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Chronic Understaffing in Nursing Facilities: Punitive Damages

Camay Williams brought a wrongful death and survival action against Willow Terrace and Albert Einstein Health Network on behalf o f Marcel Mackey, claiming that various healthcare workers were negligent in their care and treatment of Marcel.

Marcel was a very sickly man when he entered the care of these hospital providers in 2007 complaining of thirst and incontinence. He had a history of two above the knee amputations, diabetes, multiple strokes, dementia and various other maladies. While he was at the hospital he developed a pressure ulcer on his sacrum. When he was transferred to a long-term care hospital it was noted that there was an infection in the ulcer. Marcel was eventually transferred to Willow Terrace and had several brief admissions to Albert Einstein Medical Center (AEMC). The admission to AEMC noted dehydration, malnutrition, pneumonia, worsening of the ulcer, poor hygiene, and infections.

Marcel passed away a little over a year after his initial admission. His death certificate lists, among other things, severe end stage ulcer. Camay argued that substandard care, staffing, assessments, oversight, and administration, led to Marcel’s death.

The jury awarded Camay punitive damages in the amount of $500,000 finding that the facilities’ conduct was willful or wanton, or exhibited reckless indifference to the rights of the deceased. Punitive damages are meant to punish the defendant for outrageous conduct and serve as a deterrent to the defendant and others who may engage in similar conduct. The defendants in this case appealed the punitive damage award stating that the evidence presented fell short of the minimum required to warrant consideration of punitive damages.

Camay called several employees of Willow Terrance and AEMC to testify during the trial. The employees testified that Marcel was supposed to be repositioned every two hours and note it in his chart or his ulcer wound would worsen. There were portions of his chart, which were silent on repositioning, for example in the month of August there were 33 eight-hour shifts with no mention of repositioning. Multiple employees complained of chronic understaffing and testified that even with all staff present there were not enough employees to reposition all the patients every two hours. One nurse testified that Marcel’s ulcer was the size of a dinner plate and infected with a foul smell and puss drainage. Another nurse testified that when she changed the wound dressings it was clear that they had not been changed every shift as required. Further, nurses testified that incomplete chart entries revealed a lack of catheter care, showers and skin assessments. Willow Terrace also received numerous deficiencies from state inspectors.

Camay also called an expert who testified that the facilities were operating “woefully below the standard of care” and that they played a substantial role in Marcel’s death. Another expert testified that the failure to reposition played a large role in the deterioration of the ulcer and ultimately in his death.

The reviewing court upheld the lower court’s punitive damage award finding that the facilities acted in an outrageous fashion, in reckless disregard to the rights of their patients and created an unreasonable risk of physical harm to Marcel. The court relied heavily on the record of chronic understaffing and its resultant inability to care for patients.

Williams v. Willow Terrace, PICS Case No. 13-1208 (C.P. Philadelphia April 8, 2013) Jackson, J.

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