Litigating the Nursing Home Case

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American Bar Association, 2009 - Law - 272 pages
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Contents

Introduction
3
Understanding the Nursing Home Environment
9
2 Background
10
3 Federal Funding Brings Control
12
5 Regulatory Interaction with Tort Liability
13
6 Purposes of the Nursing Home Stay
14
7 Significance of the Federal Categories
15
9 Political Aspects
16
10 Dehydration
139
11 Setting the Standard of Care
140
12 Evaluations of Patient Nutritional Needs
141
14 Baseline Evaluations
142
Liability for Infections and Other Injuries
143
2 Scalding and Drowning
144
3 Insects
145
Nursing Home Admission and Discharge
147

Ownership and Administration
17
3 Role of the Corporate Budget Official
18
Responsibilities of Professionals
21
Roles and Liabilities of Nursing Professionals
23
2 Staffing Levels
24
4 Allocating Responsibilities
25
5 Professional Responsibility
26
Roles and Liabilities of Physicians
27
2 Contractual Obligations
29
5 Actual Supervision of Patient Care
30
7 Role in Restraints
31
Support Roles of Specialized Organizations
33
2 Pharmacy Support
34
3 Laboratory Support
36
4 Rehabilitation
37
6 Administration
38
8 Accounting
39
Facility Safety Issues
41
3 Floods and Evacuations
42
Liability for Neglect Skin Ulcers and Infection Problems
43
2 Legal Issues
45
3 Dividing the Causes
46
4 Care Must Be Continuously Supervised
48
6 Standard of Due Care
49
7 Short Staffing
50
8 Evidence
51
10 Damages
52
13 Other Infection Concerns
53
15 Summary
55
FallRelated Injuries
57
2 Frequency and Severity of Nursing Home Patient Falls
59
3 Measures to Avoid Fall Injuries
60
4 Patient Evaluation
61
5 Procedures and Documentation
62
6 Responses to the Fall Event
63
9 Legal Implications of Fall Injuries
64
10 Proving Nursing Home Negligence in the Fall Case
66
11 Assembling the Proof of Causation
67
12 Few Fall Cases Reach Appellate Levels
68
13 Evaluating Potential Litigation
69
15 Policies and Noncompliance
71
17 Summary
72
Liability for Neglect Wandering Elopement and Escape
73
2 Response When Patients Escape
76
3 Why Patients Wander
77
5 Staff Responsibilities
78
7 Lessons from the Cases
79
8 Summary
80
Use of Patient Restraints
83
2 Restraints and Uses
84
3 RestraintInjury Litigation
85
4 CMS and State Norms
86
5 FDA Hazard Alerts
87
Assault and Abuse
89
2 Criminal Aspects
92
3 Definitions
93
4 Sources of Assaults
95
5 Regulatory Duty of Care for Protection of Patients
96
6 Nursing Home Response to Assaults
98
7 Framing the Complaint for Civil Tort Liability
99
8 State Alternative Malpractice Remedies
102
9 Defending the Nursing Homes Supervision
103
10 Rape and Sexual Assault
104
11 Effects of Shock and Public Outrage
107
13 Allegations of Employee Hiring and Supervision Errors
108
14 CMS and State Penalties
110
16 Liability Insurance
111
17 Evidentiary Issues
112
Liability for Prescription Drug Problems
115
2 What Drug Related Problems Arise?
116
3 Shared Liability Malpractice or Drug Problems?
117
4 Malpractice by Misprescribing
118
5 Polypharmacy
120
6 Overdosing
121
7 Misdelivery
122
8 Inattentive Medical Oversight
123
9 Drugs as a Patient Restraint Option
124
Liability for Food Problems Malnutrition Dehydration and Choking
127
2 Why Litigation Occurs
129
3 Types of Harm from Food
131
4 Chronic Risk Weight Loss and Wasting
132
5 Learnings from the Cases
133
6 Acute Risk Choking and Aspiration
134
7 Expert Testimony
135
8 Responsibility for Care and Feeding
136
9 Tube and Pump Feeding
137
3 Economics of Admission Balancing
148
5 Involuntary Discharge
149
6 Appeal of Involuntary Discharge
150
Assembling the Complaint
151
3 Elements of Due Care
152
4 Elements of Corporate Responsibility
153
6 Statute of Limitations Defenses
154
Defendants
155
2 Interconnected Corporations
156
3 Deposing Corporate Spokesmen
159
6 Products Liability
160
Evaluating the Potential Plaintiff
161
2 Deterioration of Mental and Physical Condition
162
3 Testimony Issues
163
7 Standing and Family Representation
164
8 Practical Issues
165
State Oversight and Regulation
167
2 State Licensing
168
3 Ombudsman Roles
169
Attributing Shared Fault
171
2 Nursing Liability
172
4 Corporations Research
173
5 The Role of Respondeat Superior Liabilities
174
Witnesses
175
2 When Are Experts Needed?
177
4 Current Administrators
178
5 Current Medical and Nursing Staff
179
6 Former Staff Members
180
7 Support Staff
181
10 Fact Witnesses
182
12 Deposing the Corporate Representative
183
Use of Government Survey Findings
185
2 Utility of Survey Findings to Plaintiffs
187
3 Authentication and Admissibility
188
Documentation Needs and Sources
189
2 Assembly of Records for Expert Review
190
3 Effect of Alteration or Destruction
191
4 Patient Privacy Issues
192
6 Informed Consent
193
9 License and Survey Data re the Nursing Home
194
ProductRelated Risk Issues
195
2 Reporting Injuries by Devices and Drugs
196
3 Causation and Liability Allocation
197
Causes of Action
199
2 Negligence
200
3 Wrongful Death Statutes
201
4 Statutory Causes of Action
202
5 Medical Malpractice
203
6 Intentional Torts
204
8 Misrepresentation
206
10 False Claims Act
207
11 Infliction of Emotional Distress
208
13 Breach of Contract
209
15 Class Actions
210
Damages Issues
211
3 Calculating Damages
212
4 Allocating Liability
213
6 Effects of Tort Reform
214
8 Statutory Damage Provisions
216
Defenses
219
2 Defenses Related to Patients
220
3 Defenses Related to Families
221
Arbitration
223
2 The Case for Requiring Arbitration by Contract
224
4 Costs and Award Limitations
225
5 Procedures
226
Motion Practice
229
2 Failure to State a Claim
230
5 Motions to Dismiss
231
Trial Procedure Issues
233
2 Presentations and Demonstrative Evidence
234
4 Impeachment and Response
235
Insurance
237
2 Settlement Authority at Policy Limits
238
3 Bad Faith Litigation
239
Verdicts and Settlements
241
2 Settlement Influences
242
5 Special Verdicts and Interrogatories
243
8 Releases of Selected Defendants
244
Repayment of Liens and Offsets
245
2 Informing the Client Early
247
3 Continued Eligibility
248
Conclusion
249
Table of Cases
253
Index
263
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