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There are times when I’m sitting across the table from a defendant’s attorney where I must remind myself that there really are two sides to every argument. When bad things happen to patients in nursing homes and skilled nursing facilities that look black and white to me, but which are explained away with some bogus excuse, it literally makes my blood boil.

Take, for example, the case of fecal impaction. One of my elderly clients was so constipated that she was completely unable to void — until the condition finally killed her. I’m sitting across the table from an attorney who says to me, “Well, Wendy, your client was taking lots of meds that gave her constipation, and that’s a natural side effect of the medication.”

“Really?!” I could feel my blood pressure rising. “It’s natural?” I asked incredulously.

“Well, yeah. I can get doctors to testify that these kinds of issues are normal.”

“No, sir, there’s nothing normal about an 85-year old suffering excruciating pain for days until she finally dies because no one at your client’s facility bothered to provide adequate monitoring or care. There’s nothing normal about finding a dry, softball-size fecal impaction in an 85-year old woman’s autopsy! ”

It didn’t have to come to this. There are minimum standards of care required at every facility that houses elderly patients, and the residents are owed at least that much.

In this case, every facility has an obligation to monitor the bowel and bladder habits of its patients because so much of their overall health depends on it. There are standing orders at every nursing home and skilled nursing facility to track them. If a patient goes for three days without going to the bathroom, there is something horribly wrong, and immediate medical intervention is warranted. There’s no middle ground on this; you can’t argue that it’s normal and that everything will work out. My patient died because many people at her facility failed to provide adequate monitoring or treatment.

When I trace it back, it’s almost always due to a highly preventable cause – inadequate staffing. The administrators and executives of nursing home chains and skilled nursing facilities want to save money, and the easiest way to do that is to hire fewer people and to make the existing staff handle more patients.

I believe that most nurses and nursing assistants at facilities really do want to do the right thing and that they are genuinely good people. Unfortunately, they are put in untenable positions. There is too much to be done in the hours they have, and they are forced to cut corners. It’s easier to give powerful meds to sedate patients and keep them quiet than to deal with them when they become agitated or upset. It’s faster not to rigorously track bladder and bowel habits than to spend the time to meticulously write down every piece of information. The jobs require more hours than the nursing staff at many facilities can possibly give. I don’t blame the nurses; but I do blame the executives, the managers, the administrators, and the corporations who set up staffing systems that are doomed to fail.

Yes, there are always two sides to every argument but sometimes, when they screw up, the other side needs to acknowledge and own up to the facts.