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 About Adam Peck

Adam J. Peck, ESQ is a principal with Peck Law Group, APC. In 2008, Mr. Adam Peck received his Juris Doctorate from Whittier Law School where he graduated Cum Laude. His practice is primarily dedicated to representing Elders, Dependent Adults, along with their loved ones and family members, who have suffered horrific personal injuries.

Managing Agent in an Acute Care Facility

The final element to prove in any elder abuse case in the State of California is that a managing agent knew of, ratified, or is personally guilty of the reckless conduct indicates Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck.

In an acute care facility, look to who created the policies and procedures, who was responsible for insuring that the nursing staff knew, understood, and applied the policies and procedures, who decided the staffing levels for the units on which your client was a patient, who trained the staff on the proper use of beds and mattresses, etc.

Helpfully, the only published opinion that discusses the element of managing agent in an elder abuse case is regarding elder abuse in an acute care facility. See Marron, supra, 108 Cal.App. 4th 1049. The court in Marron found that a nursing supervisor in a hospital is a managing agent.

Recklessness in an Acute Care Facility

As in a skilled nursing facility, reckless conduct certainly occurs in the acute care setting and in many of the same ways, such as poor training and understaffing says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Below is a short outline of specific areas of potentially reckless conduct that plaintiffs’ attorney should watch for in an elder abuse case against an acute care facility.

Failure to Follow Policies and Procedures:

The policies and procedures from an acute care facility often provide a wealth of information. Make the effort and take the time to fully familiarize yourself with the hospital’s and / or skilled nursing facilities policies and procedures regarding patient care, skin care, wound prevention and wound care, lift teams, beds and mattresses, and any other policies which may affect the care that was provided to your client. In depositions, one should ask each nurse, wound nurse, and supervisor about his or her familiarity with the policies and procedures. Look through the medical records carefully. It is quite likely that the care provided to your client grossly failed to meet the hospital’s own policies and procedures on numerous occasions and, in fact, the care providers were not even familiar with the policies and procedures. indicates Los Angeles Elder Abuse Lawyer Steven Peck.

Regularly, nurses fail to request a consultation when it was required; Skin assessments are not completed on a regular basis; Wounds are not cared for as required by the policies and procedures; and Charting is wholly inadequate pursuant to the policies. Ask your expert and you may very well learn that had the hospital followed its own policies, the injury most likely would not have occurred. Failure to follow policies and procedures and failure to ensure that the nursing staff is familiar with the policies and procedures constitutes recklessness, in that the individuals involved knew that there was a high probability that this conduct would cause harm and knowingly disregarded this risk

Failure to Properly Train Nurses:

The nurses’ failure to understand and have knowledge of the hospital’s policies and procedures is one example of a failure to properly train the nursing staff. Independent of the policies and procedures, you may also discover that the nurses do not have a complete understanding of skin care and wound prevention. Their provision of care may fall below the standard of care. As in cases against skilled nursing facilities, request and review the in-service training offered by the hospital.

Failure to Provide Adequate Staffing Levels:

As in a skilled nursing facility, an acute care facility will also sacrifice adequate staffing levels for budgetary concerns. You may find that your client required three people to turn him, but that it was difficult, if not impossible to find three available people in the ICU to perform this repositioning every two hours. Hospitals also often employ Wound, Ostomy, and Continence nurses (“wound nurse”). While there is no legal staffing requirement for wound nurses, the hospital itself may have budgeted for one or more wound nurses and determined a medical need for one or more wound nurses. Yet, despite this determination, the hospital may fail to staff at this level.

Failure to Place Patient on the Correct Bed or Mattress and/or False Reliance on a Mattress:

A major, recurring issue in these cases is the bed and/or mattress on which the patient was placed. Certain beds and mattresses are used for lung therapy, others are recommended for pressure-relief and pressure-reduction. Hospitals and their staff often confuse the two. Many of these beds and mattress overlays rotate the patient from side to side. Many nurses mistakenly believe that this constitutes “repositioning” and record such “repositioning” in the medical chart. This is incorrect and illustrates, again, the poor training provided to the nursing staff. Many experts will explain that bed rotation is not a replacement for manual repositioning every two hours.

Elder Abuse Concerns Custodial Neglect That Causes Bed Sores says California Nursing Home Abuse and Neglect Attorney Steven Peck

As previously noted, a major step in an elder abuse case against an acute care facility is educating the various players that the neglectful acts at issue are custodial in nature, rather than professional says San Franscisco Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Three seminal California cases on custodial neglect provide a strong starting point for this educational process and help dispel the defense argument that the development of a decubitus ulcer, for example, cannot rise to the level of custodial neglect under Welfare and Institutions Code §15610 et seq. In all three cases the courts held that the development of a decubitus ulcer was sufficient to constitute custodial neglect.

For example, the Covenant Care case dealt with the development of a Stage IV pressure ulcer. Plaintiffs in that case alleged that the decedent was left lying in his bed, unattended and unassisted for excessively long periods of time; he developed ulcers on his body that exposed muscle and bone and became septic. (Covenant Care, Inc. v. Superior Court (2004) 32 Cal.4th 771, 772.) The court held that under those facts, the plaintiffs had sufficiently alleged a cause of action under Welfare and Institutions Code §15610 et seq.

In Delaney, plaintiffs alleged that the health care providers allowed the decedent’s serious pressure ulcers to occur and worsen. It was also alleged that there were violations of medical monitoring and that plaintiff was not adequately turned and was neglected. (Delaney v. Baker (1999) 20 Cal.4th 23, 27-28.) Based on these allegations, the court stated that there “was substantial evidence that defendant’s failed, over an extended period of time, to attend to her advanced bedsores, and otherwise neglected her in such a way to contribute to her pain and suffering and eventual death, which was determined to be reckless, given defendants’ knowledge of decedents’ deteriorating condition and plaintiff’s repeated efforts to intervene in her mother’s behalf.” (Id. at 41.)

And in another seminal case on elder abuse, Mack v. Soung (2000) 80 Cal.App.4th 966, also involved the development of a decubitus ulcer. In this case as well, the court found that plaintiffs had sufficiently alleged a cause of action for custodial neglect under Welfare and Institutions Code §15610 et seq.

Most often, a decubitus ulcer case against an acute care facility will contain facts that are nearly identical to the facts identified in the above-referenced cases. Though this may seem obvious, point this out to the defense attorneys. Draw the logical conclusion – as in the cases discussed above, the acts and omissions of the defendant hospital, skilled nursing facility, long term care facility, that resulted in the development of decubitus ulcers constitute custodial neglect under Welfare and Institutions Code §15610 et seq.