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Hayward v. Jack's Pharmacy Incorporated6/15/2005
as an attending physician in that their duties as Medical Director involve in essence supervision of the medical care as practiced within the facility which implies supervising their own care.
And so I will say that the faults that I found in terms of the prescription of long-acting Haloperidol in terms of his, Dr. Thurston's practice as an attending physician, imply an additional failure of supervision on his part as Medical Director.
I also as mentioned earlier felt that retaining a resident who has not signed in and in fact who actively demonstrates his desire to leave a facility against that person's will and administering medication against the will of a patient both are failures of standard of care, and the Medical Director has a duty to supervise the general practices of a nursing home. And if those are representative of the practice of the nursing home, that would be a failure on his part as Medical Director.
I also acknowledge that an individual error of practice within a nursing home can't possibly be supervised by the attending-by the Medical Director, and that just a single example of a practice that falls below the standard of care of the nursing home does not necessarily mean that the Medical Director themselves fell below the standard of care.
So, in that respect I'll say that I only fault Dr. Thurston's failure to supervise Dr. Thurston in this case, but not his other actions as Medical Director.
[Counsel for Dr. Thurston's Estate]:
Q: All right. So, if we can clarify this then, Doctor, regarding Dr. Thurston as potential Medical Director of Valley Vista, you have no opinions that he breached any standards of care other than regarding his own actions as a practicing attending physician?
[Dr. Luxenberg:] No, again as his practice as an attending physician went against the regulations of nursing home, and I'm certainly assuming that his own examination confirmed that he was aware that [Delbert] was not conserved and had the right to leave the facility, et cetera, then anything that he did as attending physician should have been stopped by the Medical Director, and his failure to do that implies a failure as medical director.
So, all the things that I object to in terms of the care of [Delbert] reflect on the practice of Dr. Thurston as Medical Director, but those aren't independent of his practice as attending physician.
The upshot of this testimony is, we believe, that when a medical director is actually treating the patient in the nursing home, in the manner in which Dr. Thurston was treating Delbert in this case, any particular act cannot be assigned separately to a particular capacity. As Dr. Luxenberg pointed out, if Dr. Thurston failed in his capacity as medical director, that failure is based on his own failures as a physician prescribing Haldol to a patient in a nursing home. We acknowledge the affidavit of Dr. Frederick Haller, who had served as medical director of a nursing home in another small, rural Idaho community. He said, essentially, that when he was actually treating individual residents, he was acting as a physician and not a medical director. Under the statute, however, we are unable to split those hairs. In judging Dr. Thurston's performance as a physician, we cannot ignore his training and experience as a medical director-the individual charged with supervising patient care. He cannot simply swap his medical director hat for his physician hat depending on the service he was providing, especially in this case, where he was performing both simultaneously.
Neither can we ignore the place in which Dr. Thurston was treating Delbert: a nursing home faci
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