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Article:
"Anaheim nursing home fined $50,000
in patient choking death"


Original source:
http://www.ocregister.com/articles/patient-state-nursing-2070592-face-staff#

The Orange County Register

Unidentified man choked and was improperly believed to have ’do not resuscitate’ order.

BY COURTNEY PERKES
The Orange County Register

An Anaheim nursing home has been fined $50,000 in the death of a patient who choked on his dinner and did not receive "prompt emergency medical care" from paramedics because staff incorrectly believed he did not want to be resuscitated.

The discipline against Parkview Healthcare Center is the second time in recent months that state health regulators have fined an Orange County nursing home in the choking death of a patient. In April, Palm Terrace Healthcare and Rehabilitation in Laguna Hills was fined $75,000 after a patient, who was drowsy from morphine, choked on a piece of meat while eating alone in her room.

In the case involving Parkview, an unidentified man in his 40s choked to death less than a month after he was admitted last fall, according to an investigation report by the California Department of Public Health.

Cathy West, director of quality assurance for the nursing home, said Parkview has appealed the fine because they believe staff properly fed the patient and did not delay efforts to revive him.

The patient suffered from a brain injury, difficulty swallowing and partial paralysis, and could no longer safely feed himself, according to his medical records cited in the state report.

On Oct. 12, the patient choked on a piece of burrito after grabbing it from his tray at about 5:30 p.m. According to the state report, a member of the nursing staff was in the room preparing the patient’s drink at the time.

"Unfortunately he was able to grab food before a CNA could get it from him," West said. "It’s an unfortunate incident."

Staff performed the Heimlich maneuver without success. As a nursing assistant was instructed to begin CPR, a nurse left the room to check the patient’s face sheet – a summary of his health record. The face sheet incorrectly said he had a "do not resuscitate" order, according to state documents. The nurse had doubts, according to the state’s investigation, and called the man’s sister at 5:36 p.m.

The documents say the patient’s sister told state investigators that the nurse said her brother "is turning black, do you want him revived?"

The sister said yes and the nurse then called 911 and went back to the patient’s room to help with CPR, the state records show. The patient was pronounced dead at the hospital at 6:11 p.m.

The state’s report concludes by saying the nursing home failed to ensure the patient was consistently supervised during his meal or that he received prompt emergency care as called for in his advance directive document.

West disputed those findings.

"We really don’t feel it was a relevant delay because they did implement CPR," she said.

She did acknowledge that the patient’s face sheet was wrong but since then "we’ve absolutely reviewed all face sheets making sure they match the documents on the record."

Choking can occur in patients with paralysis or drowsiness because eating is more complicated than it appears, said Dr. Laura Mosqueda, a UC Irvine geriatrician.

"It’s automatic so we don’t think about it," Mosqueda said. "It really requires planning and motor skills, cognitive and physical ability. Eating is a really complicated series of events. There are a lot of muscles involved."