## Facts

- Martha S. French, an elderly nursing-home resident with serious comorbidities and prior pressure ulcers, was admitted to Stratford House.
- Admission materials identified her as susceptible to pressure ulcers, and Stratford House created a care plan requiring regular repositioning, prompt cleaning after incontinence, and adequate hydration and nutrition.
- The estate alleged that staff, including certified nursing assistants, often failed to reposition her, failed to keep her clean and dry, and did not follow the care plan.
- The estate also alleged chronic understaffing and that supervisors knew of recurring problems but did not correct them.
- French’s condition worsened; she was transferred to a hospital where she was found to have a urinary-tract infection and multiple infected pressure ulcers.
- She died three days after hospital admission.
- The estate sued for wrongful death, asserting ordinary negligence, negligence per se based on nursing-home regulations, violations of the Tennessee Adult Protection Act (TAPA), and punitive damages.

## Issues

1. Whether the allegations against a nursing home for resident injury and death must be treated solely as medical malpractice, or may include ordinary negligence based on routine custodial care.
2. Whether alleged violations of state and federal nursing-home regulations may support negligence per se, and whether alleged TAPA violations may support liability in this setting.
3. Whether summary judgment dismissing punitive damages was proper.

## Decision

- The Tennessee Supreme Court held the complaint alleged both medical malpractice and ordinary negligence, depending on whether the conduct involved professional medical judgment or routine care.
- The Court ruled that ordinary negligence claims could be supported by negligence per se based on state and federal nursing-home regulations defining the duty of care.
- The Court held that alleged TAPA violations could be used in support of ordinary negligence claims concerning abuse or neglect of a vulnerable adult.
- The Court affirmed reinstatement of the punitive damages claim and remanded for further proceedings.
- Disposition: affirmed in part, reversed in part, and remanded.

## Legal Principles

- Nursing-home litigation may include both medical malpractice (professionally technical medical treatment requiring expert proof and compliance with malpractice procedures) and ordinary negligence (non-technical routine care understandable to lay jurors).
- Failures involving custodial care—such as turning and repositioning, hygiene, hydration/nutrition, adherence to an existing care plan, staffing adequacy, CNA supervision/training—may constitute ordinary negligence rather than medical malpractice.
- State and federal nursing-home regulations may define the scope of a nursing home’s duty and may support negligence per se when the alleged breach concerns routine care obligations.
- Alleged violations of TAPA may serve as proof supporting ordinary negligence claims based on neglect or abuse of a vulnerable adult in institutional care.
- Punitive damages may proceed when the record could support a finding of sufficiently culpable conduct (e.g., knowing disregard of risks tied to staffing and recurrent care failures), making dismissal at summary judgment premature.

## Conclusion

The court clarified that nursing-home wrongful-death claims may proceed under both malpractice and ordinary negligence theories, permitted use of nursing-home regulations and TAPA as supporting proof for ordinary negligence (including negligence per se), reinstated punitive damages, and remanded for further litigation.


Estate of French v. Stratford House, 333 S.W.3d 546 (Tenn. 2011)