MDH finds nurse neglect led to resident's death at Northfield facility

 Laura Baker Service Association’s campus is located at 211 Oak Street in Northfield. Photo: KSTP/Matt Belanger, File
Laura Baker Service Association’s campus is located at 211 Oak Street in Northfield.

January 28, 2019 12:20 PM

The Minnesota Department of Health released its findings related to a death at a Northfield facility with a prior case of confirmed neglect.

According to the latest report, MDH representatives conducted an investigation in September at the Laura Baker Services Association campus at 211 Oak Street to look into an allegation of maltreatment.


MDH officials concluded a facility nurse was responsible for neglect after a male resident of the facility developed a fever and cough that turned into pneumonia. The resident then died as a result of lobar pneumonia with empyema, according to the MDH report.

A review of the resident's records revealed he was not to be left alone in his room without supervision and was to be checked on every 30 minutes while awake and every 60 minutes while sleeping. As the resident was unable to identify whether he was having a medical emergency, according to his records, staff members were responsible for determining whether emergency assistance was required.

According to the resident's log, the resident was given cough syrup and a pain reliever when he developed a cough and fever. It was reported the resident was very weak and unable to lift his feet or move in his wheelchair, according to the MDH report.

Another staff person alerted the nurse under investigation that the resident was suspected of having pneumonia but reported not hearing back from the nurse beyond being told to check on the resident and confirm his symptoms.

The following morning, an unlicensed staff member discovered the male resident was unresponsive and without a pulse. That staff member called emergency medical system staff, who, upon arrival, confirmed the resident had died.

The nurse under investigation stated she had assessed the client a day before he fell ill and said he had not yet developed a cough or fever, according to the MDH report. The nurse said she did not directly speak with the staff member who reported pneumonia concerns but spoke with other staff members who said the client "seemed better."

The nurse said she thought the resident "was playing up his symptoms and it was behavioral," the MDH report states.

MDH officials reported finding no documentation the nurse ever contacted a physician or sent the resident to a physician for a medical evaluation, given his change in condition.

As a result, the MDH determined neglect had been substantiated against the nurse.

The Laura Baker Services Association facility was previously investigated for the death of a female resident at the facility following a fall in January 2018.

RELATED: Police Report Reveals More about 'Neglect' Death of 63-Year-Old at Northfield Facility

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Rebecca Omastiak

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