A residence condemned for the death of a user due to dehydration: "The workers could not cope"

Lucia C. passed away at the age of 77. After a long and complicated process in her family, she entered the nursing home in her town. The Alzheimer's that she had been diagnosed with for six years had caused this woman to lose her independence. “The decision was made with great sorrow, but it had to be made. At home it was very complicated, ”recalls Javier A., ​​one of Lucía's four children, about her decision to transfer her mother to a center for the elderly. She entered the Amma nursing home in Betelu (Navarra) on October 6. A month later she was admitted to the Navarra Hospital Complex with severe dehydration. The doctors calculated that she had arrived at the emergency room with "a water deficit of about 5-6 liters", according to the documentation consulted by elDiario.es. She died a week later.

The events took place in 2017. Lucía's children and husband have needed five years for the judicial process opened against the residence to end and for them to begin their mourning. The Provincial Court of Navarra has sentenced the center for the elderly to pay compensation of 100,000 euros and appreciates "negligent conduct by the staff of the residence in terms of their obligation to care" for Javier's mother, "specifically" in the need "to keep her hydrated", as stated in the sentence issued on June 30 and which became firm last Wednesday, according to the family's lawyer, Lorena Pastor.

“These procedures remove everything [el cuerpo]. Every time you have to talk about it, it prevents you from closing the wound. Finally, it's over. We have a final judgment and we will heal”, explains Javier. In his conversation with elDiario.es, Lucía's son remarks that his mother "had to be helped for everything." "You had to be with her 24 hours a day," he adds. And that is why they made the decision to go to a residence. After the outcome, he explains that her father "has not raised his head." "Very bad. A lot of guilt for having taken her to the residence. With a broken voice, he thus summarizes the emotional state of her father.

The medical report issued after the death, which elDiario.es has accessed, details that Lucía had been around four or five days without showing "collaboration" to feed. She arrived at the hospital with a "low level of consciousness" and "significant sign (sic) of dehydration." After the initial health inspection, the doctors informed the family of "the seriousness of the patient's situation."

Javier assures that he and his brother were the ones who sounded the alarm at the senior center when they went to visit their mother. “I saw something happen. I took his pulse and it hardly had any. We said it at the residence. At first they didn't tell us anything and, by chance, that same night he entered the [el hospital de] Pamplona”, he remembers five years later.

The sentence reproaches the company for not supervising the hydration, the state of the urine and the consumption of liquids by Javier's mother while she was in the center for the elderly, as recommended by the Spanish Society of Geriatric and Gerontological Nursing. “Despite the fact that Mrs. C. had not had adequate intake for days, there is no evidence that she had been incorporated into any hydration protocol, nor that the residence staff carried out the proper control, since the defendant did not provide the follow-up notebook of the residents to whom he alluded in his witness statement” a nurse, the magistrates point out.

Along the same lines, the judges consider that the workers should have insisted on Lucía's "rehydration" and, "if not achieved", refer the patient to the hospital, "instead of limiting themselves to communicating the situation" of "a generic way" to the doctors of the health center and of the medical clinic that supervised the user of the center for the elderly.

Regarding these communications between the workers of Amma Betelu and the doctors, the provincial court maintains that from the residence the doctors were not informed "in a precise and detailed manner of the fluid intake" of Lucía, "nor of the physical signs (especially levels of urine formation) from which poor hydration status could be inferred.

“In the residence a chaos was perceived. The workers couldn't cope. [Notamos] a bit of chaos.” This is how Javier remembers those days. Neither his brothers nor his father have wanted to denounce the staff of the center. The lawsuit was directed against the company that managed the nursing home at the time, Asistencial Villa de Betelu SA. “We understand that the responsibility lies with the company. I, as a user, cannot get involved in what each worker must do. I don't manage that,” he points out.

Lucía's family is very disenchanted and disappointed with the management of the company. “Since my mother left the residence, at no time did they contact us or take an interest in how we were doing,” recalls Javier. And he adds: “At no time have they worried on an emotional level or on any other level. They have gone for the 'pela'.

Currently the Amma Betelu residence is managed by the Amavir group, which will be the one to pay the compensation. The company took over the management of the senior center weeks after Lucía's death, on December 31, 2017, according to company sources, who also highlight that the ruling grants "part of the responsibility" for what happened "to the external medical service". and released from the nursing home.

"By protocol", the same sources point out, the management of the residences managed by Amavir "contact" the families of deceased users to offer their condolences. As in this case they cannot "guarantee that this was done", the group assures that it "apologizes" to Lucía's family if that was not the procedure after the death of this user. In addition, they point out that they learned of the conviction for the call from elDiario.es since “the insurance company” had not notified them of the ruling.

Throughout the entire legal procedure "it has become evident" that behind the management of the center for the elderly there is "a company" that "only seeks money", laments Javier. The ruling of the Provincial Court of Navarra has halved the compensation that in 2019 was imposed by the court of first instance number five of Pamplona. That ruling sentenced the company to pay 200,000 euros to Lucia's children and husband, considering that "the dehydration" diagnosed in the resident was "entirely attributable to the residence" because it derived "from an inadequate provision of care supervision" .

"They only appealed for compensation," says Javier. The company appealed the ruling, assuring that there was no "causal relationship between the actions of its employees and the death of the patient", and the Court has taken into account some of its reasoning. Among the arguments of the center for the elderly, the lawyers of the defendant company also pointed out that “the exclusive responsibility imposed” on the residence should be moderated.

The magistrates of the second instance have upheld some of these claims, among them that of shared responsibility. Therefore, they indicate that, if "the defendant is also accused of not having given" Lucía "due attention to avoid dehydration", "it would make no sense" to exonerate the doctors - from the health center and the medical clinic who supervised the resident–, taking into account that they were aware of the resident's “eating problems”.

On the other hand, they add that the dehydration diagnosed in this 77-year-old woman "is also related to medical aspects" and, for that reason, they point out that the doctors who supervised the resident failed to fulfill "their obligations."

In order to justify the reduction of compensation by 50%, the judges say that "the causal relationship between the negligent act of the residence and the death" of Lucía is not proven. Therefore, to quantify the compensation again, they resort to a doctrine known as "opportunity loss", which uses "the calculation of probabilities" to reach a conclusion in those situations in which there is no "absolute certainty" when determining the “causal link between an event and the result”.

It has taken five years to bring this cause to an end. To Javier this period seems "excessive". During this time, residences were the focus of information in the first wave of the pandemic, in the spring of 2020. The number of deaths and the high incidence of the virus in these centers warned about the situation of some of these social resources. . "I don't even want to think about what has happened. We haven't wanted to think about anything," he says, recalling those months. From now on, with their legal proceedings now closed, the family hopes to begin mourning Lucia's death.

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