Some states require any potential professional negligence case to undergo a review by a medical panel before being filed in state court. This process ensures that only cases meeting the criteria for professional negligence are pursued, thus preventing unfounded malpractice claims.
Louisiana is one such state that requires the involvement of a medical review panel before filing a professional negligence case. In cases where a plaintiff files a lawsuit without first requesting a medical review panel, the defendant has the option to raise a "prematurity" exception to the lawsuit.
This allows the defendant to challenge whether the plaintiff is entitled to proceed with the court suit.
In the following case, the question arose as to whether the requirements of the medical review panel were met when a nursing home resident's wife filed a lawsuit following her husband's death from sepsis. Here, I explore the case and the impact of the prematurity exception.
Facts of the case
The wife’s husband was a resident of the nursing home for about 11 months. Her husband died one day after discharge due to sepsis that was allegedly caused by decubiti.
The widow submitted a request for a medical review panel (MRP). Roughly one month following the MRP request, the widow proceeded to file a lawsuit against the nursing home, its administrator, the director of nursing (DON), and the assistant director of nursing (ADON).
In the lawsuit, the widow made several allegations against the defendants. She claimed their conduct and failure to take appropriate action in caring for her husband violated the applicable standards of care, and that their actions resulted in both intentional and negligent infliction of emotional distress.
The widow said her husband suffered from incontinence and required frequent diaper changes. Despite her husband’s requests to have his diapers changed, they were not changed in a timely manner.
In addition, she said her husband’s skin condition and decubiti were not properly monitored despite the nursing home’s knowledge of decubitus wounds on his buttocks.
She also stated that these negligent acts and omissions caused her deceased husband “pain and suffering, emotional anguish, mental distress, humiliation, embarrassment, and indignity.” In addition, the failure to change the diapers when needed and to carefully monitor his skin and decubiti caused a “degradation of his overall health, infection, sepsis, and death.”
The widow alleged that this conduct was due to the facility's rationing of diapers. A former certified nursing assistant (CNA), who worked at the nursing home while the deceased husband resided there, provided testimony confirming the existence of a "diaper rationing system."
The CNA testified she believed the system was in place to save money. The diapers were stored in a locked room, requiring staff members to get permission from either the DON or the ADON in order to access them. Once staff obtained the diapers, the key to the room had to be immediately returned to either the DON or ADON.
However, there was no spare key to use to access the storage room when the DON or ADON were unavailable. Therefore, staff members had to attempt to reach them at their homes, which wasn't always possible. As a consequence, staff was forced to resort to using bed sheets or blankets as makeshift diapers. Staff supervisors were allegedly fully aware of this practice.
The defendants filed for a prematurity exception and, despite the circumstances of the case, the trial court upheld the exception, resulting in the dismissal of the widow's lawsuit without prejudice. This type of dismissal allowed her to refile the lawsuit at a later time.
The widow filed an appeal challenging the decision, specifically contesting the dismissal of claims related to the neglect of her immobile and incontinent husband's diapering, changing, and hygiene.
Appellate court ruling
After a thorough review of state case law, the Louisiana Medical Malpractice Act, and the review panel requirements the court determined that the widow's claims pertaining to the violation of her husband's dignity, encompassing his physical discomfort, embarrassment, emotional distress, and loss of personal dignity could proceed in her existing lawsuit.
The court concluded that these claims did not necessitate expert testimony regarding the breach of standards of care and therefore were not required to be reviewed by the MRP.
Nevertheless, the court determined that all claims related to wounds, infections, medical treatment, sepsis, and death must be referred to the MRP. These claims should be supported by medical expert opinion, particularly regarding sepsis as a contributing factor in the husband's death, which allegedly resulted from the lack of care provided by the nursing home staff.
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