Mitchell v. Baptist Healthcare Sys., Inc.
| Decision Date | 16 October 2015 |
| Docket Number | NO. 2014-CA-000125-MR,2014-CA-000125-MR |
| Parties | BETTY RIGGS MITCHELL, A/K/A BETTY RIGGS, ADMINISTRATRIX OF THE ESTATE OF MICHAEL DAVID RIGGS, DECEASED; CHRISTY K. RIGGS, AS NEXT FRIEND OF ALLISON RIGGS, KIMBERLY RIGGS, AND APRIL RIGGS, MINORS APPELLANTS v. BAPTIST HEALTHCARE SYSTEM, INC., D/B/A CENTRAL BAPTIST HOSPITAL APPELLEE |
| Court | Kentucky Court of Appeals |
NOT TO BE PUBLISHED
APPEAL FROM FAYETTE CIRCUIT COURT
In order to fully understand the facts of this case, some background information is essential. In 1994, Michael Riggs was diagnosed with diabetes after he passed out behind the wheel of his automobile in his home state of South Carolina. Riggs's physician informed him that he "would be dead by 40" if he did not stop drinking alcohol. Over the ensuing sixteen years, Riggs continued to abuse alcohol. Additionally, Riggs failed to properly take the medication prescribed to him as treatment for his diabetes. Instead, he attempted to control his condition by occasionally taking his medications when he felt like it was needed. During this time, he developed vision problems, congestive heart failure, seizures, hypertension, and kidney disease associated with his uncontrolled diabetes. The kidney disease eventually progressed into kidney failure. In December 2009, when he was 39 years old, Riggs's heart had already deteriorated to the point that he required the placement of a pacemaker.
In February 2010, Riggs's adult son, Dewayne Riggs, lived in Pineville, Kentucky, and Riggs lived in Aiken, South Carolina, with his mother, Betty Mitchell. Riggs did not own an automobile, and Dewayne drove to South Carolina to pick up Riggs for a trip to Kentucky. Before the group started to Kentucky on February 13, 2010, they stopped at a liquor store and purchased abottle of liquor that Riggs "drank straight" and shared with another passenger during the trip.
The next morning, on February 14th, Riggs walked into a Delta Gas Station in Pineville, Kentucky. A call was subsequently placed to 911 after Riggs began complaining while in the gas station that his pacemaker was misfiring. Upon arrival of EMS, Riggs told the EMTs that his pacemaker had shocked him four times that morning and that the pacemaker had been placed six months prior. Riggs was transferred via ambulance to the Pineville Community Hospital (Pineville Hospital). Riggs freely admitted to the nursing staff at Pineville Hospital that he had abused drugs and alcohol over the previous 20-30 years and acknowledged drinking at least half of a pint of alcohol each day with his last intake the night of February 13, 2010. He also gave a history of cardiac problems, congestive heart failure, diabetes, and renal failure. Riggs provided a list of his home medications to the triage nurse at Pineville Hospital. For purposes of this appeal, it is relevant to note that Riggs did not disclose a medication called Glimepiride, an oral medication he had previously been prescribed for treatment of his diabetes.
While in the emergency room, blood work was done which was significant, amongst other things, for a critically high blood sugar level of 934. Riggs was administered a few different medications in the emergency department at Pineville Hospital, including 20 units of Humulin R insulin via IV at 2:45 p.m. The emergency medicine physician, Dr. Cabuay, assessed Riggs and determinedthat Riggs would need a higher level of care for assessment of his pacemaker, and subsequently contacted Dr. Thomas Goff, a cardiologist, to see if Dr. Goff would accept transfer of Riggs to Central Baptist in Lexington. Dr. Goff did indeed accept the transfer, and Riggs was transported via ambulance to Central Baptist in stable condition, arriving at the hospital at or around 5:00 p.m. on February 14, 2010.
Riggs was admitted by Dr. Goff to a telemetry unit for cardiac monitoring. Upon admission, Riggs informed Toni Marhefka, RN, of his home medications, noting that he took Lantus 10 units subcutaneously every night for treatment of his diabetes. Riggs again failed to inform Central Baptist nursing staff that he had also been prescribed Glimepiride in addition to his insulin to treat his diabetes. Riggs was noted to be alert, oriented, and able to provide a fairly detailed history of his various medical conditions. Riggs's initial blood glucose level at Central Baptist was 507 as of 5:00 p.m. Dr. Goff's initial diabetic management orders were for Lantus 10 units to be administered subcutaneously at bedtime, moderate sliding scale insulin, and blood sugar checks before meals and at bedtime, as well as a consult from the internal medicine service to manage Riggs's diabetes. Riggs's blood glucose levels were repeated via Accuchek finger sticks at his bedside at 5:01 p.m. with a level of 502; at 5:04 p.m. with a level of 507; and at 5:05 p.m. with a level of 501. Riggs's blood glucose level was subsequently checked by the laboratory at 5:20 p.m. and was noted to be 474, and again checked at 6:00 p.m., at which time the blood glucose level was 463. At 6:00 p.m. NurseMarhefka administered 10 units of Lantus to Riggs as ordered by Dr. Goff. Riggs's previously high blood glucose levels were reported by telephone to Dr. Goff, and he ordered Nurse Marhefka to administer 20 units of Novolog subcutaneously.
Sherri Mays, RN, assumed care of Riggs from Nurse Marhefka at approximately 7:00 p.m. Upon her initial assessment of Riggs at 7:30 p.m., Nurse Mays noted Riggs to be alert and oriented to person, time and place, and also noted him to be appropriate and cooperative. A bedside finger-stick at 8:34 p.m. revealed a blood glucose of 561, followed by a level of 600 obtained at 8:38 p.m. Dr. Julia Lyles, a hospitalist at Central Baptist, subsequently performed the consult ordered by Dr. Goff for management of Riggs's diabetes. In her consult note, Dr. Lyles documented her conversation with Riggs, during which he told her that he took 20 units, not 10 units, of Lantus every night and was also on Novolog sliding scale insulin for treatment of his diabetes. He reported difficulty controlling his high blood glucose level due to steroid medications he took for his renal failure. He also reported his consumption of one pint of liquor the previous evening. Dr. Lyles made note of Riggs's blood glucose levels at Central Baptist. She subsequently wrote orders at 9:00 p.m. for his Lantus to be increased to 20 units subcutaneously at bedtime, as well as 10 units of Novolog insulin to be given with meals, in addition to the moderate sliding scale insulin previously ordered by Dr. Goff upon admission. Riggs's finger-stick blood glucose level was 571 at 9:58p.m., at which time Nurse Mays administered 12 units of Novolog insulin per sliding scale and 20 units of Lantus subcutaneously as ordered by Dr. Lyles.
Throughout the evening of February 14 and into the early morning hours of February 15, Riggs was regularly rounded upon by Nurse Mays and Tiffany Hale, a patient care technician. The two staff performed hourly rounds, with Nurse Mays assessing Riggs on the even hours and Hale rounding upon Riggs on the odd hours. Nurse Mays noted Riggs to be alert and oriented at 10:00 p.m., at which time he was resting on top of his bed and watching television, still wearing his street clothes (Riggs had previously refused to change into a hospital-issued gown). Riggs was noted to be awake and resting in bed at 11:06 p.m. and again at 12:00 a.m. During the safety round performed by Tiffany Hale, PCT, at 1:00 a.m., Riggs was still resting on top of his bed in his street clothes but was asleep with the lights on. Nurse Mays assessed Riggs at 2:00 a.m., at which time she noted him to be asleep but arousable. Hale and Nurse Mays again noted Riggs to be asleep and resting on top of his bed at 3:00 a.m. and 4:00 a.m., respectively, with Mays further noting that Riggs was arousable and responded to her voice. Hale also noted during her 3:00 a.m. assessment that Riggs had repeatedly used his bedside urinal. Nurse Mays further testified at trial that when she rounded upon Riggs throughout the night, she would check the patency of his IV line, during which she would touch his arm. Nurse Mays testified that at no time during the night was Riggs ever exhibiting symptoms consistent with hypoglycemia, and he made no complaints.
Shortly before 5:15 a.m., Hale performed her safety rounds and took vital signs of the patients for the morning set of vitals. Hale started to take vitals on Riggs, but found him to be unresponsive. She performed an Accuchek and noted his blood glucose level to be critically low at 38. Nurse Mays was called to the room and one ampoule of D50 (dextrose) was administered to Riggs to increase his blood glucose. A rapid response was also called at that time. Nurse Mays obtained a repeat blood glucose at 5:20 a.m., at which time it was 202, with another blood glucose of 223 measured at 5:23 a.m. Dr. Lyles and Dr. Goff were paged by the rapid response team at 5:30 a.m., at which time a Code 19 was also called. Riggs was transferred to radiology for a CT scan of his head at 5:50 a.m., while nurse Mays paged the neurologist on call. Following the CT scan, Riggs was taken to the intensive care unit (ICU). Riggs was noted to have an altered mental status secondary to the hypoglycemic event, acute respiratory failure, and diabetes.
Later on the morning of February 15th in the ICU, Amy Vibbert, RN, found a...
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