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DEADLY UNDER-STAFFING
A recent Georgia case illustrates the perils of under-staffing, and of having LPNs function as RNs. 71-year-old Bobby Copeland lived at a long-term care facility when, at about 10:45 pm one night, an LPN observed brown vomit on his clothing and abdominal distention. She also noted the absence of bowel sounds in three quadrants. The long-term care facility routinely staffed the night shift solely with LPNs. Because there was no RN to address her concerns, the LPN called a Physician’s Assistant and asked if Bobby should be sent to the hospital. Without assessing the patient personally, the PA determined that this was not necessary. He ordered diagnostic tests, including an abdominal x-ray.
The LPN checked on Bobby throughout her shift. His bowel sounds did not improve and his distress increased. She reported her observations to the day shift nurse, as well as to the supervising RN at about 7:00 am the following morning. Despite relating her concerns and observations, Bobby was not assessed until 9:15 am. At this point he was complaining of abdominal pain. The x-ray ordered the previous night was not performed until a little before 10:00 am. The PA who had ordered the diagnostics did not assess Bobby until 10:15 am. At about 11:00 am, he was finally transported to an emergency room. At about 5:30 pm he was transferred to the ICU where he died later that night. Cause of death? Not surprising – ADRS related to aspirating fecal material.
Bowel obstructions are life-threatening emergencies. An LPN who observes brown vomit, abdominal distention, and the absence of bowel sounds needs an RN who can then perform a complete patient assessment. She should not have to call a PA herself, then be left to observe a patient moaning through the night. Nurses should not accept a PA simply giving orders for diagnostics without seeing the patient personally. The LPN was correct – he needed to be sent to a hospital. He needed to be sent at 10:45 pm, not 12 full hours later.
Bobby’s son brought a lawsuit against the long-term care facility, the PA, the hospital he was sent to, and the doctors in that ER. He alleged that the long-term care facility negligently staffed the night shift. RNs were routinely not scheduled to work the night shift, leaving LPNs without anyone available to properly assess patients. Evidence showed that the staffing decisions were made as business decisions, and were not based on patient care needs.
A jury awarded $7.5 million dollars – 20% of which was apportioned to the long-term care facility - $1.5 million dollars. The long-term facility appealed the judgment, but the Georgia Court of Appeals ruled against them and upheld the verdict.
One and a half million dollars. How much money would the facility have spent to staff even a single RN on each unit? Considerably less than this judgment and the legal fees. And by the way, their nursing staff, particularly that LPN, has been traumatized. And by the way, one of their residents needlessly suffered and died. Was it worth it?
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