By Jan. J. Gorrie, Esq.
Buchanan, Ingersoll Professional Corp.
News: An elderly man was admitted to a hospital for observation. The following morning, the patient spilled hot tea in his lap during breakfast, resulting in burns severe enough to require surgical repair. The patient brought suit against the provider, which was settled for $100,000 prior to trial.
Background: In August 1999, the 87-year-old plaintiff had coronary artery bypass surgery, followed by a complicated and lengthy recovery. His treating physician noted that "his mental faculties were definitely declining, and as his progress was monitored, it was also noted that he was taking numerous medications that were probably excessive.’"
On Oct. 1, 2000, he developed constant minimal substernal chest pain that radiated to his left arm, and his son transported him to the hospital in the early morning hours. He was examined in the emergency department and found to be essentially pain-free. His private physician admitted him to the hospital for observation and further testing. Further tests failed to show any evidence of an acute injury.
The next morning, a nurse brought him a breakfast tray with very hot water for tea. He claimed that, while unattended, he inadvertently spilled the tea onto his lap scalding his left thigh, perineum (the space between the anus and the scrotum), and his right posterior thigh.
The patient’s burns were managed conservatively at the hospital with antibacterial dressings. A plastic surgeon’s examination revealed deep and partial thickness burns to the left thigh, measuring 22 cm by 18 cm; to the right posterior thigh, which were 12 cm by 6 cm; and to the shaft of the penis and scrotal area and perineum, measuring 4 cm by 4 cm. He underwent whirlpool treatments, but the wounds failed to respond. On Oct. 13, 2000, the plastic surgeon performed a tangential excision of full-thickness skin burn of the left anterior thigh, right posterior thigh, and perineum with split thickness graft under general anesthesia.
The plaintiff maintained that his treating physician failed to inform the hospital of his need to be carefully observed due to his compromised mental faculties and that the hospital was negligent in failing to monitor him and serving him hot liquid while by himself. Both hospital and physician claimed they were unaware of any condition of limitation that precluded serving him hot liquid.
Prior to trial, the action was settled for $100,000.
What this means to you: We learned from a famous fast-food hot coffee spill just how much of a potential risk hot water can be. The facts in that case are somewhat different than in this scenario — in the fast-food incident, the person was fully clothed and apparently had no limitations of movement.
"This was an elderly gentleman, 87 years old, which brings with it some of the physical changes that come with the natural process of aging, such as the loss of adipose tissue and the fragility of the skin. With the altered mental state and advanced age, it is probable that he had slower reactions as well. With this patient’s current physical and mental status, the nurse’s admission intake assessment should have provoked nursing interventions to address appropriate care and preventive nursing measures focused on those observations," notes Leilani Kicklighter, RN, ARM, MBA, CPHRM, CHt, director of risk management services at the Miami Jewish Home and Hospital for the Aged.
Hospital and other licensing regulations govern the temperature of the potable water coming out of the facets in these facilities to prevent the potential for inadvertent or accidental burning/scalding patients. Regulations also cover the temperatures considered satisfactory for the safe and sanitary storage, preparation, and distribution of food. Generally, storage of food is recommended to be below 41° F or above 140° F to reduce the risk of foodborne pathogens — except during periods of preparation and service.
"By regulation, the temperature of potable water should be no greater than 120° F, and most facilities keep water in the 108°-118° F range. And the water for the gentleman’s tea could have just as easily been soup," Kicklighter says. "At this point, we don’t know if this patient was capable of feeding himself or if he needed assistance. Neither do we know if the nurse prepared the tray for the patient or just delivered it and left the patient to fend for himself. At the time of admission or at least in conjunction with the first meal, time should be taken to assess the patient abilities and to at least assist by setting up their meal tray, which would include pouring coffee or tea, if served in a teapot. Similarly, milk is usually served in a carton, and many patients cannot open them easily by themselves.
"In this instance, the water for the tea was obviously TOO hot, as evidenced by the location and severity of the burns sustained by this patient. It seems that the severity of the burn was also aggravated by the fact that the hot water fell on both sides of the right thigh and between the patient’s legs and pooled there, causing more of a burn than if the patient had more agility and mobility to be able to move and get out to the pool of hot water," Kicklighter says.
"What this means to the risk manager is that steps should be taken to work with the dietary department and the nursing unit directors/managers to determine where the water and coffee furnished with the meals is generated. If it is put on the meal trays by the dietary personnel when preparing the trays, that is one issue. If it is placed on the trays when they are served, then the process on the unit needs to be evaluated. Each alternative then calls for a set of preventive interventions, but in any case a threshold temperature for hot coffee, tea water, soup, and other hot liquids for consumption should be established. Food thermometers should be located on each unit and staff shown how to use them to assure the liquid isn’t too hot," recommends Kicklighter.
"Unfortunately for this patient, it was not simply a matter of serving him hot liquids — it was the serving of liquids that were much too hot. And both he and the facility were burned," concludes Kicklighter.
• Anonymous Burn Patient v. Anonymous Hospital and Physicians, Los Angeles County (CA) Superior Court. Abram C. Zukor, Zukor & Nelson, Beverly Hills, CA, for the plaintiff.