Understaffing Equals Elder Abuse

In the recent case of Worsham v. O’Connor Hospital (2014) 226 Cal. App. 4th 331 a patient brought an act against a hospital for elder abuse claiming that, as a result of understaffing and undertraining at the hospital, Worsham suffered a fall, breaking her hip.

In a short opinion the Court criticized the pleadings as failing to supply specific facts supporting her elder abuse claim. According to the Court:
“The allegations in the Second Amended Complaint are not sufficient to render O’Connor’s conduct in failing to provide adequate staffing anything more that professional negligence. The allegations, if true, demonstrate O’Connor’s negligence in undertaking medical services, not a ‘fundamental failure to provide medical care for physical and mental health needs.’” Id. 338.

From a legal standpoint the difference between a “professional negligence” and elder abuse are enormous. A professional negligence case is brought under MICRA and there are severe limits on the recovery of damages.

Respectfully, the Worsham Court got it wrong. Innumerable studies have shown that lack of adequate staffing has a direct relationship to the quality of care provided in nursing homes. As noted in the Journal of Nurses Economics (2006) Minimum Nurse Staffing Rations for Nursing Homes “the positive relationship between nurse staffing levels and the quality of nursing home care has been demonstrated widely.” See also Nicholas G. Castle, Nursing Home Caregiver Staffing Levels and Quality of Care, a Literature Review, Journal of Applied Gerontology (2008). However, in Worsham the Court, in a broad statement with no analysis and even less reasoning, holds that chronic understaffing of a healthcare facility in violation of state and federal law which causes injury to a patient is not “elder abuse.” This would appear to be in direct conflict with our Supreme Court’s admonition in Delaney v. Baker (1999) 20 Cal. 4th 23, 42 that the phrase “professional negligence” is to be construed narrowly “to protect elder adults through that application of heightened civil remedies from being recklessly neglected at the hands of their custodians…”

Until Worsham, California case law was clear that a hospital’s conscious understaffing and poor training can lead to serious injury. Merron v. Superior Court (2003) 108 Cal App. 4th 1049, 1067. (Defendant hospital’s failure to take remedial action despite having knowledge of complaints of inadequate staffing constituted reckless neglect and material grounds for plaintiff’s elder abuse claim.) In that case the hospital nursing staff acknowledged that lack of adequate staffing prevented them from meeting individual patient care needs which “posed a potential threat to the health and (their) patients”. (Id. 1068 note 12)

In fact, courts in California have consistently emphasized that residents have “the right to reside in a facility with an adequate number of qualified personnel to carry out all of the functions of the facility.” Shuts v. Covenant Hold Co. LLC (2012) 208 Cal App. 4th 609, 615.

In many of the nursing home cases we have been involved in we have often seen a conscious decision by nursing homes to understaff their facilities with full knowledge that the understaffing will severely affect the quality of care. This is not isolated. Rather, unfortunately, it is all too common. See New York Times , “At Many Nursing Homes More Profit and Less Nursing” (Sept. 23, 2007); California Watch, Nursing Homes Received Millions while Cutting Staff, Wages (July 29, 2011). While there may be occasions where understaffing is not elder abuse, the Worsham decision fails to make that distinction and its sweeping statements and lack of analysis will significantly damage the ability of elders to obtain just remedies for injuries caused due by the “conscious disregard” of their caretakers.

Having adequate staff in our nursing homes is mandated by law because without such staff people are left alone, unprotected, and subject to horrible abuse and neglect and, in many instances even death. The Worsham decision only confuses that well established law and puts California’s elderly population at serious risk.