| Nursing-Home Patient Chokes on |
| Food After Nurses Ignore |
| Instructions to Assist Her in Eating |
| Nursing Home Negligent in Not Instructing |
| Its Employees With the Standard of Care Required |
| You Don't Need an Expert to Tell |
| You That the Patient Needs to be "Spoon-Fed" |
Steve C. Nichols, administrator of the estate of Blanche Arlene Nichols, filed this wrongful death action against Beverly Enterprises-Virginia, Inc. Beverly Enterprises-Virginia operates a nursing home under the trade name Lynn Shores Manor in Virginia Beach. Blanche Nichols was a patient there until her death. Steven Nichols alleged that Blanche Nichols choked and died because Beverly Enterprises' employees failed to assist her with eating. The jury returned a verdict in favor of the administrator and fixed damages at $100,000.
Facts: Blanche Nichols was diagnosed as having Alzheimer's disease. When she was no longer able to care for herself, her two sons, Steven Nichols and Gary R. Nichols, and their respective wives, provided primary care to her for approximately three years.
Blanche Nichols' mental capacity was impaired, and eventually she had to be restrained. She was unable to eat unassisted. In December 1988, Blanche Nichols choked while eating pancake. Her daughter-in-law performed a "Heimlich maneuver," which forced the material from Blanche Nichols' throat. In January 1989, Blanche Nichols choked while eating. As a result of this incident, she was admitted to a hospital for approximately a week.
In December 1989, Gary and Steven Nichols concluded that they were unable to provide the care that their mother needed. Subsequently, she was admitted to Lynn Shores Manor on December 15, 1989.
Around time of admission, Steven Nichols had a lengthy conversation with Jan Aubrey Marion, Jr., administrator of admissions at Lynn Shores Manor. Steven Nichols informed Marion that Mrs. Nichols could not eat unassisted. Steven Nichols also informed Marion of Mrs. Nichols' prior choking incidents. The nursing home's records that Marion completed, dated December 15, 1989, reveal that Mrs. Nichols required assistance when eating.
Kathy Nichols, Steven Nichols' wife, met with Marion around the time of admission and informed him that Blanche Nichols had choked twice previously. Marion informed Kathy Nichols that he would convey this information to the nursing home employees who would be working with Blanche Nichols.
On December 16, 1989, Kathy Nichols visited with Blanche Nichols "around lunchtime." While Kathy Nichols was visiting her mother-in-law in her room an employee of Lynn Shores Manor entered the room with a tray of food and placed the tray on a "little rolled table." No one from the nursing home, however, returned to assist Blanche Nichols with eating. Therefore, Kathy Nichols assisted her mother-in-law with her food.
Bonita Johnson, an employee at Lynn Shores, delivered a dinner tray to Mrs. Nichols on the evening of December 17, 1989. No one assisted Mrs. Nichols with her food. Phyllis L. Jones, a nurse's assistant helper, delivered a dinner tray to a woman who shared a room with Mrs. Nichols. No one had instructed Jones to assist Mrs. Nichols with her food. As Jones was helping Mrs. Nichols' roommate with her food, Jones noticed that "Mrs. Nichols didn't seem quite right." When Jones observed that Mrs. Nichols was sitting in her chair with her head turned sideways, she "ran immediately to get help."
Rebecca Taylor, a licensed nursing assistant, and Viola Fletcher, a licensed practical nurse, removed Mrs. Nichols from the chair and placed her on the bed. According to Taylor, Mrs. Nichols was dead when Taylor and Fletcher placed Nichols' body on the bed. Fletcher, however, testified that during this time, Mrs. Nichols was still alive and talking.
Fletcher knew that Mrs. Nichols "needed to be spoon-fed" and that someone "had to keep an eye" on her. Additionally, Fletcher testified that if Bonita Johnson left a tray of food in Mrs. Nichols' room, then that "would have been a mistake."
Dr. Faruk Presswalla, the deputy chief medical examiner for Tidewater, performed an autopsy of Blanche Nichols' body. He testified that the cause of Mrs. Nichols' death was asphyxia, commonly referred to as choking. Food had obstructed a portion of Mrs. Nichols' air passage, and some of the food was lodged in her windpipe.
Court Decision: The defendant asserts that the plaintiff sought to prove that the defendant was negligent because of its failure to inform its employees that Mrs. Nichols needed assistance when eating. The defendant contends that expert testimony is necessary to establish the appropriate standard of care and any breach thereof. Additionally, the defendant says that the plaintiff failed to "show what the standard of care required Lynn Shores to do with the information the Nichols family claimed they gave about the prior choking incidents, or with the information from the hospital record that said that the patient needed to be fed all of her meals." The plaintiff did not put on an expert witness and properly qualify that witness as an expert on nursing home intake assessments or as an expert witness on how a patient is to be fed. The plaintiff, however, argues that under the facts and circumstances of this case, expert testimony is not necessary. We agree with the plaintiff.
Issues involving medical malpractice often fall beyond the realm of common knowledge and experience of a lay jury. Therefore, in most instances, expert testimony is required to assist the jury. Expert testimony is ordinarily necessary to establish the appropriate standard of care, a deviation from that standard, and that such deviation was the proximate cause of damages.
In certain rare instances, however, as here, expert testimony is unnecessary because the alleged act of negligence clearly lies within the range of the jury's common knowledge and experience.
Here, the evidence is sufficient to support the jury's finding of negligence without the necessity of expert testimony on the appropriate standard of care. The defendant was aware of Mrs. Nichols' mental and physical condition. The defendant knew that she was unable to feed herself and that she had two serious choking incidents. In spite of this knowledge, the defendant's employee left a tray of food with Mrs. Nichols and failed to provide assistance to her. Certainly, a jury does not need expert testimony to ascertain whether the defendant was negligent because its employees failed to assist Mrs. Nichols under these circumstances.
Beverly Enterprises v. Nichols 247 Va. 264; 441 S.E. 2d 1; 1994 Va.
