Lay Testimony Is Enough to Establish Abuse of Nursing Home Patients - Stone v. Missouri Dept. of Health Services
As a Pennsylvania nursing home lawyer, I frequently use witnesses to abusive behavior at nursing homes when my cases go to trial. Those witnesses are not always experts in what constitutes abuse; they are simply the people who happened to be nearby when the incident occurred. So I was interested to see a recent ruling from the Missouri Supreme Court saying the testimony of a non-expert witness is enough to prove that a nurse knowingly abused a patient. In Stone v. Missouri Department of Health Services, the complaint was actually from the nurse, Catherine Ann Stone, who was appealing a temporary disqualification from working that stemmed from allegations that she abused a patient.
Stone was a charge nurse at a nursing home; part of her job was to dispense medication to patients who needed it. In the incident underlying her case, she had to give medication to K.S., a female patient with dementia and mental disabilities who was known to become agitated and violent when receiving mediation. The instructions for K.S. said to leave her alone if this happened and try again later. On this occasion, after K.S. knocked a spoon away from her mouth and hit Stone in the shoulder, Stone asked a nursing assistant to restrain the arm. Stone then forced the spoon into the patient's mouth, pushing her head forcefully against the back of a wheelchair. A dietary aide who witnessed this said K.S. was upset and crying, and took steps to calm her down rather than remove her from the dining room, as Stone instructed.
The dietary and nursing aides reported the incident and Stone was suspended, then fired. The incident was also reported to the state, which concluded that the incident was abuse and Stone would be disqualified from working as a nurse in Missouri for 18 months. Stone filed an administrative appeal, which she lost. She then appealed to state trial court, which reversed the decision, saying expert testimony was needed to show that K.S. suffered any physical or emotional harm. The state appealed.
The Supreme Court started by noting that the "injury or harm" necessary to find abuse is not defined by the statute or caselaw. However, previous nursing home abuse decisions had established that there is a low threshold for finding injury or harm, and that the mere fact of striking a patient necessarily involves injury or harm. In those decisions, expert testimony was not necessary. The same applies here, the Supreme Court said. Laypeople may testify as to what they experienced, and no special expertise is necessary to determine whether someone with mental disabilities is suffering. The court also found that Stone committed the abuse knowingly, because a reasonable person would have known that it would be emotionally distressing for K.S. to be held down and force-fed her medication, especially because she was known not to like her medication. Thus, the Supreme Court reversed the trial court and authorized the state to disqualify Stone from nursing for 18 months.
As a Philadelphia injury lawyer, I believe the court was right to find that a lay witness is enough to establish whether an action constituted abuse of a person with dementia. I believe most people would be emotionally distressed if they were physically held down and force-fed medication. A person with mental disabilities is not likely to feel differently about it, although it may be harder for that person to express it. In fact, judging by the facts laid out in this opinion, K.S. reacted with clear signs of fear and distress: screaming, crying and attempts to move away. Improper restraints are a clear type of Pennsylvania nursing home abuse, because they restrict the patient's liberty and autonomy for the convenience of the nursing home's staff. As a Philadelphia medical malpractice lawyer, I believe nursing homes can and should do better, even if it requires them to take a little more care.