown emesis.

  Finally the assisted living staff on their own called 911.  At the hospital he was diagnosed with renal failure and septic shock and died the next day.  In the disciplinary hearing filed against the nurse practitioner there was testimony she should have gone to see the patient instead of simply sending faxes back and forth and should have consulted with her supervising physician for direction or asked the physician himself to see the patient.  Expert testimony indicated that the patient’s life could likely have been saved if he had been promptly started on antibiotics.   The California Court of Appeal agreed with the Board of Nursing’s decision to place the nurse practitioner on probation. Wolff-Baker v. Board, 2018 WL 3688393 (Cal. App., August 3, 2018).

Additional references from nursinglaw.com

http://www.nursinglaw.com/assisted-living-dementia-care.htm

http://www.nursinglaw.com/assisted-living-fall.htm

http://www.nursinglaw.com/assisted-living-memory-care.pdf

http://www.nursinglaw.com/assisted-living-mobility.pdf

http://www.nursinglaw.com/skilled-care-assisted-living.htm

http://www.nursinglaw.com/assisted-living-mobility-issues.htm