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ManorCare Slapped with $10M Lawsuit

July 18, 2002

Not only is ManorCare Health Services of Fair Oaks under state investigation, but it's been slapped with a $10 million civil suit by a Fairfax man contending that medical malpractice by the nursing home caused his grandfather's "wrongful" death.

"I just don't want anyone else to go through this," said Darren Davis, whose grandfather, Richard Whitfield Tompkins Jr., died Jan. 13 at Inova Fair Oaks Hospital, after being rushed there by ambulance from the nursing home. "My grandfather never needed anyone and, at this time of his life when he needed help, he wasn't receiving it."

A widower after 55 years of marriage, Tompkins, 83, lived with his daughter Donna Davis (Darren's mother), of Fairfax Station's Wolf Run Shoals community. On Dec. 12, he suffered a stroke rendering him paralyzed on the right side and needing tube-feeding and rehabilitation, after being released Dec. 27 from Fair Oaks.

"That was the only reason he needed to go to ManorCare," said his grandson. "[His death] was the last thing any of us expected. We figured ... he'd be home in a month or two."

Instead, according to the motion for judgment filed July 9 in Fairfax County Circuit Court, Tompkins "suffered appalling conditions in the last several weeks of his life, culminating in his death."

He had no breathing problems when he entered ManorCare, but the medical examiner reported his cause of death as "upper airway obstruction due to mucoid impaction."

ManorCare spokeswoman Julie Beckert said the facility "did provide appropriate care for [him] and our internal investigations and documentation will confirm this. We are disputing the state's initial findings. ManorCare is committed to providing quality care to the residents they serve."

HOWEVER, FAMILY MEMBERS and the Virginia Department of Health say otherwise. An adjudication officer with the Health Department should rule within 30 days whether the state investigation's conclusions are founded and ManorCare should be punished.

In Tompkins' case, by the time rescue personnel from the Fair Oaks Fire Station received a 911 call from the facility on Jan. 13, he was running a 103.6 fever and was in severe respiratory distress. A state inspection report on ManorCare says a paramedic found Tompkins alone in his room and in such bad condition that his supervisor advised him to report it to police as a case of possible neglect.

According to the lawsuit, because ManorCare staff had allegedly not given Tompkins any oral care "for at least several days," so much mucous had built up and hardened in his throat that the emergency-room doctor at Fair Oaks was unable to successfully insert a breathing tube into him. Instead, he had to perform a tracheotomy. But Tompkins had a heart attack and died in the emergency room.

That physician reportedly told the state inspector that, when Tompkins arrived in the emergency room, he had a generalized body infection and was "struggling to breathe." According to the state report, "The physician said he removed the endotracheal tube that had been inserted by emergency personnel because it was clogged. He stated that, when he tried to reinsert the tube, the [patient's] epiglottis 'broke in half.' The physician [said] that [Tompkins'] tongue was like 'shoe leather' and that none of the tissue in his [throat] was viable."

But Tompkins' family says he had no such problems at the outset. The lawsuit states that, when Tompkins first went to ManorCare, it planned to assist him with "all activities of daily living." These included feeding him through a tube, bathing him, attending to his toilet functions and taking measures to prevent pressure sores or other illnesses or injuries during his stay.

Yet the suit alleges that — despite complaints from Tompkins' family to staff — nurses' notes indicate that he "often went several hours without treatment, supervision or assistance of any kind." The suit also states that the reportedly "scant records" kept by the ManorCare staff treating him included two feeding-instruction sheets "marked with the same date, initialed by two different nurses, containing entirely inconsistent information."

The suit says Tompkins' charts don't mention treatment for a pressure sore — found beneath his spinal column when he was admitted — until Jan. 8, some 13 days later. Also according to the suit, his chart contained several notations, between Jan. 9-13, regarding his labored breathing, "but no indications that [his] physician was apprised of this condition, nor [that] any treatment [was] rendered."

ON JAN. 13, ManorCare called 911.

"Upon arrival, emergency personnel were shocked to find [Tompkins] completely unattended, having extreme difficulty breathing, [feverish], with an ineffective nebulizing mask over his mouth," the lawsuit states. "Emergency personnel were further appalled to note [his] lips were dry and cracked ... and his [body condition indicated he] had not been bathed, shaved or cared for in several days."

A paramedic later told the state inspector that Tompkins "smelled bad, like he hadn't had a bath in a week," the state report says. It also quotes the paramedic as saying, "[Tompkins'] tongue looked like a 'fried potato' and the entire inside of his mouth and tongue, as well as around his mouth, were coated with a thick, yellow crust."

According to the report, the paramedic said that he and his co-worker intubated him (placed a tube through his mouth or nose to his throat to help him breathe). But during the procedure, he said, the tube hit what turned out to be a loosened part of Tompkins' tongue.

The lawsuit charges that ManorCare "failed to provide adequate hygiene care" and that Tompkins' children "would often find [his] urine catheter overflowing on the floor of [his] room." Furthermore, although his records contained no notations that he was to be restrained, when family members visited him Dec. 29, the suit states, they reportedly found his left wrist tied to a bed rail by a rope-style bracelet.

According to the suit: "[Tompkins'] call bell was located on the right side of his bed and — given that he was paralyzed on his right side and his left hand was tied to the bed rail — he was unable to call for help."

Citing a "conscious disregard for [his] safety and wellbeing," the lawsuit alleges that Tompkins' death was caused by a combination of "nursing home negligence, inattention and outright neglect." The family says ManorCare had a duty to provide the care Tompkins needed and not "mistreat" and "abuse" him.

AS A RESULT, says the suit, he "suffered the discomfort and shame associated with day after day of an utter absence of basic personal and oral hygiene of any kind." Furthermore, it says that, according to the emergency-room physician, Tompkins "appeared to be cognizant of his surroundings and remained so until shortly before his death."

The state inspection conducted Jan. 15-28 found several deficiencies and concluded that ManorCare failed to prohibit "mistreatment, neglect and abuse" of Tompkins and two other patients. The report also noted that ManorCare staff "failed to stay with [Tompkins] after calling 911 and failed to provide appropriate mouth care."

The state further concluded that ManorCare "failed to provide care and serves [for Tompkins and three other patients] that allowed them to maintain their highest practicable sense of physical and/or mental wellbeing." The state also found deficiencies in other patient-care areas and in the meals provided.