There were limited records as the daughter did not want to alert the nursing home that she had contacted an attorney. The preliminary review would be based on intake information and hospital records.

Christine assessed what else would provide the attorney value; he said, “let’s talk about the realities of the nursing home world, the good, the bad, and the in-between; the things I won’t find in the records.”

Christine researched the facility’s ratings, state surveys, and the related federal standards 42 CFRs (Code of Federal Regulations) and state Life Safety fire codes. The nursing home was rated 1 out of 5 on Medicare.gov, much below average. State inspection reports revealed multiple citations related to smoke deficiencies, patterns of citations, and F Tags related to residents’ safety.

Intake call information from the daughter, who was his activated healthcare power of attorney, was that her father was unattended by nursing home staff, and he suffered burns to his face while smoking with oxygen running in his nose. She alleged that nursing home staff did not provide a safe way for her father to smoke, they did not follow their own smoking policy, they did not make sure smoking materials were not in his possession or in his room, and they ignored his repeated requests for assistance with smoking.

Records available for review were a transfer record from the nursing home to the hospital, an EMS report, ED records, history & physical, physician orders, physician consult reports, physician progress notes, nursing notes, and discharge summary.

Medical record documents confirmed flash injury type burns to the face, singed eyebrows and hair in nares, several areas of superficial partial thickness burns to the cheeks with blisters. He complained of pain in his eyes. Treatment and orders included intravenous fluids, acetaminophen for pain in the ED, burn MD consult, ophthalmology consult, oxygen at 2Liters per minute with careful placement of nasal cannula.

Burn care in the hospital consisted of allowing blisters to open on their own, gentle cleansing with normal saline for open areas, and open areas to be kept uncovered. He received acetaminophen for pain. Ophthalmology consult indicated there was no injury to the eyes.

The hospital discharge summary instructions included the importance of preventing infection in the open blistered areas, to continue with same care as in the hospital, and to follow up with burn MD for any signs or symptoms of infection. The burn MD wrote that full healing is expected within three weeks.

Christine provided verbal and written education to the attorney regarding the types of injuries, mechanism of injury, authoritative clinical sources for reference, and applicable federal regulations for nursing homes (42 CFR 483) related to resident rights to be free of abuse and neglect, smoking policies, regulations pertaining to quality of care, and avoidable versus unavoidable accidents.

Christine’s opinion was based on review and analysis of intake information from the attorney, available medical records, research regarding the injuries sustained, and research regarding the facility. The nursing home had substandard ratings and a pattern of noncompliance with federal and state codes. Christine’s opinion was that the nursing home was negligent in its care of the resident; this was an avoidable injury had the resident been satisfactorily supervised by nursing home staff. However, the injuries were not extensive, and no permanent disfigurement was expected. Thus, the incident did not meet sufficient criteria for merit. The attorney agreed with Christine’s opinion that the case was nonmeritorious, and the attorney decided he would not move forward.

Christine advised the attorney that the state Life Safety code requires the nursing home to report all incidents of fire to the DQA (Division of Quality Assurance) within 72 hours. The daughter has the right to call the DQA and report the incident and should be encouraged to do so.

Christine advised the attorney that if further calls from the daughter described additional incidents of neglect and abuse, then records from the nursing home should be obtained. It would be important to obtain MDS (Minimum Data Set) documents, interdisciplinary care plans, policies related to allegations, physician and nurses’ notes, physician orders, medication and treatment records, social service notes, CNA documentation, staffing levels on dates of alleged incidents.

OUTCOMES: Goals identified in consultation with the attorney were successfully achieved. He was pleased with the written report, the verbal education regarding the nursing home environment, and the education regarding burn injuries. The attorney stated that the work Christine did exceeded his expectations.