Falls and keeping elderly nursing home residents safe

February 9, 2015, by

For most families who have already experienced the traumatic effect of having to place their loved one in a nursing home, they are too often familiar with the dangers associated with falls. Between 30% and 40% of all people over the age of 65 in some form of a long-term care facility will fall within a given calendar year. This number increases to 50% for residents who are 80 years or older. This means that, on average, 50% of all long-term care facility residents will fall each year. These falls often result in injury to the resident and sometimes those injuries are catastrophic.

In fact, the injuries that result from falls are so severe that they account for 62% of all emergency room visits for those 65 years of age or older. A major issue associated with falls is the generalized belief among healthcare professionals in nursing homes that falls are unavoidable and an inevitable part of the aging process. This erroneous belief is alarming for two reasons: 1) complications from falls are the leading cause of death in those older than 65, and 2) falls are manageable and preventable.

Upon admission to a nursing home, an elderly resident should be assessed for his or her risk of falls. This assessment should take into account the resident's history of falls, difficulties in gait and balance, medications, and any preexisting illnesses or diseases. Should a resident experience a fall after admission, the facility and its employees should treat this occurrence as a "Significant Change of Condition." Significant changes of condition in residents require that a resident be reevaluated and an updated/modified plan of care be instituted for that patient. Interventions to be implemented upon evaluation of this significant change of condition can include: bed mats, bed alarms, wheelchair alarms, walking assistive devices such as a cane or walker, modification of medication dosages, and the requirement that residents have a staff member assist them when moving about. When nursing homes fail to update the resident care plan or acknowledge that a significant change of medical condition has occurred it can result in a deviation from the standard of care. Negligence in regard to resident falls are extremely common because of understaffing in the facilities and inadequate education of the staff on how to address falls.

After the fall has occurred, it is also critical that nursing homes determine the root cause of the fall. Unfortunately, the main cause of the fall is often ignored or not investigated by the staff. This leads to recurrence of falls in these elderly adults and often times can leave families of the resident confused as to why their loved one is severely injured or has passed away. Families of these nursing home residents are entitled to know why their family member fell and what interventions have been implemented to reduce the risk and occurrence of falls in the future. They are also entitled to notice when a significant change of condition has occurred. Increasingly, long-term care facilities do not inform families of an elderly resident's fall, especially when injuries are not readily apparent to the staff. Most nursing homes run by a corporate enterprise have detailed procedures in place for effectively communicating falls to families and treating the falls. These procedures are usually instituted in compliance with state and federal laws regarding the standard of care owed to residents. These procedures promote a safe environment. When these policies are violated, long-term care facilities can be held accountable for injuries to a resident and in the worst of cases, their untimely death.

Key Points:

- The nursing home has a duty to keep elderly residents safe.
- Falls in a nursing home can seriously injure and/or kill an elderly resident.
- Falls are preventable.


Kiel, Douglas P. "Falls: Prevention in Community-dwelling Older Persons." UpToDate. Wolters Kluwer Health, 25 Feb. 2014. Web. 21 Nov. 2014.

Kiel, Douglas P. "Falls in Older Persons: Risk Factors and Patient Evaluation." UpToDate. Wolters Kluwer Health, 29 July 2014. Web. 21 Nov. 2014.

Malnutrition in the Elderly

January 7, 2015, by

Malnutrition is a widespread problem in most long-term care facilities. A 2013 study using the Mini Nutritional Assessment found that 60.2% of nursing home residents studied were categorized as malnourished. Another study found that 71% of elderly adults who were hospitalized met the criteria for malnutrition or were malnourished. For the elderly, weight loss associated with malnutrition can have serious negative consequences to overall health and is often times predictive of mortality because it is more difficult for these elderly patients with other comorbidities to recover from the effects.

Nutritional needs of elderly residents and patients are determined by multiple factors. They include: the level of activity, energy expenditure, and the necessary caloric intake, as well as personal food preference, underlying diagnoses such as diabetes, and a resident's ability to chew and digest food. A commonly accepted definition of clinically important weight loss is a loss of 4 to 5 percent of total body weight over a six to twelve month period.

Because malnutrition is such a common problem in nursing homes, it is vital that health care professionals in these facilities regularly monitor residents for symptoms of malnourishment and adjust their diets as required. An initial evaluation of a resident's nutritional status should be conducted on any resident who is noted to have lost weight. The healthcare professionals should:

• Document the weight loss/gains regularly;
• Order an evaluation of appetite and dietary intake by nutritionists within the facility;
• Determine if there has been a change in hunger such as number of meals consumed, amount of food consumed, portion size, and whether or not the resident feels full;
• Perform a complete history and physical examination and order the necessary labs for a resident; and
• Order any subsequent evaluations should the resident's nutritional status fail to improve.

In performing evaluations of these residents, healthcare professionals should consider any preexisting comorbidities or other factors that may be affecting a resident's loss of appetite. Comorbidities that directly affect nutritional status can include: depression, dementia, congestive heart failure, COPD, Parkinson disease, Alzheimer's, and dysphagia. Furthermore, numerous medications that are regularly prescribed to older adults can adversely affect their diet. These medications can include: Digoxin, Lortab, Percocet, Lexapro, Zoloft, diuretics for high blood pressure, and Topomax for use with treating seizures.

Comorbidities combined with medications, loss of energy, and difficulty chewing put these elderly residents at high risk for malnourishment. It is critical that healthcare professionals in the long-term care setting detect and treat these issues early on as they can have serious consequences on a resident's quality of life. Nurses and CNAs who are in daily contact with these residents are in the best position to detect changes in a resident's diet and unusual weight loss. The standard of care requires that these healthcare professionals recognize the signs associated with malnourishment and take an active role in reducing the effects and treating the issue by documenting the weight loss, ordering a nutritional evaluation, adhering to dietary recommendations (including nutritional supplements such as shakes) for the residents, and updating care plans to reflect the change in condition.


Ritchie, M.D., Christine. "Geriatric Nutrition: Nutritional Issues in Older Adults." UpToDate. Wolters Kluwer Health, 10 July 2014. Web. 20 Nov. 2014.

Stange, I., K. Poeschl, C.C. Sieber, and D. Volkert. "Screening for Malnutrition in Nursing Home Residents: Comparison of Different Risk Markers and Their Association to Functional Impairment." National Center for Biotechnology Information. 1 Apr. 2014. Web. 21 Nov. 2014.

Pressure Sores

November 24, 2014, by

Pressure sores, also known as decubitus ulcers or even more commonly as bedsores, develop when continuous pressure to certain areas of the body begins to breakdown the skin because of decreased mobility. Pressure sores develop most commonly over bony prominences of the body such as the sacrum, a triangular bone at the base of the spine and at the upper, back part of the pelvic cavity. They can sometimes develop underneath casts, splints, or cervical collars. Approximately sixty percent (60%) of pressure ulcers develop in the area of the pelvis.

Although decreased mobility resulting in continuous pressure to these areas is the most common cause of sores, other factors can also increase the risk of development in adults. These factors include: malnutrition, obesity, decreased sensory perception, decreased activity, friction and shear, increased moisture, increased age, smoking, emotional stress, and skin temperature.

So, how do pressure sores play into nursing home abuse? Decreased mobility in elderly residents and hospital patients combined with other factors can put these people at high risk for developing pressure sores. If left untreated or undiagnosed, pressure sores can be extremely harmful and even deadly. Deviations from the standard of care or negligence for these residents and/or hospitalized patients include failure to properly treat these pressure sores; failure to properly diagnose these pressure sores; failure to properly assess these pressure sores under certain measurement scales; and failure to modify or change the plan of care when a pressure ulcer develops.

Residents of nursing homes and patients hospitalized for extended lengths of time need to be evaluated under The Braden Scale or Norton scale, which are two important tools used to determine who is at risk for developing pressure sores and how high that risk may be. The Braden Scale is the more common of the two and is used in the long-term care setting. Six subscales measure sensory perception, skin moisture, physical activity, nutritional intake, friction and shear, and ability to change and control body position. Patients or residents who score a 12 or below on the Braden scale are considered at high or severe risk of developing pressure sores.

Treatment of pressure sores varies depending on the stage that a sore is scaled at the facility. It is extremely important that nurses, doctors, and CNAs identify pressure sores, skin tears, or blisters that could lead to pressure sores during an admission. It is also imperative that care providers properly scale pressure sores and change the care of plan as they develop or worsen. There are five stages of pressure sores: Stage I, Stage II, Stage III, and Stage IV. There is also an "unstageable" pressure sore. After a pressure sore develops beyond stage IV, it is considered unstageable and is highly dangerous to the patient or resident's health. It is highly susceptible to infection. Interventions in preventing pressure sores from developing include: frequent repositioning, incontinence care, and utilizing support surfaces. Usually, any pressure sore that develops to Stage III or beyond requires surgical interventions such as debridement, which is removal of dead or damaged and infected tissue.

Doctors, nurses, certified nursing assistants (CNAs) and other staff employed by nursing homes and hospitals have a duty to meet the national standard of care when diagnosing and treating pressure sores. For instance, the standard of care requires that nurses assess, diagnose, plan, and evaluate every patient on every shift. The standard of care also requires that patients be evaluated using the Braden or Norton scales for their risk of skin breakdown by assessing each of the six subscales. The standard of care further requires that nurses and/or staff be knowledgeable as to wound care prevention, diagnosis, and treatment through continuing education such as in-services. Furthermore, the standard of care requires that nurses and CNAs implement the interventions and treatment that doctor's and wound care nurse's orders for each patient. When these doctors, nurses, CNAs, and other staff deviate from the standard of care it can be harmful to the overall health of a patient or resident and in some cases deadly.

At Ragland & Jones, LLP, we have handled many nursing home and hospital cases throughout Georgia where an elderly loved one was neglected and unfortunately developed pressure sores. Most pressure sores are preventable and with proper care can heal if they do develop.

Overuse of Psychotropic Medications in the Elderly

October 14, 2014, by

The excessive use of psychotropic medications among the elderly has been an ongoing battle as nursing homes become more prevalent. With the passing of the Omnibus Budget Reconciliation Act (OBRA) of 1987, the federal government attempted to limit the use of these medications by citing facilities under 42 CFR 483.25(l) for failure to ensure that each resident's drug regimen was free from unnecessary drugs. Specifically, this regulation sought to limit the use of excessive doses of medications for excessive durations without adequate monitoring. However, the government's effectiveness in regulating their use has fallen short of success.

So, what makes the overuse of these medications so deadly? A main reason for limiting the use of these medications in elderly residents is to prevent the occurrence of side effects. Many residents in long-term care facilities are battling mental disorders and these medications are a way to treat various episodic events.

However, these psychotropic medications are often used as a chemical restraint on these elderly residents in situations that do not warrant their use. A chemical restraint is "the use of a drug to control an individual's behavior and is legally appropriate only if used to ensure the physical safety of residents or other individuals." 42 CFR 483.13(a) mandates freedom for every resident from medically unnecessary physical or chemical restraints imposed for purposes of discipline or convenience. OBRA mandates the restriction of these medications for chemical restraint purposes because the risk to elderly residents is a high one.

Studies have shown that most residents receive at least one psychotropic medication and they are often administered without an appropriate diagnosis by physicians and without proper monitoring by the facility staff. Recognizing the side effects of these medications at the onset is the most critical stage in the prevention of harm to the resident, particularly in preventing the deterioration of mental function and falls.

Psychotropic medications place the elderly at an even higher risk of fall because dizziness is a common side effect of these medications and is often experienced when a resident changes position. Many times, residents are unaccompanied by nursing home staff thereby resulting in dangerous and deadly falls.

The Federal Drug Administration (FDA) has gone so far as to issue a Public Health Advisory for atypical antipsychotic medications such as Risperdal, Clozapine, and Zyprexa. The FDA determined that death rates are much higher for elderly people with dementia taking these medications. Unfortunately, the use of these medications is quite common in the nursing home arena and many residents are administered at least one of these atypical medications.

In conclusion, the elderly are often chemically restrained by use of these psychotropic medications when it is unwarranted by their condition. Furthermore, these medications are overused and monitored inappropriately by the staff of nursing homes. These violations of the standard of care place the elderly at risk of falls, complications from overdose, and an untimely death. Overuse of these medications is yet another form of elderly abuse. Limiting their use in the nursing home setting, providing appropriate dosages, and properly monitoring residents for side effects are effective ways to limit the negative consequences associated with these medications.


Gillick, MD, Muriel, and Mark Yurkofsky, MD. "Medical Care of the Nursing Home Patient in the United States." Medical Care of the Nursing Home Patient in the United States. Wolters Kluwer Health, 13 Aug. 2014. Web. 14 Oct. 2014.

"Mental Health Medications." National Institute of Mental Health. U.S. Department of Health and Human Services, 2010. Web. 14 Oct. 2014.

Infectious Outbreaks in Nursing Homes

October 13, 2014, by

Long-term care facilities are at a high risk of endangering the lives of their residents when they fail to properly control infectious diseases. Residents are confined to small spaces and often their daily living activities occur in groups. Furthermore, the elderly are particularly vulnerable in that many of their immune systems are already fighting other diseases. This vulnerability makes it difficult to diagnose infections in the elderly early on and in turn this delays prevention and treatment. It is estimated that infections contribute to sixty-three percent (63%) of deaths in long-term care facilities and are the primary reason for twenty-five to fifty percent of transfers of the elderly to hospitals. The Center for Disease Control estimates that one to three million serious infections occur every year at these facilities including: urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections and many others. It is estimated that as many as 380,000 elderly residents who develop these serious infections will die.

Nursing Homes are required to have an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. Under the infection control program, the nursing home is required to investigate, control, and prevent infection. 42 C.F.R. § 483.65.

Evan Jones has settled a case against a Georgia long-term care facility that failed to properly control and prevent the spread of multiple infectious diseases including: Group A Streptococcus, which later developed into necrotizing fasciitis. This is essentially a "flesh eating" bacteria. As a result of this infection spread within the facility, five residents developed the infection and three of the five residents passed away, including our client's family member. By April, three healthcare works and thirteen other residents had developed the infection according to the infection control log. A review of the facility records revealed that the nursing staff of this long-term care facility were improperly trained and instructed in recognizing signs and symptoms of these types of infections. Furthermore, they were unable to effectively control the spread of these infections through specific isolation control techniques (standard precautions may include gloves, masks, gowns, etc.)

Unfortunately, lack of training and understaffing are commonplace among these long-term care facilities. They are also contributing causes to the high mortality rate among the elderly who develop these infections.

Currently, Evan is pursuing legal action against another Georgia facility exhibiting similar characteristics in their prevention, control, and treatment of Clostridium difficile colitis, or "C. diff." C. diff is a condition that develops when bacteria within a person's body begins to release toxins that attack the lining of the intestines. C. diff most commonly affects residents of long-term care facilities and hospitals. It is typically a treatable condition, however when it is left undiagnosed and untreated by these long-term care facilities, it becomes a life-threatening condition to the elderly. Failing to properly diagnose and treat these infectious diseases is a violation of the standard of care of long-term care facilities.

In conclusion, the elderly are often immunosuppressed and susceptible to infection. Infectious outbreaks can have deadly consequences but can be prevented with a timely diagnosis, proper care, and infectious control techniques that apply to all healthcare providers, family, and visitors.


1. Richards, Michael, and Rhonda Stuart. "Principles of Infection Control in Long-term Care Facilities." UpToDate. Wolters Kluwer Health, 14 Nov. 2013. Web. 10 Oct. 2014.

Arbitration and the Elderly

October 8, 2014, by

Many nursing homes and assisted living/personal care homes are requiring family members and residents to sign Arbitration Agreements as a condition of residency. An arbitration agreement essentially is a contract between the family and the facility whereby any dispute including violations of federal, state law, and incidents of malpractice are decided by an arbitrator and/or an arbitration panel. The family and resident agree to waive their constitutional right to trial by jury. Often, the agreement also specifies that arbitration should also be conducted by a list of persons who defend or support nursing homes.

The arbitration agreement is inherently unfair, and "one-sided" so it should never be signed. If a nursing home attempts to require a resident, family member, or a person with a valid general power of attorney to sign, refuse to do so and immediately go to another facility. It cannot be made a condition of residency under Georgia Law.

Evan Jones has been very successful in having courts across Georgia declare that arbitration agreements are inherently unfair, unconscionable, and void as a matter of law. However, a recent trend has been that in Georgia and nationally, arbitration agreements have been upheld and a nursing home and/or assisted living, personal care home case has been removed from court and a trial by jury to arbitration panel.

Evan Jones has also been successful at trying cases in arbitration. Recently, in 2013, he tried a case in arbitration against a national chain and was awarded a $617,295.24 verdict. This amount may be the largest arbitration award in a nursing home abuse case in the State of Georgia . Unfortunately, most arbitration awards are much lower than what a jury would award under the same circumstances.

This particular arbitration involved an elderly woman who was roughly handled and/or abused by nursing home employees. Furthermore, twenty-one (21) depositions were taken. Thousands of documents were produced and four years of litigation ensued. The nursing home never voluntarily produced any documents and never offered to settle the case. It only carried $25,000 in insurance which is less than most people personally carry for car insurance.

Evan hired a renowned orthopedic/trauma surgeon at Vanderbilt University; a professor of family practice (with added qualifications in Geriatrics) at Morehouse University; the DeKalb County Medical Examiner; and a nurse in Tampa, Florida to serve as experts in the case. He also interviewed and obtained favorable testimony from the treating orthopedist, local hospitalist, and the Fulton County Medical Examiner. Through the discovery process, Evan learned that this particular nursing home had a pattern and practice of physically abusing residents and then would try and "cover" it up. Evan presented this evidence at arbitration and also evidence that the nursing home staff had fraudulently and falsely created records that demonstrated that the severely injured resident was able to walk and shower. However, she was lying in her bed in tremendous pain with comminuted (crushed) fractures of both of her legs. She later developed respiratory distress and had trouble breathing because of fat emboli as a result of the fractures. The fractures ultimately led to her death.

The nursing home never admitted the fraud, misconduct, or pattern of abuse. It tried to argue that the fractures developed during the paramedic's transfer to the hospital, or from sitting down on a "toilet top." Luckily, the evidence and testimony against the nursing home was overwhelming. The arbitrator was experienced and fair. He found for the resident's daughter and awarded the $617,295.24. The nursing home chain has since declared bankruptcy.

Polypharmacy --- Too Many Medications

October 7, 2014, by

As stated in our previous blog, Polypharmacy occurs often in cases that we have reviewed against nursing homes and assisted living facilities. According to medical literature, polypharmacy impacts the elderly in the following ways:

Older individuals are at greater risk for adverse drug events due to metabolic changes and decreased drug clearance associated with aging; this risk is compounded by increasing numbers of drugs used.
Polypharmacy increases the potential for drug-drug interactions and for prescription of potentially inappropriate medications. [Weng MC, Tsai CF, Sheu KL, et al. The impact of number of drugs prescribed on the risk of potentially inappropriate medication among outpatient older adults with chronic diseases. QJM 2013; 106:1009.].
Polypharmacy was an independent risk factor for hip fractures in older adults in one case-control study, although the number of drugs may have been an indicator of higher likelihood of exposure to specific types of drugs associated with falls (eg, CNS active drugs). [Lai SW, Liao KF, Liao CC, et al. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine (Baltimore) 2010; 89:295.].
Polypharmacy increases the possibility of "prescribing cascades" [Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997; 315:1096.]. A prescribing cascade develops when an adverse drug event is misinterpreted as a new medical condition and additional drug therapy is then prescribed to treat this medical condition.
Use of multiple medications can lead to problems with medication adherence, compounded by visual or cognitive compromise in many older adults.

Polypharmacy is so prevalent in nursing homes that it requires that all care providers continuously review a resident's medication regimen and that they have a thorough understanding of the side effects of each and every medication. Any significant change of condition in the resident's medical condition could be the result of polypharmacy. If a loved one has suffered from a fall, change in behavior, developed a sudden delirium, or developed nutritional problems, consider that the root cause may be polypharmacy.

Rochon, MD, MPH, FRCPC, Paula. "Drug Prescribing for Older Adults." UpToDate. Wolters Kluwer Health, 28 Mar. 2014. Web. 7 Oct. 2014.

Medication Errors have Deadly Consequences

October 6, 2014, by

Medication errors occur frequently in nursing homes and personal care homes. We have handled cases where the elderly resident received the wrong medication or too much medication. Often, medication errors can lead to adverse reactions such as falls, impaired cognition, and even depressive disorders.

In nursing homes and/or assisted living facilities, it is important for family members to closely monitor their loved ones medication regimen. In nursing homes and assisted living, the care provider has a duty to notify the attending physician of any significant change in an elderly resident's condition because of an adverse reaction to medication error. Additionally, each medication administered must be written in the Medication Administration Record (MAR). Unfortunately, miscommunication between care providers often occurs and leads to injury or even death. In other words, the care provider fails to communicate to the family and/or physician that a particular medication has caused a significant change in the resident's condition.

In a case we settled recently, the nursing home mistakenly gave one of its residents a nitroglycerine paste which caused the resident to develop hypotension (low blood pressure) which resulted in a severe fall and his subsequent death. Furthermore, this particular nursing home had long-standing systemic issues regarding medication errors which caused the serious injury and/or deaths of several of its residents. It had a duty to ensure that its residents were free from any significant medication errors. 42 C.F. R. § 483.25 (M)(2). It violated this federal regulation and also failed to communicate this mistake to the family and attending physician. As a result, a beloved family member died prematurely.

"Polypharmacy" is also a rising issue in nursing homes which leads to resident injury and/or death. Polypharmacy is when the care provider gives the elderly resident too many or multiple medications. Elderly residents often have many pre-existing illnesses or medical conditions that require multiple medications. Many times, all of these medications together cause adverse reactions. We have handled many nursing home cases where polypharmacy caused the resident to fall resulting in the resident's death.

It is important for family members to understand what types of medications are being given on a daily basis to their elderly loved one. This knowledge can prevent a catastrophic outcome.


September 30, 2014, by

Elderly residents are prone to unattended and/or unsafe wandering known as elopement. Elopement frequently occurs in nursing homes and assisted living and/or person care homes. Residents can elope within the facility or even leave and wander several miles from the facility. It can be prevented.

Risk factors for elopement can include Dementia, Alzheimer's, polypharmacy (too many medications), or a change in living environment.

An elopement can be very dangerous and can lead to serious injuries or even the death of an elderly resident. Residents have been known to wander throughout the facility and fall off of loading docks or even wander outside of the facility and wander into unknown areas where they are at further risk to dehydration, malnutrition, hypothermia, and heat exhaustion.

An assisted living/personal care home and/or a nursing home has a duty to create a safe environment for a resident. Part of creating that safe environment is identifying those residents who are at risk for elopement. A care plan should be created to protect that resident. Additionally, the nursing home and/or assisted living/personal care home needs to have a "safety plan" that ensures that every door is properly locked and that exits to outside the facility have functioning alarms. Residents who have a tendency to wander need to be checked on more frequently. Any significant change in the resident's condition, such as increased confusion, needs to be reported directly to the attending physician.

An elopement can be prevented with proper care.

A Preventable Killer: The Risk of Ignoring Suicidal Warning Signs

September 23, 2014, by

The subject of this blog entry focuses on the standard of care of psychiatrists in the State of Georgia and the duty owed to their patients under the law.

Mental illness has a long history of stigmatization in the United States. Non-profit organizations, advocacy groups, and others too often overlook the mentally ill. The mentally ill have been shuffled from institution to institution, never being made to feel that they have a home or a support system. They too often receive the minimum care available and are not properly treated by their physicians. The general public misunderstands mental illnesses and the stigma surrounding these illnesses often forces those suffering from them to be outcast in their communities.

Mental illness is a common contributing factor to suicide, another stigmatization in our society, and the total suicide rates in the United States far exceed the death tolls from war, murder, and AIDS. 30,000 Americans die each year from suicide and nearly 765,000 Americans attempt it, which means every 17 minutes in America someone will take their own life. Unfortunately, the stigma surrounding mental illness and suicide means the issue is blatantly ignored. This in turn means that the public is extremely misinformed about the issues. The truth is; with suicide being the third leading cause of death among Americans aged 15 to 24, society as a whole can't afford to ignore the effects of mental illness any longer. Suicide is one of the most preventable killers, but until we train more effective healthcare professionals and educate the general public on basic warnings, myths, and facts about suicide it will remain in the forefront of causes of death. C.C. Risenhoover, The Suicide Lawyers 111-14 (2004).

Our firm filed suit on behalf of our client and the conservator of her estate for catastrophic injuries she sustained in a 2005 suicide attempt in. Dating back to 2001, our client had an extensive history of mental illness. It was in 2001 that she became a patient of the defendant psychiatrist in this case. After several hospitalizations and commitments to a group home, the Defendant diagnosed our client with severe major depressive disorder and several other disorders on August 26, 2005. Three days later, our client was discharged from the group home either at her own request or for "administrative reasons." During her stay, our client never received a suicide or self-injury risk assessment, nor did she receive an adequate psychiatric evaluation from the Defendant. She was never considered for hospitalization even though she was admitted to the group home because of clinical instability and danger of suicide. Just two short days after our client was discharged, she poured gasoline over herself and set herself on fire sustaining irreversible injuries.

The defendant psychiatrist moved for summary judgment in the case, meaning he argued that there was no genuine issue as to any material facts and therefore he was not liable. In his motion to the court, he argued that he had no control over our client at the time she attempted suicide and because he lacked the necessary control over her as a patient, he had no affirmative duty under the standard of care to prevent her suicide attempt and subsequently was not liable for any resulting harm to her.

The trial court denied his motion for summary judgment and the Defendant appealed to the Georgia Court of Appeals.

The Georgia Court of Appeals found that a psychiatrist who treats a patient on a voluntary, outpatient basis could be held liable for that patient's injuries in a suicide attempt if the psychiatrist's failure to involuntary commit the patient fell below the requisite standard of care and that failure proximately caused the patient's injury. Peterson v. Reeves, 315 Ga. App. 370, 370-78 (Ga. Ct. App. 2012), cert. denied, 727 S.E.2d 171.

The Court of Appeals expounded upon this holding by stating that the General Assembly in 2011 made clear that patients receiving treatment for mental illness should receive care and treatment that is suited to their needs and nothing in the Code section relieves any physician, including psychiatrists, from liability for failing to meet the applicable standard of care. The Court goes on to state that while the Defendant had no duty to guarantee that his patient did not attempt suicide, he had a long-recognized duty inherent in the doctor-patient relationship to exercise the applicable degree of care and skill in the treatment of his patient.

Later the Court stressed that just because a psychiatrist's patient is not hospitalized at the time of his or her suicide attempt, the psychiatrist can still be held liable for failing to meet the standard of care.

The holding in Reeves v. Peterson is critical to medical malpractice claims involving psychiatry because Georgia case law, prior to this ruling, was ambiguous as to whether an affirmative duty was owed to a non-hospitalized, psychiatric patient who harms himself or herself. Although the Court's ruling created no new "duty to commit," it did assert the finding that psychiatrists, just like any other physician, can be held liable when their failure to commit a patient or their treatment of that patient falls below the requisite standard of care in the profession and proximately causes injury to the patient.

Courts across the country have been able to use the holding and reasoning from this case in molding their own standards in psychiatric cases including the Supreme Court of Rhode Island. Almonte v. Kurl, 46 A.3d 1, aff'd, (R.I. 2012). The conclusions of law were also noted in secondary sources such as Terence Campbell & Demothenes Lorandos, Cross Examining Experts in Behavioral Sciences (2013).

In sum, there are several important conclusions to be drawn from the holding in this case:

• Psychiatrists, like any other physicians, are now held accountable when their failure to commit a patient leads to injury, if it is shown that their treatment fell below the applicable standard of care;
• psychiatrists owe a duty to their patients to perform an adequate psychiatric evaluation, conduct a suicide and self-injury risk assessment, and properly consider patients for hospitalization when it is warranted;
• psychiatrists owe a duty to their patients to properly medicate and treat their condition; and
• psychiatrists cannot claim that merely because their patients were not hospitalized at the time they committed or attempted suicide, they are not liable for their patient's injuries or death.


April 17, 2014, by

Choking is a common occurrence in Nursing Homes. Nursing Homes and their staff have a duty under the standard of care to prevent an elderly resident from choking on his or her food. It can be prevented with proper care. Many nursing home residents have been diagnosed with Alzheimer's/Dementia, Parkinson's, and have suffered a prior stroke. These residents often suffer from dysphagia, or "difficulty swallowing."

Upon admission, the Nursing Home has a duty to have the resident evaluated by a speech pathologist who can perform swallowing studies and a dietitian who may have to change the resident's meals to "soft" or "pureed," to prevent choking.

Evan Jones has prosecuted several choking cases in the past few years. Each time, the nursing home failed to place the resident on the appropriate diet. The resident choked on a piece of steak and asphyxiated. These deaths could have been prevented with proper care and proper speech and dieting evaluation.


March 3, 2014, by

Falls occur in nursing homes. Falls can increase with age. Falls can be prevented. Bed alarms, floor mats, toileting plans, and regular nursing observations and an appropriate care plan can prevent falls. The nursing home has the duty under federal law, state law, and the standard of care to protect elderly residents from falling.

Falls can result in serious injury and even death to a family's loved one. Often falls lead to fractures, less mobility, and other problems such as skin break down, pressure sores, bleeding, and increased confusion.

I represent families across the state of Georgia because the nursing home failed to prevent the fall from occurring. Often these failures are the result of understaffing, undertraining, and corporate misconduct. Many times, the nursing home care providers simply do not have enough time during their 8 hour shift to prevent an elderly resident from falling. When an elderly resident falls, more care is needed and the nursing home must change the resident's care plan after a thorough evaluation.

Making Nursing Homes a Safer Place

February 20, 2014, by

Throughout Georgia our elderly are being mistreated and abused. Elderly residents are living in dangerous environments. Their Resident Rights, Quality of Life, and Dignity are being trampled upon. Just in the past year alone, I have prosecuted Nursing homes who have seriously injured or even killed elderly residents by putting "profits over people." Nursing Homes have intentionally cut their support staff such as certified nursing assistants (CNAs) and nurses, to save money. Unfortunately, this understaffing means less attention and care to a family's loved one but more corporate profits. As a result, deadly falls have occurred. Residents have developed infected bed sores, and some have died from malnutrition, and dehydration. I prosecute these cases and hold the wrongdoers accountable. Hopefully, one day, through these efforts, Nursing Homes will be safer places for our elderly and loved ones.

Understaffed, Undertrained, Underpaid

December 17, 2013, by

One would think that with the many state and Federal laws enacted to guarantee that nursing home residents and patients experience a certain quality of life, they would be treated with dignity and given the care they deserve. Right?

Unfortunately many of those laws have been poorly written and inadequately enforced. As a consequence, instances of abuse and malpractice border on epidemic proportions, including shoddy wound care, dehydration, malnutrition, infection, falls and unacceptable treatment of skin maladies.

There are numerous reasons for this, but one remains consistently at the forefront: At many nursing homes the system for treatment is based on care being provided by the least trained and lowest paid members of the facility's staff.

In many of the nursing homes I have visited, Certified Nursing Assistants handle most of the daily care of residents. Typical CNAs have the least training of all the staff people in the facility, yet they are the ones charged with the oversight of patients at the most dangerous time - at night.

Recently I handled a deposition involving a nursing home that had only two staff people on the premises at night to care for 60 residents. Even if they were fully trained, there is no way two people could adequately respond to the needs of that many elderly people.

In this particular case, a bed alarm and floor mats had not been utilized as an aged woman's care plan required. The care plan is the medical playbook for each resident. The mats and bed alarm were not provided, even those she had a history of numerous falls.

The woman suffered a serious injury and died, an obvious case of sheer neglect.

There are laudable exceptions of course, but many of the nursing homes I have encountered through my practice of law are chronically understaffed. My job as an attorney representing victims of gross neglect is not just to seek a proper settlement, but also to help in bringing about positive changes through the sheer pressure of economics.

In my next post I'll tell you about a common nursing home practice in which you, unknowingly, can literally be signing your or your loved one's life away.

Understanding the Problem from Both Sides

December 17, 2013, by

When the time comes to find a nursing home for a family member, loved one or even ourselves, our rightful expectation is to select a place that provides appropriate care and assures that prompt attention will be received whenever needs arise. Sadly, too often that is not the case.

Even though the nursing home industry is highly regulated by state and Federal laws, there remains a desperate need to improve conditions in many of the centers dedicated to the aging and infirm.

I'm one of the few attorneys in the state of Georgia that has observed legal issues at nursing homes from both sides. For a number of years I actually defended nursing homes in a variety of cases, so I know the inner workings of those care facilities. It was actually as a result of those experiences that I felt impressed to switch sides, so to speak, and represent people that had victimized by what I realized is a very broken system.

With Baby Boomers aging and every day joining the growing list of potential nursing home residents and patients, the problems I've seen will only intensify without legal measures forcing corrective action.

I've been practicing law since June 1991, the first four years serving in the U.S. Army as a member of the JAG Corps as both prosecutor and trial counsel.

In that role I served with a number of elite units, including the 7th Infantry Division, the 3rd/325 Airborne Battalion, and 173rd Airborne Brigade. The training and experience I gained in prosecuting military cases helped lead me professionally to where I am today.

After being honorably discharged, over the next eight years I was with two different law firms in insurance defense, representing physicians, hospitals and nursing homes. Then I embarked on a solo law practice for 18 months, during which time I went to court on behalf of victims of nursing home malpractice for the first time. This was in January 2003, representing a family that lost a loved one who had died after becoming injured in a care facility.

In the summer of 2004, Danny Ragland and I joined as partners in the firm of Ragland & Jones, LLC, where my primary areas of emphasis have been nursing homes and medical malpractice.

Over the coming weeks I'll be using this blog to discuss some of the systemic problems I've seen in nursing homes, reasons for them, and what steps you can take legally to ensure your loved ones receive the proper care you expect and are treated with the dignity they deserve.