Courtesy of Godoy Medical Forensics
What if there is a delay in care and the patient is taken to the emergency department severely ill?
When does the culpability of their illness fall on the IHSS caregiver or family members?
I have had two recent cases asking just that question: In both cases, the issue was that pressure ulcers had formed and the patient arrived at the hospital with multiple and severe wounds. The patient arrived septic and in an altered mental state. Naturally, the nurses were horrified and called Adult Protective Services and the police.
In each case, the whole picture needs to be taken into account and questions need to be answered:
- Is the patient of sound mind and able to get to the hospital on their own? If the patient is able to call for an ambulance or a ride, investigation needs to be done as to why they didn’t seek medical care.
- Is there more than one caregiver that was responsible, and if so, who is at fault? There are times when more than one person is caring for the patient. It may be that all caregivers are at fault or that one had a higher level of responsibility.
- When was the last time the patient was seen by any caregiver? Pressure ulcers begin to form within one to two hours and can become an open wound in less than 12 hours (Wake, 2010).
- What could the caregivers have done differently? It is impossible to prevent pressure ulcers from forming when the caregiver is in the home for two to four hours per day. Therefore, they need to recognize that an ulcer has formed and arrange for the patient to be seen by their doctor for treatment orders.
- Was the caregiver trained to recognize the early signs of pressure ulcers? Pressure ulcers in the first stage are simply red areas of the skin. It is unlikely that an untrained caregiver would recognize the ulcer at this stage.
A review of the medical records needs to occur, as well. What stage were the ulcers when the patient was admitted? What risk factors does the patient have for pressure ulcers? What is their baseline mental status? Were the ulcers properly treated after admission?
Regardless of whether the case is criminal or civil, there must be proof that the caregiver was negligent and that the negligence was what caused the patient to become ill. Whether the caregiver was a family member or an IHSS provider or both will play a role in the case. What training did they receive, if any? If multiple caregivers are involved, was one more responsible than the others? What triggered the call to the police? Could it have been prevented? Should the patient have been seen sooner? Had the patient been seen?
Speak up: What other implications are there? Are you an attorney who has handled a case like this? What was your experience? Share and allow others to learn from your past cases.