Misplaced Feeding Tubes: Malpractice & Wrongful Death

Misplaced Feeding Tubes: Malpractice & Wrongful Death

Feeding tubes, including Nasogastric (NG) and Percutaneous Endoscopic Gastrostomy (PEG) tubes, serve as essential life-support systems for patients who cannot swallow safely. However,, these devices can become instruments of tragedy when basic safety protocols are ignored. When a feeding tube is misplaced—often inserted into the lungs instead of the stomach—the result is frequently a preventable, and agonizing death. In the healthcare industry, such occurrences are often classified as “Never Events,” meaning they are errors so egregious that they should never happen under any standard of proper medical care.

How Misplacement Occurs

The most common and devastating error is respiratory insertion, which is when the tube is accidentally placed into the windpipe (trachea) and either the chest cavity (pleural space) or the lungs instead of the food pipe (esophagus).

If this error is not immediately caught and the feeding pump is turned on, the patient suffers a “dry drowning” as the liquid formula floods their lungs and respiratory system.

Beyond this catastrophic respiratory error, other critical forms of misplacement include:

• Intravascular Insertion: The feeding fluids are delivered into a blood vessel instead of the digestive tract.
• Peritoneal Perforation: The tube punctures the wall of the esophagus or stomach, causing the feeding contents to leak into the abdominal cavity and cause a severe infection.
• Intracranial Insertion: An extremely rare but fatal complication, usually after severe face or head trauma, where the tube enters the brain cavity.
• Bowel Perforation: Damage or a tear to the intestinal wall that occurs during the surgical placement of a PEG tube.

Recognizing the Signs of Injury and Facility Neglect

When these errors occur, the immediate medical consequences for the patient can be severe. Because many victims are already in a weakened state or suffering from cognitive impairments like dementia, they may be unable to articulate their distress. Families should be vigilant in observing and recognizing signs of neglect.  Things to watch out for are:

• • Aspiration Pneumonia: A severe lung infection and inflammatory reaction that occurs when foreign liquids, like feeding tube formula, are mistakenly breathed into the lungs.
  • Septic Shock: A life-threatening condition where a massive, widespread infection, often from internal leakage (Peritonitis) caused by a perforated stomach or esophagus, leads to dangerously low blood pressure.
  • Cyanosis: A visible medical sign where the skin (especially lips and fingertips) turns blue or grayish due to a sudden and critical lack of oxygen in the blood.
  • Subcutaneous Emphysema: Air bubbles trapped right beneath the skin, creating a crackling sensation; this symptom strongly suggests a tear or puncture in the patient’s respiratory system (like the lung or windpipe) or digestive tract.
  • Acute Respiratory Distress Syndrome (ARDS): A rapid and critical form of lung failure that prevents the lungs from effectively transferring oxygen to the rest of the body, often requiring urgent mechanical ventilation.
    

Proving Malpractice and Establishing the Standard of Care

Proving medical malpractice in these cases requires demonstrating that the healthcare provider deviated from the established “Standard of Care.” The gold standard for verifying the placement of an NG tube is a radiographic X-ray. Relying on outdated methods, such as the “whoosh test”—where a nurse listens for air bubbles in the stomach—is widely considered insufficient and negligent in modern medicine. Malpractice also may occur when a radiologist misinterprets a confirmation X-ray or when nursing staff fail to wait for the official X-ray read before initiating the feeding.

Systemic Failures: Nursing Home Understaffing and Safety Lapses

In the nursing home environment, these devastating errors are frequently symptoms of systemic issues rather than isolated mistakes. Federal regulations, specifically 42 C.F.R. §483.25(g), mandate that facilities provide the necessary services to prevent complications from enteral feeding, including aspiration pneumonia and dehydration. However, chronic understaffing often leads to “shortcut” medicine. When there are not enough nurses to properly monitor a resident, the head of the bed may not be elevated to the required 30–45 degrees, or the markings on a tube may not be checked for migration. These lapses in supervision create a high-risk environment where a once-properly placed tube can shift into a dangerous position without anyone noticing.

Pursuing Accountability Through Wrongful Death Claims

When a misplaced feeding tube leads to a fatality, the family may have the right to pursue a wrongful death claim. These legal actions seek to hold the negligent facility or hospital accountable for the loss of a loved one’s life and the profound loss to  the survivors. While defense attorneys often attempt to argue that the patient was “frail” or that the death was an “unavoidable complication,” the law is clear: frailty is not an excuse for neglect. Aspiration is a known risk, but pumping formula into a patient’s lungs due to a failure to verify placement is a clear breach of duty.

The Indiana Medical Malpractice Act and the Review Process

For families seeking justice in Indiana, it is important to understand the procedural hurdles involved. Under the Indiana Medical Malpractice Act, claims must generally pass through a Medical Review Panel before a lawsuit can proceed in state court. This panel, comprised of three healthcare providers and one attorney chairperson, evaluates whether the evidence supports a claim that the provider failed to meet the standard of care. This administrative phase is a critical “gatekeeper” that requires expert testimony and a comprehensive review of all medical documentation.

Protecting Your Rights: Preservation of Evidence

Holding the negligent healthcare providers accountable not only provides closure for the family but also forces facilities to improve their safety protocols, potentially saving the lives of other vulnerable patients in the future. The first priority in these cases is the immediate and thorough preservation of evidence. Families should act quickly to secure unedited medical records and all imaging studies—particularly confirmation X-rays—taken during the time of the incident. 

In cases where a death follows a tube replacement or adjustment, requesting an independent autopsy is often the most definitive way to prove that misplacement was the cause of death. Because these cases involve highly technical medical data and complex regulatory standards, consulting with a seasoned nursing home neglect attorney is essential. An experienced lawyer who understands the intricacies of “Never Events” can navigate the medical review process and ensure that evidence is properly preserved, and  the facility is held responsible for its failures.

The Importance of Acting Without Delay

Time is a critical factor in any medical negligence case, as Indiana law imposes a notoriously strict statute of limitations for filing claims. In most instances, a victim has only two years from the date of the alleged malpractice to initiate a claim or be forever barred from seeking recovery. Waiting until the deadline is approaching is dangerous, as a thorough medical and legal analysis must be completed before a “Proposed Complaint” can even be filed with the Indiana Department of Insurance. If you suspect that a feeding tube error has occurred, it is vital to contact an attorney immediately to protect your legal rights and ensure that critical evidence is not lost or destroyed.

Furthermore, certain types of claims, such as those against government-run facilities, may require a “Tort Claims Notice” to be filed within as little as 180 days. Because the Indiana Medical Malpractice Act requires an administrative review that can last several years, acting promptly is the only way to move toward a resolution. Once the Medical Review Panel issues its opinion, the claimant usually has only a 90-day window to file their case in state court. Delaying even a few days could result in the permanent loss of the right to hold the negligent parties accountable for the harm they caused.

A Commitment to Patient Safety and Justice

A misplaced feeding tube is a tragedy that is almost entirely preventable through the adherence to basic, life-saving medical protocols. When healthcare providers prioritize efficiency over accuracy or allow systemic understaffing to compromise patient safety, the consequences are permanent and devastating. At Powless Law Firm, we believe that every patient deserves the highest standard of care, and every family deserves answers when that standard is breached. By holding negligent facilities accountable through the legal system, we not only seek justice for individual victims but also advocate for a healthcare environment where “Never Events” truly never happen.

Frequently Asked Questions (FAQ)

Q: How do I know if my loved one’s feeding tube was misplaced? Signs of misplacement often include sudden respiratory distress, coughing, choking, or a drop in oxygen levels immediately following a tube insertion or replacement. In more subtle cases, the patient may develop unexplained abdominal pain, vomiting, or a fever (indicating sepsis or peritonitis).

Q: Is aspiration always a sign of medical malpractice? Aspiration is a known risk of tube feeding, but there is a clear distinction between a medical risk and medical neglect. Malpractice occurs when the facility fails to follow protocols that minimize this risk—such as failing to verify placement via X-ray, failing to elevate the head of the bed, or ignoring clinical signs of respiratory distress.

Q: What if the facility says the death was “unavoidable”? Nursing homes often use “frailty” or “pre-existing conditions” as an excuse for poor outcomes. However, federal law (42 C.F.R. §483.25) requires facilities to provide care that prevents avoidable complications. Our job is to determine if the death was truly unavoidable or the result of a failure to meet the standard of care.

The Powless Law Firm is an Indiana law firm that represents victims and families statewide in serious cases involving medical negligence, nursing home neglect, birth injury, personal injury, and wrongful death. If you have concerns about medical negligence, please contact us at (877) 469-2864. Together, we can make a difference.

Contact Powless Law today for a free, confidential consultation. Let us help you find the answers you were denied in the exam room.

The Powless Law Firm represents families across Indiana—from Indianapolis to Fort Wayne and Evansville—in cases involving nursing home negligence lawsuits, birth trauma lawsuits, medical malpractice birth injury claims, and cerebral palsy lawsuits. As experienced medical malpractice attorneys in Indiana, we are here to listen to your story and help you find the way forward.

Call (877) 469-2864 now for a free, confidential consultation. There is no fee unless we win your case.