Nearly two years after the suspicious death on April 6, 2018, of an 82-year-old retired U.S. Army sergeant in a West Virginia VA hospital, family members have filed a lawsuit seeking damages due to his death being ruled a homicide after an autopsy was performed six months after his death.
The suit alleges that hospital staff and doctors were negligent and did not respond properly to the man’s condition after he was diagnosed with a severe drop (hypoglycemia) in his blood sugar. The man’s death was determined to have been caused by an unprescribed and unneeded insulin injection.
The veteran’s death is classified as one of the 11 suspicious deaths under investigation by federal authorities related to a pattern that has surfaced involving incidents occurring on one specific floor of the facility during the 1 a.m. to 6 a.m. night shift. The incidents all involved unexplained sudden and severe hypoglycemia in patients and are believed to have started as early as July 20, 2017.
The lawsuit claims the family was not initially told about the circumstances of the veteran’s death, and the facility also did not report it as an adverse sentinel event that met criteria for an autopsy. An adverse sentinel event is defined by the VA as an unexpected occurrence involving death.
The authorities are investigating one person of interest in all of the deaths-a nursing aide who worked during the 1 a.m. to 6 a.m. shift on that specific floor. Her identity has not been made public because she has not been charged.
Compliance Perspective
Failure to recognize and investigate patterns and determine the root cause for incidents where unexplained and abnormal life-threatening conditions, like hypoglycemia in non-insulin using residents, may be deemed abuse, neglect, and immediate jeopardy, and considered provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points
- Review policies and procedures regarding investigation of deaths due to unexplained causes.
- Train staff to be alert to any suspicious, repeating incidents where residents suddenly exhibit unexplained conditions like hypoglycemia, and report those incidents to a supervisor or through the Hotline.
- Periodically audit to determine if the facility is investigating unexplained deaths due to unknown or suspicious circumstances.
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