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[U] Blango v. Jeanes Hospital, Inc.

Superior Court of Pennsylvania

October 1, 2013

SHIRLEY E. BLANGO, EXECUTRIX OF THE ESTATE OF JOE NATHAN BLANGO, SR., AND SHIRLEY E. BLANGO, INDIVIDUALLY, Appellant
v.
JEANES HOSPITAL, INC., OPERATING AS JEANES HOSPITAL, TEMPLE UNIVERSITY HEALTH SYSTEMS, INC., HILLCREST CONVALESCENT HOME, INC., CRESTVIEW CONVALESCENT HOME, INC., GERIATRIC & MEDICAL SERVICES, INC., GENESIS & MEDICAL COMPANIES, INC., GENESIS HEALTHCARE HOLDING COMPANY I, INC., GENESIS HEALTHCARE CORPORATION, JER PARTNERS, FORMATION CAPITAL, LLC SHIRLEY BLANGO, EXECUTRIX OF THE ESTATE OF JOE NATHAN BLANGO, SR., AND SHIRLEY E. BLANGO, INDIVIDUALLY, Appellant
v.
JEANES HOSPITAL, INC., OPERATING AS JEANES HOSPITAL, TEMPLE UNIVERSITY HEALTH SYSTEMS, INC., HILLCREST CONVALESCENT HOME, INC., CRESTVIEW CONVALESCENT HOME, INC., GERIATRIC & MEDICAL SERVICES, INC., GENESIS & MEDICAL COMPANIES, INC., GENESIS HEALTHCARE HOLDING COMPANY I, INC., GENESIS HEALTHCARE CORPORATION, JER PARTNERS, FORMATION CAPITAL, LLC SHIRLEY E. BLANGO, EXECUTRIX OF THE ESTATE OF JOE NATHAN BLANGO, SR., AND SHIRLEY E. BLANGO, INDIVIDUALLY
v.
JEANES HOSPITAL, INC., OPERATING AS JEANES HOSPITAL, TEMPLE UNIVERSITY HEALTH SYSTEM, INC., HILLCREST CONVALESCENT HOME, INC., CRESTVIEW CONVALESCENT HOME, INC., GERIATRIC & MEDICAL SERVICES, INC., GERIATRIC & MEDICAL COMPANIES, INC., GENESIS HEALTHCARE CORPORATION, FORMATION CAPITAL, LLC AND JER PARTNERS APPEAL OF: JEANES HOSPITAL, INC., Appellant

NON-PRECEDENTIAL DECISION

Appeal from the Order Dated November 17, 2010, in the Court of Common Pleas of Philadelphia County Civil Division at No. October Term, 2007, No. 004518

BEFORE: FORD ELLIOTT, P.J.E., MUNDY AND FITZGERALD, [*] JJ.

MEMORANDUM

FORD ELLIOTT, P.J.E.

This is an appeal and cross-appeal from the judgment entered November 17, 2010, in favor of Shirley E. Blango and against Hillcrest Center and Jeanes Hospital. Joe Blango died on April 18, 2008, allegedly as a result of negligent care at Hillcrest Center and Jeanes Hospital. His wife, Shirley E. Blango, brought a wrongful death and survival action against the defendants; following a jury trial, the jury found in favor of Mrs. Blango and awarded $1, 000, 000 in compensatory damages, finding Hillcrest and Jeanes Hospital each 50% liable. After a separate hearing on punitive damages, the jury awarded punitive damages against Jeanes Hospital and Hillcrest in the amount of $1, 500, 000 and $3, 500, 000, respectively. On post-trial motions, the trial court remitted the punitive damage awards to $500, 000 and $1, 000, 000. These appeals followed.[1]

The trial court has aptly summarized the facts and procedural history of this matter as follows:

This matter was brought by Plaintiff Shirley Blango as executrix of her late husband Joseph Blango's Estate and in her own right for a wrongful death claim and a survival action based upon Mr. Blango's admission to both facilities during the period of May 21, 2006 and ending on June 13, 2006. A jury trial began in this matter on February 9th, 2010 before the Honorable George W. Overton.
The Plaintiff's daughter Sheila Rutherford testified that her father had generally good health with some problems with arthritis and his weight generally stayed the same throughout his life. She testified that her mother called her on May 21, 2006 and said her father was not moving or speaking and he subsequently was admitted to Jeanes Hospital that same day. She testified that she visited him every day for the five days he initially stayed at Jeanes Hospital. He wouldn't eat his food and was only offered regular food and never any soft food or supplements. The Plaintiff was then transferred to Hillcrest Center for ten days. At Hillcrest the Plaintiff also "never ate" and the center staff would just take back whatever food was brought in for the Plaintiff. Ms. Rutherford testified that she never saw her father turned on his bed while at [H]illcrest and noticed that he had feces in his diaper. Mr. Blango then was brought back to Jeanes Hospital because he became sick on June 5, 2006 and was there for three days. Ms. Rutherford testified that her father became noticeably thinner and the diet he was offered was never altered. Ms. Rutherford stated that she learned of her father's bedsores during his second stay at Jeanes Hospital from her mother. She testified that her father was always on a regular mattress with no additional supports. On June 13th, 2006, Mr. Blango was transferred to Abington Hospital and at that point they learned of an infection in the bedsore in his sacral area (the area at the top of his buttocks). He stayed at Abington Hospital for approximately five to six weeks and the infection lasted for the rest of his life when he was taken care of by his family and homecare nurses.
There were a series of videos admitted that showed the homecare routine for Mr. Blango. His family was trained to reposition Mr. Blango every few hours and there was a wound care home nurse but the bedsore continued for the duration of his life. Eventually, Mr. Blango's kidney had to be removed at Einstein Hospital. Mr. Blango passed away in April of 2008.
Nurse Kathleen Fletcher testified as an expert for the Plaintiff and was accepted as an expert in gerontological nursing. She reviewed the records in the case and found that defendants' care fell below the standard particularly in the areas of transition of care and communication. She testified that over the course of his admissions to both defendant facilities, his weight decreased from 190 pounds to 168 pounds. She testified that there was no documentation about his diet at Jeanes Hospital or Hillcrest Center and that his protein stores had declined in his first visit to Jeanes Hospital. Furthermore, she opined that Jeanes Hospital did not communicate the status of Mr. Blango's skin to Hillcrest Center which she stressed was important because of his skin vulnerability. She testified that Hillcrest noted in their records that when admitted from Jeanes Hospital, he had three beginning pressure ulcers with [one] on each ankle and one on his sacrum. Furthermore, she testified that Hillcrest Center's transfer form fell below the standard of care.
Edna Cox, a registered dietician, was accepted by this court as an expert. She testified that Jeanes Hospital failed to provide even the most minimally acceptable care and there was no nutrition assessment despite severe weight loss. She furthermore testified that it was below the standard of care to not order a report on his Albumen levels. She testified that failure to monitor the intake and output of fluids fell below the standard of care as well. As for Defendant, Hillcrest Center, she testified that they "woefully neglected to provide even the minimally acceptable nutrition services." The meals offered fell below the standard of care and the Center could have offered supplements such as Ensure or boosted the calories in his current food. Ms. Cox also addressed the care plan created by Hillcrest on the 29th of May. She said that plan fell below the standard of care because it was not followed through upon and did not address the pressure sores.
Dr. James Steg testified for the Plaintiff and was accepted by this court as an expert. Dr. Steg testified that Mr. Blango contracted a urinary tract infection during his first stay at Jeanes Hospital and that infection contributed to the development of a pressure ulcer. Dr. Steg made his determination based on an analysis of urine culture results. He also testified that when Mr. Blango was admitted to Abington hospital both e-coli and MRSA infections were found in his sacral wound.
Nurse Mary Lynn King testified on February 26th, 2010. She was accepted by this court, without objection, as an expert in wound care and wound care ostomy. She testified to a reasonable degree of nursing certainty that neither Jeanes Hospital nor Hillcrest Center met their standard of care for the plaintiff. In terms of the first visit to Jeanes Hospital she testified that "the documentation, the assessments, and interventions in this case that were put on his skin or not on his skin were not adequate." Specifically she testified that Jeanes Hospital failed to assess Mr. Blango's risk for skin breakdown by not giving him a "Braden score, " and failed to use preventative measures for bedsores. She also opined that the standard of care was not met for Mr. Blango's visit to Hillcrest as well. Specifically, she cites the fact that there was documentation of turning Mr. Blango on days when he was not in the facility. There was documentation that Mr. Blango was repositioned on June 6th, June 14th and June 15th and he was not at Hillcrest Center on those days. She testified that documentation of services that could not have occurred does not meet the standard of care.
Dr. Richard Berg testified and was accepted by this court as an expert in infectious disease. He testified that the sacral ulcer and wound that Mr. Blango had at the time of discharge from Hillcrest Center to Abington Hospital was the source and cause of the chronic sepsis that he had for the rest of his life. He further testified that the sacral bedsore was infected on June 13, 2006 when Mr. Blango got to Abington Hospital. The culture revealed both e-coli and MRSA in the wound and that eventually reached his kidney and the kidney had to be removed. Furthermore, the original bedsore that Mr. Blango got at Jeanes Hospital and Hillcrest Center increased his risk for developing additional smaller wounds. Dr. Berg testified that Mr. Blango's kidney had not been previously infected and that the chronic sepsis prevented healing of the wounds. Finally, Dr. Berg opined that the costs of care were necessitated by the bedsore.
Plaintiff Shirley Blango testified about the care given to her late husband at Jeanes Hospital and Hillcrest Center. She produced two photographs of her husband's wound and indicated that it was a similar representation to how the wound looked when he was admitted to Abington Hospital. She testified that that wound existed until Mr. Blango's death in April of 2008. She indicated that Mr. Blango had a stroke on May 21, 2006 and was taken to Jeanes Hospital. She testified that he could not feed himself and was unable to eat the solid food that the hospital brought for him. Furthermore, none of the Hospital staff attempted to help Mr. Blango eat. She said she never saw anyone reposition Mr. Blango at Jeanes Hospital and that he was always on his back whenever she saw him.
She also testified about Mr. Blango's care at the Hillcrest Center. Ms. Blango testified that she never saw anybody turn or reposition Mr. Blango at the Hillcrest Center. She also indicated that she never saw anyone feed him or give him a diet other than solid food and that as a consequence, Mr. Blango rarely ate. She also testified that often Mr. Blango would go a long time without his pamper being changed and would be sitting in his own feces and commented to her that "they have me sitting in my own poison." She testified that Mr. Blango never received adequate physical therapy and that therapy consisted of sitting in a room and being told to "hold his head up." She further testified that during and after his second admission to Jeanes Hospital she was never informed of any bedsores on Mr. Blango's body and did not learn of any until he was back at Hillcrest the second time. She stated that she first saw the actual wound at Abington Hospital when he was first admitted and was informed of the danger of this condition.
Ms. Blango testified that Abington Hospital advised her to place Mr. Blango back into a nursing home but she refused. Instead, her entire family was trained in how to take care of Mr. Blango at home. She testified that because of the expenses incurred that she had to get a reverse mortgage on their home. Mr. Blango died at home surrounded by most of his relatives and family.
On March 5th, 2010, the jury reached a verdict where they found both Defendants 50% liable for their negligence. The jury awarded $500, 000 for the survival action, $0 for the wrongful death action and $500, 000 for the loss of consortium. Moreover, the jury found both defendants liable for punitive damages.
On March 17th, 2010, this court reconvened for the punitive damages portion of the trial. Hillcrest Center called one witness, Carol Dougherty, and Jeanes Hospital called the Chief Financial Officer for the Hospital. The jury found Jeanes Hospital liable for $1.5 million dollars in punitive damages and Hillcrest Center liable for $3.5 million dollars in punitive damages. On September 13, 2010, this court heard arguments for both post-trial relief and remittitur. On September 29, 2010, this court denied post-trial relief ...

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