No liability in feeding tube case

A man in his late 40s was living in a nursing home. He was legally blind and suffered from dementia, multiple sclerosis, urinary incontinence, and difficulty swallowing. For this reason, a percutaneous endoscopic gastrostomy tube was inserted and the man returned to the nursing home.

Following the tube placement, the man’s family was informed by one of his surgeons that the patient would be unable to eat or drink until the next day and that an IV would be provided for nourishment. However, due to the patient’s smoking, an IV was not an option.

An order signed by a nurse practitioner, who wasn’t a defendant in the case, indicated that the patient could be given pudding-thickened liquids. Upon return to the nursing home, the patient was given approximately eight ounces of thickened liquids. Nurses checked in on the patient every 30 minutes to an hour throughout the evening and found that his abdomen was normal, his belly was soft and there was some scant serosanguineous drainage at the PEG site.

At approximately 4:45 a.m., the patient experienced a respiratory crisis. He was transferred to the hospital at 6:00 a.m. Physicians found that the PEG tube was leaking and the patient was taken to surgery. He was found to have a gangrenous bowel, which resulted in sepsis, and he was pronounced dead 12 days after the placement of the PEG tube.

The plaintiff’s expert testified that as a result of the patient being fed through the tube too quickly, his stomach became distended and pulled away from the abdominal wall, creating a leak into his peritoneal cavity with peritonitis. In addition, he testified that filling the stomach caused the aspiration that caused pneumonia, leading to his death.

Defense experts explained that there are multiple theories as to when to begin feeding following placement of a PEG tube.

They testified that restricting the patient’s feeding and use of the tube for 24 hours after surgery is typical for an open procedure — not a laparoscopic procedure. The defense experts testified that the feeding did not cause any problem to the patient and that the patient aspirated saliva, which resulted in the pneumonia.

The pneumonia then caused a septic state and loss of blood pressure, which in turn resulted in an ischemic bowel and necrosis. Subsequently, the necrosis caused perforation and peritonitis, leading to shock and death.

The jury found in favor of the defendants with no credible evidence of any violation of the standard of care in providing an order allowing nourishment less than 24 hours after the placement of a PEG tube.

Type of Action: Medical malpractice

Injuries alleged: Death

Date of verdict: Jan. 9, 2008

Submitted by: Peter C. Knight, Morrison Mahoney, Boston (for the defendant primary care physician)