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  1. #1
    baesmile1 is offline Junior Member
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    Do I have a case? PEG tube misplacement

    What is the name of your state? Virginia

    I am wondering if I have a case. I have consulted with an attorney, and talked with several nurses not in this direct field, who all think that there is a case. Long story short - my brother, 31, had muscular dystrophy and lost all on command muscle movement including talking and swallowing. He had a PEG tube placed for feeding purposes and was able to communicate by moving his head as we called out the alphabet. He was not mentally impaired in any way. He entered into a nursing home on 4/15 and got the PEG tube on 6/4. On 7/12 he got his hand caught on the tube and pulled it out.

    Following pulling the tube out, the nurse placed a "button" in the site, and later inserted a foley catheter. This all appears to be normal, although the nurse faxed the dr, asking if they should replace or send to gastroenterology for replacement. The dr responded via fax "OK to try" The foley was replaced, however no testing to determine correct placement was done. At this time, feedings were resumed, actually increased by the dr from 4 cans to 6 cans/day this same day. Immediately upon the nourishment feeding, he began moaning in pain - 2 hours following this, he was taken to the emergency room.

    Upon arrival, it was not thought that there was a surgical emergency. However, 5 hours later 2 doctors indicated that they had confirmed placement was in the peritoneal cavity rather than the stomach, and that emergency surgery was needed in order to remove the infection (Peritonitis).

    8 days later he passed away, his death certificate and the death/discharge summary list peritonitis as the cause along with cardiac failure. Prior to this, he had some heart issues, but not this same type. His disease was characteristic of thickening of the walls of the heart, and it was documented in his semi-annual dr appts that his heart was stable with medication.

    I am concerned because I have checked and the nursing home has a clear record with no incidents for this time period. Also - I complained about having to pay the holding fee on top of the hospital bill, as I was the person responsible for payment, and the nursing home & I got into a verbal dispute about this. I initially send something about a lawyer, and then did not pursue any further communication direct with the nursing home. The same day, the director of risk management for the health care chain (hospital, nursing home all the same) called me and within the week I was advised not to pay any bill I received. To me, that was an admission of wrong doing.

    The lawyer that I have met with has advised that I will be charged approximately 2000 for a consultation with a medical expert to determine if a case can be filed. I am hoping someone will know if this seems to be a case. My gut tells me I have basis, but I am not educated completely on this, however I have found information indicating that placement must be checked and documented to ensure proper placement, this was not done in the medical records.

    Thank you in advance for any assistance.
  2. #2
    notsmartmark is offline Member
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    Was it Duchenne's muscular dystrophy?
  3. #3
    baesmile1 is offline Junior Member
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    No, he had Friedrichs Ataxia.
  4. #4
    rmet4nzkx is offline Senior Member
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    Please consult a medmal attorney who handles medmal or pI lawsuits all the time, they will have the resources to research the lawsuit for your family.
  5. #5
    baesmile1 is offline Junior Member
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    Does this mean that you think there is substance for a case? Just checking. Was not sure if anyone had more information on these types of cases, and if just not checking placement would be considered medmal. Thanks!
  6. #6
    rmet4nzkx is offline Senior Member
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    Quote Originally Posted by baesmile1
    Does this mean that you think there is substance for a case? Just checking. Was not sure if anyone had more information on these types of cases, and if just not checking placement would be considered medmal. Thanks!
    There are several issues that is why I said to consult a medmal or PI attorney who can determine the merit of the case. One issue of course will be the prognosis of the patient when these evens began.
  7. #7
    panzertanker is offline Senior Member
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    Quote Originally Posted by baesmile1
    Does this mean that you think there is substance for a case? Just checking. Was not sure if anyone had more information on these types of cases, and if just not checking placement would be considered medmal. Thanks!
    The reason you need a medmal consult is b/c a thorough review of the medical records will be needed to ascertain if any deviation from the standard of care occurred.
    There are specific checks to perform that ensure correct PEG tube placement, and these should have been charted.
    PEG tubes can/ARE replaced without x-ray verification ALL the time, but, placement is verified through other means.
    Re-placing a PEG tube without an x-ray is NOT grounds for malpractice...
    I have noticed that even intelligent people ask assinine questions every now and again.
    Disclaimer: I know a few lawyers. None of them is named panzertanker.
  8. #8
    baesmile1 is offline Junior Member
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    Thank you for your help. I agree that these can be replaced bedside without xray, however, there is an aspiration test and a ph test that can & should be conducted to verify correct placement. Neither of these were charted as being done, the only indication around the replacement is that when the foley catheter was inserted, the patient "tolerated well". I feel that in talking to the director of risk mgmnt for the health system, they admitted there was negligence when they relieved me of all charges, even prior charges incurred at the nursing home, and the hospital bill. I am just trying to determine if it is something that I should pursue without having to spend the initial 2500 expert review.

    Thanks again for your help.
  9. #9
    ellencee is offline Senior Member
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    Quote Originally Posted by baesmile1
    What is the name of your state? Virginia

    I am wondering if I have a case. I have consulted with an attorney, and talked with several nurses not in this direct field, who all think that there is a case. Long story short - my brother, 31, had muscular dystrophy and lost all on command muscle movement including talking and swallowing. He had a PEG tube placed for feeding purposes and was able to communicate by moving his head as we called out the alphabet. He was not mentally impaired in any way. He entered into a nursing home on 4/15 and got the PEG tube on 6/4. On 7/12 he got his hand caught on the tube and pulled it out.

    Following pulling the tube out, the nurse placed a "button" in the site, and later inserted a foley catheter. This all appears to be normal, although the nurse faxed the dr, asking if they should replace or send to gastroenterology for replacement. The dr responded via fax "OK to try" The foley was replaced, however no testing to determine correct placement was done. At this time, feedings were resumed, actually increased by the dr from 4 cans to 6 cans/day this same day. Immediately upon the nourishment feeding, he began moaning in pain - 2 hours following this, he was taken to the emergency room.

    Upon arrival, it was not thought that there was a surgical emergency. However, 5 hours later 2 doctors indicated that they had confirmed placement was in the peritoneal cavity rather than the stomach, and that emergency surgery was needed in order to remove the infection (Peritonitis).

    8 days later he passed away, his death certificate and the death/discharge summary list peritonitis as the cause along with cardiac failure. Prior to this, he had some heart issues, but not this same type. His disease was characteristic of thickening of the walls of the heart, and it was documented in his semi-annual dr appts that his heart was stable with medication.

    I am concerned because I have checked and the nursing home has a clear record with no incidents for this time period. Also - I complained about having to pay the holding fee on top of the hospital bill, as I was the person responsible for payment, and the nursing home & I got into a verbal dispute about this. I initially send something about a lawyer, and then did not pursue any further communication direct with the nursing home. The same day, the director of risk management for the health care chain (hospital, nursing home all the same) called me and within the week I was advised not to pay any bill I received. To me, that was an admission of wrong doing.

    The lawyer that I have met with has advised that I will be charged approximately 2000 for a consultation with a medical expert to determine if a case can be filed. I am hoping someone will know if this seems to be a case. My gut tells me I have basis, but I am not educated completely on this, however I have found information indicating that placement must be checked and documented to ensure proper placement, this was not done in the medical records.

    Thank you in advance for any assistance.
    When a PEG tube is pulled out, the proper response is to place a button in the hole through which the tube exited. Only an RN who has met all qualifications for and demonstrated competence in PEG tube replacement can insert a device other than the button into the hole for the PEG tube.

    In your description of events, the proper response would have been to place the button, contact the primary (attending) physician and get a consult with specialized procedures and, or the surgeon (gastroenterologist) who placed the PEG tube.

    The surgeon who places the PEG tube determines when the patient will begin to receive feedings via the PEG tube. Routine and usual procedure is to start using the PEG tube immediately in smaller increments and progressing to full strength and maximum rate.

    The Nursing Home appears justified in billing you. The Nursing Home appears to have caused your brother to incur significant damages that would not have occurred but for the professional malpractice by the RNs and the physician who gave orders for the nurses to insert a foley into the stoma when a simple phone call to the enterogastrologist would have prevented any damage from occurring.

    Go for it.
    EC
    Last edited by ellencee; 02-28-2006 at 10:20 PM.
  10. #10
    baesmile1 is offline Junior Member
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    I have contacted several lawyers, and it seems that there is a little difference in who wants to look into it further, and who declines representation. One of the lawyers always goes to court, and does not allow settlement and they felt as though a jury trial would be difficult as they will look into life expectancy, and quality of life at the time of injury. I am just wondering, as one attorney suggested writing a letter to the hospital/nursing home, and pursuing a settlement that way. As the exectuor of the estate, can I sue on the grounds of the pain in which he suffered? I do not meet with the other lawyer until next Thursday, and am very curious which grounds I should be looking into. I have met with one lawyer who is willing to take the case, and am waiting for a few others to call me back.

    Thanks again for all of your help!
  11. #11
    rmet4nzkx is offline Senior Member
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    Quote Originally Posted by baesmile1
    I have contacted several lawyers, and it seems that there is a little difference in who wants to look into it further, and who declines representation. One of the lawyers always goes to court, and does not allow settlement and they felt as though a jury trial would be difficult as they will look into life expectancy, and quality of life at the time of injury. I am just wondering, as one attorney suggested writing a letter to the hospital/nursing home, and pursuing a settlement that way. As the exectuor of the estate, can I sue on the grounds of the pain in which he suffered? I do not meet with the other lawyer until next Thursday, and am very curious which grounds I should be looking into. I have met with one lawyer who is willing to take the case, and am waiting for a few others to call me back.

    Thanks again for all of your help!
    You are welcome, keep us updated.
  12. #12
    ellencee is offline Senior Member
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    Quote Originally Posted by baesmile1
    I have contacted several lawyers, and it seems that there is a little difference in who wants to look into it further, and who declines representation. One of the lawyers always goes to court, and does not allow settlement and they felt as though a jury trial would be difficult as they will look into life expectancy, and quality of life at the time of injury. I am just wondering, as one attorney suggested writing a letter to the hospital/nursing home, and pursuing a settlement that way. As the exectuor of the estate, can I sue on the grounds of the pain in which he suffered? I do not meet with the other lawyer until next Thursday, and am very curious which grounds I should be looking into. I have met with one lawyer who is willing to take the case, and am waiting for a few others to call me back.

    Thanks again for all of your help!
    The attorneys will tell you on which 'grounds' you may sue. Wrongful death seems the most likely form of medical malpractice that applies to your claim. I may be mistaken, but I believe the injured party's pain and suffering can not be a separate damage from wrongful death.

    Life expectancy and quality of life are issues that will affect any potential award but I believe that a jury would not be in favor of two or more licensed medical professionals that chose to exceed their respective scopes of practice rather than make a simple telephone call to the appropriate resource.

    The facility's policy and procedure manual will have PEG tube care and interventions. The job descriptions for the nurses should include qualifications for PEG tube management.

    Your state's Center for Medicare and Medicaid will have the standards of care that apply to SNF management of PEG tubes.

    Your claim does not have the potential for a huge award; keep your expectations reasonable.

    EC
  13. #13
    ellencee is offline Senior Member
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    [url]http://www.hhs.gov/dab/decisions/cr922.html[/url]
    This document contains the standards of care required by Medicaid and Medicare for the management of PEG tubes in Nursing Homes. The article deals primarily with new PEG tubes, but the standards listed are appropriate for PEG tubes that are not "new". The article describes the same physical damages as were suffered by the OP's brother.

    For those who wish to skip the article: after calling the physician and talking with the PA who directed the RN to replace the PEG tube and in a later conversation added "or send the patient to the ER" to the directions, one or more RNs replaced a PEG tube that was pulled out by the resident of the Nursing Home in the above-reference article. The patient's condition deteriorated, the patient was admitted to the hospital where it was discovered the feeding was going into the peritoneal cavity. The patient was septic and died. The Nursing Home was fined $10,000 and appealed. This article is the decision regarding the appeal. The actions of the PA, the RNs, and the Nursing Home were found to be below the acceptable standards of care and the $10,000 fine was upheld.

    EC
  14. #14
    baesmile1 is offline Junior Member
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    Thanks again for great information. Few questions... Do I have the right to ask for the manual of procedures? Is this public information, or would the state Medicare have this, or only the state information? I see your note regarding keeping my expectations reasonable. To be completely honest, it is not about the money to me - I know that people say that all the time, but it really is not. I would be donating to MDA. I am curious though if the cost of the lawyer, etc would be worth the type of claim I would make. Does this make sense? I know that noone would be able to say what amount, but expectation wise what range? In the event that the lawyer did not take the case based on a % of payout - I am also facing having to pay the 2000-2500 charge for the medical review. I just cant afford to put too much into this without at least recovering what I put in. I will pursue the complaint regardless, but just cannot determine what I am looking at as far as what I will be charged and if it will be worth it. At the same time, it is hard to place a monetary value on any of it to me.
  15. #15
    baesmile1 is offline Junior Member
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    I forgot to add one other thing. The nurse did check with the doctor - she faxed to him when the tube came out initially. The fax states... "Pulled out G-tube today. Replaced 15fr/5cc foley cath is this ok or should we send over to gastrointerology to replace on he already had? Call ASAP" The doctor's written response on the fax is "OK to try - thanks"

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