Understaffed Nursing Home Held Liable for Resident's Death From Dehydration and Malnutrition
After trial: The Arkansas Supreme Court's May 1, 2003 opinion affirmed liability on condition of remittitur, reducing the $15,000,000 awarded for negligence and medical malpractice to $5,000,000 and the $63,000,000 punitive award to $21,000,000. The $100,000 wrongful death awards to each of the four sons and the $25,000 breach of contract award against Diversicare Leasing were not part of that reduction, so accounts of the surviving judgment vary between $26,000,000 and roughly $26.4 million; we rank at the lower, more widely reported figure. Advocat and its co-defendants then sought review in the United States Supreme Court, which denied certiorari on November 10, 2003 in No. 03-160, 540 U.S. 1012. Public records do not confirm whether the corporate defendants or their insurers ultimately paid the judgment.
Won by Wilkes & Associates, P.A..
Margaretha Sauer, a 93-year-old resident of Rich Mountain Nursing and Rehabilitation Center in Mena, Arkansas, died in July 1998 after five and a half years in the facility's care. Her estate sued the nursing home's corporate owners for negligence, medical malpractice, breach of contract, and wrongful death, presenting evidence of chronic understaffing, untreated weight loss and dehydration, and unaddressed pressure sores. A Polk County jury returned combined judgments of $78,425,000, reported at the time as the largest verdict against an Arkansas nursing home. The Arkansas Supreme Court affirmed liability on condition of remittitur, cutting the negligence and malpractice damages to $5,000,000 and the punitive award to $21,000,000, and the United States Supreme Court denied review in November 2003, leaving the reduced judgment final.
What happened
Margaretha Sauer lived at Rich Mountain Nursing and Rehabilitation Center in Mena, Arkansas for five and a half years before she died at Mena Medical Center on July 19, 1998. She arrived at the hospital in a semi-comatose state and died about sixteen hours later. The cause of death listed severe electrolyte abnormalities, with Alzheimer's-type dementia and protein-calorie malnutrition as contributing factors. She was 93 years old.
At trial, evidence showed the facility failed to provide basic care in the months before her death. She lost fifteen pounds in her final month, and surgery to place a feeding tube, scheduled for July 6, 1998, was delayed. Food trays sat untouched in her room because there was no staff member available to feed her. She was found with dried feces under her fingernails from scratching herself while lying in her own waste, and staff described a pressure sore the size of a softball that had opened on her body after she went a week or longer without a bath. State inspections of the facility documented the understaffing before her death: the Arkansas Office of Long Term Care found in January 1997 that the nursing home 'failed to provide adequate nursing staff for 13 of 13 residents,' and cited it again in May 1998 for insufficient nursing staff to provide quality care.
Sauer's estate sued Advocat, Inc. and its affiliated companies, Diversicare Leasing Corporation and Diversicare Management Services Co., for negligence, medical malpractice, breach of contract, and wrongful death. The trial in Polk County Circuit Court ran eight days in June 2001, with 28 witnesses and 24 binders of exhibits. The jury found for the estate on every count, awarding $5,000,000 for ordinary negligence, $10,000,000 for medical malpractice, and $100,000 to each of Sauer's four surviving sons for wrongful death, a compensatory judgment of $15,400,000 against the three corporate defendants jointly and severally, plus $25,000 entered separately against Diversicare Leasing Corporation for breach of contract. It then awarded punitive damages of $21,000,000 against each of the three defendants, without joint and several liability, $63,000,000 in all. The combined judgments, $78,425,000, were reported at the time as the largest verdict returned against a nursing home operator in Arkansas.
Advocat and its co-defendants appealed. On May 1, 2003, the Arkansas Supreme Court upheld the jury's liability findings but held the damages excessive and affirmed on condition of remittitur. It reduced the $15,000,000 awarded for negligence and medical malpractice to $5,000,000 and cut the punitive damages by two thirds, to $21,000,000. The alternative was a new trial on damages, and published accounts put the judgment that stood at $26,000,000.
Advocat petitioned the United States Supreme Court for review. On November 10, 2003, the Court denied certiorari in No. 03-160, closing the case and leaving the reduced judgment final. The estate's trial team included Brian D. Reddick, Susan N. Childers, and Christine C. Althoff of Wilkes & McHugh, P.A. in Little Rock, and Bennie Lazzara, Jr. of the firm's Tampa office, alongside local Arkansas co-counsel. Wilkes & McHugh later became Wilkes & Associates, P.A.
Sources
This account is drawn from contemporaneous public reporting and the court record.
- 1.FindLaw, Advocat, Inc. v. Sauer, 353 Ark. 29, 111 S.W.3d 346 (Ark. May 1, 2003): full opinion text, including the counsel block naming Wilkes & McHugh, P.A. (Arkansas) by Brian D. Reddick, Susan N. Childers and Christine C. Althoff and Wilkes & McHugh, P.A. (Florida) by Bennie Lazzara, Jr. for the estate; the award breakdown and combined judgments of $78,425,000; the remittitur to $5,000,000 and $21,000,000; cause of death; the Office of Long Term Care survey findings; the pressure sore, bathing, weight loss and feeding evidence; and the eight-day trial with 28 witnesses and 24 binders of exhibits
- 2.CourtListener, Advocat, Inc. v. Sauer, 111 S.W.3d 346, 353 Ark. 29 (2003), docket 02-189: independent court record confirming the same citation, docket number, and full counsel-of-record block for the estate
- 3.CourtListener, U.S. Supreme Court order list, No. 03-160, 540 U.S. 1012 (Nov. 10, 2003): certiorari denied, confirming the reduced Arkansas judgment is final
- 4.Wilkes & Associates, P.A. (firm)
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