Articles Posted in Elder Abuse

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/personal injury case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

Physicians and other health care providers, as well as hospitals, can be held liable under the elder abuse statutes. That was the holding in Mack v. Soung (2000) 80 Cal.App. 4th 966. Such persons have “care and custody of an elder” within the meaning of the elder abuse statutes when they undertake to care for an elder. The court summed up its holding as follows:

Delaney establishes that health care providers are not exempt from liability for reckless neglect simply because the cause of action arises from the rendition of health care services. Mack v. Soung, supra, at 974.

Each of the required elements of proof to support a claim for reckless neglect of an elder is set out in the First Amended Complaint and is supported by specifically alleged facts. Those allegations together may be summarized as follows:

Katy Smith, an elder and dependent adult within the meaning of the Elder Abuse Statutes (W&I Code §15600 et seq.), was admitted to Nationwide Hospital on September 25, 2007. She was diagnosed with a cervical spine fracture. Ms. Smith had pre-existing paraplegia. For this reason and because she had a neck fracture, she was at high risk for the development of pressure ulcers.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/personal injury case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

ARGUMENT
Law Applicable to Demurrers

It is axiomatic that a demurrer does not test the sufficiency of evidence or other extrinsic matters. Four Star Electric v. F&H Construction (1992) 7 Cal.App. 4th 1375, 1379, The only issue for the Court to resolve on demurrer is whether the complaint, as it stands, unconnected with extraneous matter, states a cause of action. Gervase v. Superior Court (1995) 31 Cal.App. 4th 1218, 1224. The court’s function on demurrer is to treat properly pleaded facts as true without consideration of whether they are provable or not. Ibid.

While these rules of determining a demurrer are well known, it is often valuable to remind the moving party of them. In the case at bar, if each properly pleaded fact of elder abuse in the First Amended Complaint were stipulated to be true, the defendant could not argue that the plaintiff would not be entitled to a verdict under the Elder Abuse Statutes. This is another way of expressing the standard for judging a demurrer. When properly viewed in this way, it is plain that defendant’s demurrer is without merit.

Plaintiff Has Pleaded Facts Sufficient to State a Cause of Action for Reckless Neglect of an Elder

Defendant concedes that a cause of action for elder abuse under California Welfare and Institutions Code §15600 et seq., is a separate and distinct claim from medical negligence.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/personal injury case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

The repeated failure of the staff to follow well-known protocols for the prevention of pressure ulcers and other conditions to which Katy was susceptible is a gross departure from any standard of care and is evidence of a reckless disregard of health and safety of patients by the managing agents, officers, owners and operators of defendants.

Further allegations of reckless institutional neglect are set out in the complaint, wherein it is alleged that managing agents of Nationwide Hospital, including the Administrator and Director of Nursing, consistently failed to properly train the nursing staff, repeatedly failed to engage in chart review to assure that proper care planning and treatment was occurring, repeatedly failed to assess the competency of the nursing staff and knowing of the neglect of Ms. Smith, took no remedial action.

The complaint further sets out duties which Nationwide Hospital was required to carry out but failed to do so with references to State and Federal regulations. The breaches of duty all relate to the failure to properly initiate a care plan and carry out a care plan to protect Katy Smith from compromise to her health and safety, i.e. the development of pressure ulcers.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/personal injury case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

FACTUAL ALLEGATIONS OF THE FIRST AMENDED COMPLAINT

The First Cause of Action details the facts which would support a verdict for reckless neglect of an elder on the part of Nationwide Hospital.

It is alleged that Katy was a patient under the care of Nationwide Hospital from September 25, 2007 through October 4, 2007, with a diagnosis of neck fracture. It is further alleged that Ms. Smith suffered from pre-existing paraplegia and, while at Nationwide Hospital, she was plainly dependent upon Nationwide Hospital for virtually all activities of daily living. The complaint goes on to allege that because of Ms. Smith’s condition, Nationwide Hospital knew that she was at high risk for the development of pressure ulcers and that, if they were allowed to develop, they would be difficult to treat because of Ms. Smith’s bed-bound status and that there was a significant risk of serious consequences from their progression.

The First Amended Complaint with specificity alleges that the nurses at Nationwide Hospital knew or were obligated to know that Ms. Smith was required to be repositioned at a minimal interval of every two hours in order for a proper ulcer-prevention care plan to be carried out.

Rather than turning and repositioning Katy every two hours consistently throughout her admission, multiple members of the nursing staff did not turn her at such intervals and did not turn or reposition for periods of 3 hours, 4 hours, and 7 hours at various times during her stay. As a result of said repeated neglect, Katy developed pressure ulcers.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/personal injury case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

Plaintiff Katy Smith’s Memorandum of Points and Authorities in Opposition to Defendant Nationwide Hospital and Clinics’ Demurrer to Plaintiff’s First Amended Complaint
INTRODUCTION

Defendant Nationwide Hospital demurrers to plaintiff’s First Amended Complaint on the basis that it fails to plead sufficient facts to support a claim for reckless neglect of an elder in violation of California’s Welfare & Institutions Code §15600 et seq.

Defendant’s demurrer is without merit and is of a type filed as a matter of course in virtually all elder abuse cases. Its principal purpose is to add a burden to plaintiffs bringing such cases which was not intended by the legislature. In point of fact, the legislature in §15600 of the Welfare & Institutions Code expressed as its purpose in enacting the Elder Abuse Statutes to encourage lawyers and others to take up the cause of the neglected elderly because representation had been difficult to obtain previously due to the vagaries of the law.

Plaintiff’s pleading in the case at bar is far more particular in its factual pleading than would be required under standard notice pleading rules. It alleges facts and includes specific charging allegations which if supported by evidence at trial would justify a verdict in plaintiff’s favor on a cause of action for reckless neglect of an elder.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/medical malpractice case and its proceedings.)

In Mock v. Mich. Millers Mut. Ins. Co. (1992) 4 Cal.App.4th 306, 328, an insurance bad faith case, the court said the following with regard to punitive damages:

Even before the 1987 amendments, the courts articulated a standard for the proof of malice where, as here, no intent to harm is claimed. Such malice “implies an act conceived in a spirit of mischief or with criminal indifference towards the obligations owed to others.” In Dean Prosser’s words: “Where the defendant’s wrongdoing has been intentional and deliberate, and has the character of outrage frequently associated with crime, all but a few courts have permitted the jury to award in the tort action punitive or exemplary damages …. Something more than the mere commission of a tort is always required for punitive damages. There must be circumstances of aggravation or outrage, such as spite or malice, or a fraudulent or evil motive on the part of the defendant, or such a conscious and deliberate disregard of the interests of others that his conduct may be called wilful or wanton.”

CACI 3540 defines despicable conduct as “… conduct that is so vile, base, or contemptible that it would be looked down on and despised by reasonable people.” Again, this also has to be shown by clear and convincing evidence.

For plaintiff to prevail there must be evidence that the defendants’ employees, acted with malice as defined by Civil Code §3294, and that said malice was ratified by a managing agent, or that the managing agents themselves acted with malice. Further, plaintiff’s must have evidence that rises to the level of clear and convincing evidence. For corporate defendants like Universal and MC, the evidence must show that a managing agent of the defendant is culpable. In White v. Ultramar (1999) 21 Cal.4th 563, 577 the Supreme Court said:

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/medical malpractice case and its proceedings.)

PUNITIVE DAMAGES

Civil Code §3294 is the statutory authority for a claim for punitive damages. This statute states:

(a) In an action for the breach of an obligation not arising from contract, where it is proven by clear and convincing evidence that the defendant has been guilty of oppression, fraud, or malice, the plaintiff, in addition to the actual damages, may recover damages for the sake of example and by way of punishing the defendant.

(b) An employer shall not be liable for damages pursuant to subdivision (a), based upon acts of an employee of the employer, unless the employer had advance knowledge of the unfitness of the employee and employed him or her with a conscious disregard of the rights or safety of others or authorized or ratified the wrongful conduct for which the damages are awarded or was personally guilty of oppression, fraud, or malice. With respect to a corporate employer, the advance knowledge and conscious disregard, authorization, ratification or act of oppression, fraud, or malice must be on the part of an officer, director, or managing agent of the corporation.

Plaintiff alleges “Defendants” acted maliciously toward her with specific intent to cause injury, and as such, their conduct was despicable, and carried out with a willful and conscious disregard of the rights of plaintiff. She also alleges “Defendants” acted in a way which was fraudulent malicious and/or oppressive. It is unclear if plaintiff alleges the employees of defendants acted with malice, or if the corporate managing agents themselves did. (See Part 11 of 11.)

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/medical malpractice case and its proceedings.)

Plaintiff will not be able to state a prima facie case of neglect by clear and convincing evidence. With regard to plaintiff’s pressure sore, it started out as a friction or shear injury that occurred during a transfer to or from her bed. Plaintiff’s expert will opine it occurred when plaintiff was getting occupational therapy. There can be no possible argument to equate this injury with the level of conduct necessary to entitle plaintiff to punitive damages. Such injuries can and do happen in hospitals, particularly with obese, totally dependant patients such as plaintiff.

The expert testimony at trial, and opinions of the treating physicians at the time, will that the worsening of the initial injury was a function of plaintiff’s underlying medical condition. Plaintiff’s experts have conceded this. Plaintiff will not be able to show, by clear and convincing evidence, that any of the alleged negligence that occurred after the initial injury caused further harm.

Similarly, the events of October 10, 2006, cannot equate with elder abuse. Plaintiff’s claim of inadequate monitoring cannot rise to the level of reckless or conscious disregard of plaintiff’s safety; prospectively there was no way any of the staff could have known how long it would take for the transport department to transport plaintiff back to her room. Further, the nurse who was caring for plaintiff exercised his judgment in addressing her blood pressure; he did not neglect her. Plaintiff’s liability theories are based upon a retrospective analysis together with assumptions unsupported by the evidence. The argument that the should have called a physician, or that he should have taken other measures to address plaintiff’s blood pressure cannot satisfy what is required to establish a prima facie case of elder abuse by clear and convincing evidence.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/medical malpractice case and its proceedings.)

In Delaney the court went on to explain the difference between what could constitute professional negligence, as opposed to the type of neglect required to establish elder abuse, as follows:

This difference in focus can be clarified by considering the differing types of conduct with which section 15657 and MICRA are concerned. As discussed, section 15657 concerns “neglect,” “physical abuse,” and “fiduciary abuse.” Former section 15610.57 defines neglect as the negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care which a reasonable person in a like position would exercise. Neglect includes, but is not limited to, all of the following: (a) Failure to assist in personal hygiene, or in the provision of food, clothing or shelter. (b) Failure to provide medical care for physical and mental health needs. (c) Failure to protect from health and safety hazards. (d) Failure to prevent malnutrition. Thus, neglect within the meaning of former section 15610.57 appears to cover an area of misconduct distinct from “professional negligence.”

In section 15657.2: “Neglect,” as defined in former section 15610.57 and used in section 15657, does not refer to the performance of medical services in a manner inferior to “the knowledge, skill and care ordinarily possessed and employed by members of the profession in good standing” (Flowers v. Torrance Memorial Hospital Medical Center, supra, 8 Cal. 4th at p. 998), but rather to the failure of those responsible for attending to the basic needs and comforts of elderly or dependent adults, regardless of their professional standing, to carry out their custodial obligations. It is instructive that the statutory definition quoted above gives as an example of neglect not negligence in the undertaking of medical services but the more fundamental [f]ailure to provide medical care for physical and mental health needs. (20 Cal.4th, at p. 34.)

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this elder abuse/medical malpractice case and its proceedings.)

Neglect

Welfare & Institutions Code § 15610.57 defines the term neglect in the context of elder abuse as follows:

(a) Neglect means either of the following:
(1) The negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise.
(2) The negligent failure of an elder or dependent adult to exercise that degree of self care that a reasonable person in a like position would exercise.
(b) Neglect includes, but is not limited to, all of the following:
(1) Failure to assist in personal hygiene, or in the provision of food, clothing, or shelter.
(2) Failure to provide medical care for physical and mental health needs. No person shall be deemed neglected or abused for the sole reason that he or she voluntarily relies on treatment by spiritual means through prayer alone in lieu of medical treatment.
(3) Failure to protect from health and safety hazards.
(4) Failure to prevent malnutrition or dehydration.

(5) Failure of an elder or dependent adult to satisfy the needs specified in paragraphs (1) to (4), inclusive, for himself or herself as a result of poor cognitive functioning, mental limitation, substance abuse, or chronic poor health.

In Delaney v. Baker (1999) 20 Cal.4th 23, the Supreme Court addressed the difference between professional negligence and elder abuse in the context of neglect. The issue in Delaney v. Baker was whether the heightened remedies of the Elder Abuse Act could be obtained in an action against a health care provider. While the court held elder abuse could be alleged against a health care provider, the court also held the statutory framework of Welfare & Institutions Code § 15600 should not apply to situations involving mere professional negligence; the Supreme Court held something more egregious is necessary:

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