A La Jolla nursing home faces a large fine after a state department determined its poor care of a 79-year-old woman caused her death.
La Jolla Nursing and Rehabilitation Center on Torrey Pines Road received the most severe citation from the California Department of Health Services after the Jan. 18 death of a woman who was living at the facility. The department issued a "AA" citation to the home for failing to follow physician's orders on administering the medication he had prescribed the patient.
According to a Department of Health Services report, the nursing home did not conduct daily blood tests mandated by the physician to monitor the patient's response to the medication Coumadin, which prevents blood clots.
The patient was readmitted to the nursing home on Dec. 23, 2005, after receiving care in the hospital for fever, cough and shortness of breath. Her medical history included dementia, breast cancer, cerebrovascular accident, gout, diabetes and chronic atrial fibrillation. Upon her readmission to the nursing home, the patient's physician ordered her to receive 10 milligrams of Coumadin.
The adverse effects of Coumadin can include hemorrhaging from any tissue or organ. Daily blood tests are required in conjunction with the medication's use to monitor the patient's response to therapy and minimize the risk of internal bleeding.
The state's review of the patient's records found that 10 milligrams of Coumadin was administered for 23 days from the time the patient was readmitted to the nursing home until Jan. 16. The state found no lab reports to indicate that blood testing was done over that period of time. Though the nursing staff's patient care plan noted an "increased potential for bleeding secondary to the use of anti-coagulant," there was no evidence the tests were performed.
The Department of Health Services interviewed two nurses who had helped care for the patient. One stated she had not performed lab tests before administering the medication on Dec. 30. A second nurse stated that she had checked test results when administering Coumadin on Dec. 23, 24, 27 and 28, but the state department found that the values she had checked were from Dec. 15 and 19. Those tests were taken during the patient's hospital stay prior to returning to the nursing home and were not applicable to the ongoing Coumadin therapy.
On the afternoon of Jan. 17, the records from the nursing home indicate that the patient's condition had worsened. A nurse found the patient dry-heaving and pale. In an interview with the Department of Health, one of the nurses said the patient's vomit was bloody.
The patient was transferred to a hospital emergency room and treated for massive bleeding into the brain. Laboratory tests to evaluate the coagulating factors in the patient's blood could not be measured because of excessive anticoagulation levels. Hospital physicians concluded that the patient died do to interventricular hemorraghe and excessive anticoagulation levels.
Patti Roberts of the Department of Health Services said the investigation for the case is ongoing and that La Jolla Nursing and Rehabilitation Center has the chance to appeal. The center released a statement saying it would conduct its own thorough investigation before deciding whether or not to appeal the citation. The citation carries a $94,000 fine, which the home would not have to pay until any appeal is resolved.
Roberts said the state issues about a dozen "AA" citations each year. The citation can only be given in cases where a patient death is involved.
"It is our most serious citation," Roberts said. "Our main concern is putting into place rules and regulations so it doesn't happen again."
The Department of Health's report includes a plan of correction for the nursing home that includes measures such as creating a color-coded guide for Coumadin therapy, keeping a log of residents on Coumadin and better educating staff on anti-coagulant therapy and blood monitoring.
The organization California Advocates for Nursing Homes provides a checklist for people choosing a nursing home with specific information about what to look for when visiting a home. They can also help patients obtain information about homes they are considering. Visit their Web site at www.canhr.org.