Lawsuit Filed: Dependent Adult Man Dies at Fresno Nursing Facility; California Department of Public Health Cites and Fines Facility for Neglect
Fresno, Calif. – Danny Delafuente, a diabetic dependent adult on dialysis, was admitted to Valley Healthcare Center for rehabilitation following a below knee amputation at a local acute care hospital. The physician’s order for Delafuente indicated he was to receive dialysis on Tuesday, Thursday and Saturday at a local dialysis facility at 5 p.m. Notwithstanding this knowledge, Valley Healthcare Center failed to provide Delafuente with the medical and custodial care that he required, including failing to adhere to physician orders regarding hemodialysis treatments, promptly notify Delafuente’s physician and responsible party of changes in condition after multiple missed hemodialysis treatments and promptly transfer Delafuente after identifying his emergent medical needs. Less than four days after his admission, Delafuente died in the facility. The California Department of Public Health conducted a complaint investigation of the facility based upon the injuries suffered by Delafuente, fined the facility $20,000 and issued a Class “A” citation for failing to protect Delafuente from “neglect.”
Garcia & Artigliere filed a lawsuit against Valley Healthcare Center for elder abuse, and negligent hiring and supervision.
“Based on the California Department of Public Health’s investigation, it’s evident Valley Healthcare Center knowingly employed unfit staff, and never had any intent of providing Danny with necessary and legally required care,” said Attorney Stephen Garcia. “Class ‘A’ violations are violations which the state department determines present either imminent danger that death or serious harm to the patients or residents of the long-term health care facility would result therefrom, or substantial probability that death or serious physical harm to patients or residents of the long-term health care facility would result therefrom. The facility’s unlawful business practices caused widespread neglect of residents, most notably Danny, allowing him to suffer rapid deterioration and an untimely death.”
Allegations and Background
Upon Delafuente’s admission to Valley Healthcare Center on August 24, 2016, it’s alleged the facility was aware he suffered from significant medical conditions, including end-stage renal disease (kidney failure), dependence on renal (kidney) hemodialysis and insulin (medication to control high blood sugar) and dependent diabetes mellitus (a metabolic disease characterized by high blood sugar and usually caused by deficiency of the hormone insulin). Therefore, skilled nursing facilities, such as Valley Healthcare Center, are to not only conduct assessments of high risk residents like Delafuente, but also are to update the assessments as frequently as necessary to determine the specific interventions that should be put in place to prevent a resident from suffering further injury following any missed treatments. According to the complaint, the facility did not provide any such services or interventions to Delafuente.
Almost immediately after Delafuente’s passing, the facility’s wrongdoing was exposed by the California Department of Public Health’s (CDPH) review of his clinical record, observations of the facility and interviews of facility staff and Delafuente’s family.
During an interview by the CDPH on September 7, 2016, Delafuente’s family member stated: Danny Delafuente was an established dialysis patient and that his dialysis service was to be transferred to a more conveniently located sister dialysis facility while being treated at Valley Healthcare Center. Delafuente’s family member then stated that Delafuente was sent from the facility to the dialysis center on August 25, 2016 but returned to the facility without having received the hemodialysis treatment on that day. The facility explained to Delafuente’s family member that the reason given for sending him back to the facility without first having received dialysis was because the dialysis center needed Delafuente to have a chest x-ray done prior to receiving dialysis. Delafuente’s family member further stated when Delafuente missed his second consecutive dialysis on August 27, 2016, the facility explained that the transportation van had not picked him up at the facility for his 5:00 p.m. dialysis appointment. Delafuente’s family member also stated that his death four days after admission was completely unexpected.
During an interview by the CDPH on September 14, 2016 at 8:45 a.m., the facility’s Registered Nurse 1 (“RN 1”) stated he was assigned to care for Delafuente the night of August 27, 2016, and that Delafuente died on his shift on August 28, 2016 at 4:30 a.m. RN 1 further stated that he went out of his way to not disturb Delafuente the night he died and that he had checked Delafuente’s vital signs around 1 a.m. but had not performed a physical assessment on him as he did not want to disturb Delafuente. RN 1 then stated the information he entered on Delafuente’s into the electronic health record (EHR) on August 28, 2016 at 12:33 a.m., did not reflect the care he provided to Delafuente and he had cut and pasted the documentation from a previous entry in the EHR made by another nurse rather than information based on a physical assessment he performed himself. Then RN 1 stated on August 28, 2016 at 12:33 a.m., he had not spoken to Delafuente, listened to Delafuente’s lung sounds or asked Delafuente how he was doing and that the facility’s Registered Nurse 2 (“RN 2”) gave him a report relating to Delafuente at the beginning of his shift. RN 1 then stated he was informed that Delafuente had missed the dialysis procedure but new arrangements had been made for another day.
During an interview by the CDPH on September 14, 2016 at 8:45 a.m., RN 2 stated that he admitted Delafuente to the facility on August 24, 2016 at approximately 7:00 p.m. and that he provided care for Delafuente when he returned to the facility without having received the dialysis procedure on August 25, 2016, and again when Delafuente missed the second procedure on August 27, 2016. RN 2 then stated the transportation van did not pick up Delafuente on August 27, 2016 for his dialysis treatment. RN 2 further stated that he called the transportation company and was told all the drivers had gone home for the day, and that he knew Delafuente missed two consecutively scheduled dialysis treatments. RN 2 also stated he had not notified Delafuente’s physician of the two missed dialysis treatments and that he should have.
The CDPH detailed findings from their inspection of the facility substantiating the allegations relating to the facility’s noncompliance with federal regulations in their dealings with Delafuente in a Summary Statement of Deficiencies and Plan of Correction dated January 6, 2016, a copy of which is included with the complaint as “Exhibit 1.”