Medication Error

Wrong Insulin Dose, Other Neglect Results In $1.05 Million Nursing Home Verdict
By Gregory Froom

The estate of a diabetic woman whose blood sugar plummeted after she was injected with another patient’s insulin has won a $1.05 million verdict against the Upstate nursing home where she resided.

The estate claimed that the 85-year-old patient suffered increased dementia after an incorrect insulin dose administered by nursing home staff sent her into hypoglycemic shock, or extremely low blood sugar.

A Spartanburg County jury ordered the facility, White Oak Manor, to pay the woman’s estate $50,000 in actual damages and $1 million in punitives. The verdict was handed down in November.

The case is Clark v. White Oak Manor, Court of Common Pleas No. 04-CP-42-1932. Judge J. Derham Cole presided at trial.

The plaintiff’s attorney, Gary W. Poliakoff of Spartanburg, said the jury’s finding that White Oak Manor was reckless in its treatment of the patient made the punitive award permissible.

Spartanburg lawyer Matthew A. Henderson, who represented White Oak Manor, said he did not believe the facts justified punitives.

“I didn’t see then — and even though the jury saw it — I don’t see now any basis for punitive damages. Willful, reckless and wanton is normally the standard. There was sloppiness, yes — negligence, admitted. But a basis for punitives? I don’t see it,” Henderson told Lawyers Weekly.

The incorrect insulin dose that the nursing home administered to the woman was but one episode in a pattern of substandard care during her stay at the facility, according to Poliakoff.

“During the entire trial we continued to harp on the ongoing, numerous acts of neglect over the entire six months [she was at the home],” he said.

“We tried to try it not as a mistake occurring one day, one time — but ongoing neglect,” Poliakoff said.

“We placed a lot of emphasis on this long series of failures and neglect — some of them minor situations, but still matters of neglect. These included several long-term fecal impactions, five falls, numerous occasions of exceeding blood sugar levels without action, instances of dehydration, dramatic weight-loss and similar problems,” Poliakoff said.

The key instance of insufficient care happened on May 2, 2004, when White Oak’s staff gave the woman another patient’s insulin shot on top of her own oral diabetes medication, according to the plaintiff’s case report.

The extra insulin plunged the woman into hypoglycemic shock.

“She was in shock for several days. The defendants maintained that this was an act of simple negligence and that after several days she was at the same level of medical problems as previously,” Poliakoff said.

“There was a big dispute over that at trial. We maintained that she had early to moderate dementia before, and she had severe dementia afterwards,” he said.

“The defendant argued that she had advanced dementia before and the same level of dementia after,” according to Poliakoff.

The woman died about 15 months after she was given the extra insulin injection.

“She clearly had medical problems. She had two broken hips in the past, some level of dementia, diabetes, a heart condition and a variety of other medical problems,” Poliakoff said.

“But that’s what nursing homes are for, to take patients with medical problems,” he said.

The plaintiff and the defendant each put on experts to testify as to whether — and how much — the patient’s mental condition changed as a result of the low blood sugar incident.

The plaintiff’s expert opined that the woman suffered brain damage while she was in hypoglycemic shock. The defendant’s medical expert said he thought that her dementia was unaffected by the incident.

After the verdict was handed down, the defendant filed post-trial motions to reduce the verdict and the punitive damage award.

Poliakoff said he believes the punitives should be upheld, even though they were 20 times greater than the actual damage award.

The facts of the case met the requirements for punitives as set out in Gamble v. Stevenson, 305 S.C. 104, 406 S.E.2d 350 (1991), he said. The ratio of actuals to punitives should be upheld under the U.S. Supreme Court’s decision in State Farm Mut. Auto. Ins. Co. v. Campbell, 538 U.S. 408, 123 S.Ct. 1513 (2003), according to Poliakoff.

Henderson, the nursing home’s attorney, disagreed.

“We’re looking at a factor of 20, and courts around the country often find that to be perhaps too great a spread. I’m guardedly optimistic that the trial court or an appellate court will perhaps see it my way even though the jury didn’t,” he said.

— Questions or comments may be directed to the writer at greg.froom@sc.lawyersweekly.com.