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 Falls Residents Nursing Homes - Articles Compiled From

Legal Eagle Eye Newsletter for the Nursing Profession

Patient’s Fall: Court Sees Evidence Of Faulty Nursing Assessment Of Patient’s Injuries.

  The purple bruising to the right buttock after the patient fell should have alerted her nurses that this patient on anticoagulant therapy was at risk for internal bleeding from blunt-force trauma in her fall.  The nurses should have frequently monitored her vital signs, watched for signs of hemorrhagic shock and alerted her physician in time. COURT OF APPEALS OF TEXAS June 12, 2015

  The sixty-nine year-old patient was admitted to a medical facility for rehabilitation after back surgery.  Her admission assessment pointed to a high fall risk based on a history of multiple falls, chair-bound status, poor vision and her current medications.   Two-person assists with transfers and extensive assistance with activities of daily living were required.  She was considered to have good potential for physical rehabilitation even with her limitations.

  Deep vein thromboses in her legs were a major concern.  Her physician ordered bed rest, Coumadin and Lovenox and INR and prothrombin time checked twice weekly, which was not done after two initial readings.  Her prothrombin time was more than twice the higher value of the normal range three days before she fell.  The day she fell the patient was found sitting on the floor next to her bed.  A nurse noted that she had tried to get back into bed by herself but was unable.  The physician was notified. X-rays showed no fractures.  The next day the nurses noted there were no injuries from the fall except purple bruising on her right buttock.  The day after that the patient was pale and her breathing was labored.  She was sent to an acute care hospital.

  The patient died the next day.  The autopsy revealed retroperitoneal hemorrhage and multiple organ failure.  The cause of death was blunt force trauma associated with Coumadin therapy.  

  The Court of Appeals of Texas accepted the opinions of the patient’s family’s physician expert witness.  The expert’s principal focus was on the nurses’ faulty assessment of the patient’s condition after she fell.  The expert made only passing reference to allegedly inadequate fall-risk assessment and precautions.  According to the expert, the nurses should have realized that a patient on anticoagulant therapy is at risk for internal retroperitoneal bleeding after blunt force trauma to the lower back.  The patient’s vital signs should have been frequently monitored for signs of shock from internal bleeding.  The nurses should have realized that a rapid pulse, labored breathing, mental confusion and increased pain are potential signs of hemorrhagic shock and alerted the physician so that transfusions to reverse anticoagulation, IV diuretics to save the kidneys and intubation could have started sooner. Nexion v. Townsend, 2015 WL 3646773 (Tex. App., June 12, 2015).

Fall: Would Nursing Interventions Have Prevented The Incident?

  The family’s expert witness’s report failed to demonstrate how the nursing home’s alleged negligence actually caused the fall.  Floor mats near the bed cushion a fall when a patient hits the floor, but this patient’s death appears to have been caused when the back of his head struck the door to his room.  The expert also failed to establish that a nurse would have been able to come to the room in time to keep the patient from falling, after the bed or chair alarm sounded, if there were alarms in use.

  There is no basis upon which the Court can conclude that the facility’s negligence was a substantial factor in bringing about the patient’s death, which is a requirement for imposing legal liability on the defendant in a civil lawsuit.  COURT OF APPEALS OF TEXAS August 7, 2013

  The elderly nursing home patient suffered from senile dementia and required significant assistance with his daily activities.  A bedside urinal was provided after he fell in his bathroom and contused his chest and scalp and was found on the floor again soon afterward.  Then the physician ordered bed and chair alarms after the patient became weak, lost his balance, fell and struck the back of his head on the door and a few hours later fell again in the bathroom and the next day was found on the floor.   The patient passed away from a subdural hematoma a few days after striking his head on the door when he fell.

  The family sued the nursing home.  The family’s lawyers filed a physician’s expert report with the lawsuit reciting generic allegations that the nursing home violated the standard of care for fall prevention by neglecting to assess the patient’s potential for injury from falls and by neglecting to provide standard nursing interventions of lowering the bed, putting soft floor mats around the bed and implementing bed and chair alarms sooner.  The Court of Appeals of Texas accepted the physician’s expertise when it came to iterating standard general nursing interventions for fall prevention.   However, the expert failed to detail just how lowering the bed, placing soft mats on the floor near the bed and starting bed and chair alarms would have prevented the specific fatal injury to this patient.  That failure by their expert was fatal to the family’s legal case. Heritage v. Fitzgerald, 2013 WL 4011090 (Tex. App., August 7, 2013).

Fall: Nurse’s Fraudulent Concealment Of The Facts Extends Statute Of Limitations.

  The nurse’s fraudulent concealment from the family of the true version of how their loved one was killed will extend the statute of limitations.  The family must file suit not within two years after the resident was injured but two years from the date a former nursing home employee told them what really happened.  Under the circumstances it would be wrong to deny the family the right to forward with a lawsuit on the grounds that the statute of limitations expired before they filed it in court.

  The nursing home should not be allowed to take advantage of the fact that the true version of what happened was concealed from the family until after the statute of limitations ostensibly had passed.  Assuming they file their lawsuit within the extended time frame allowed, they will get their day in court, where the family still has to prove, as in any other professional negligence lawsuit, that the patient’s death was caused by a negligent error or omission by the nursing home’s caregiving staff. COURT OF APPEALS OF INDIANA January 31, 2013

  The elderly nursing home patient was taken to the hospital when she started vomiting a few hours after she sustained a head injury.  Her head injury led to her death in the hospital nine days later.   

  When she was hospitalized a nurse from the nursing home told the family that the patient had had sudden transient ischemic attacks in the past which could not be anticipated or prevented and that such an event was most likely what caused her to fall this time.   However, almost three years after the death a former employee of the nursing home told the daughter that her mother did not simply fall, but was attacked and pushed to the floor by another resident.  An attack by another resident, unlike the story the nurse from the nursing home gave to the family, could be grounds for a lawsuit alleging negligent failure to assess, monitor, supervise, restrain, transfer or separate the aggressor from other residents.

  The family filed a negligence lawsuit against the nursing home, but filed it well beyond Indiana’s two-year statute of limitations. The Court of Appeals of Indiana ruled that the family’s lawsuit could go forward nevertheless.  The Court ruled that fraudulent concealment by a healthcare provider of facts from the patient or from the family, facts which could be the basis of a malpractice lawsuit, extends the statute of limitations.   The statute of limitations begins ticking not when the negligence occurs, but when the patient or the family who have been misled learn or with due diligence should have learned the true version of what happened.

  The Court allowed the family’s lawsuit because it was filed within two years of when the former employee told the daughter that her mother actually was pushed down by another resident. Allredge v. Good Samaritan Home, __ N.E. 2d __, 2013 WL 372651 (Ind. App., January 31, 2013).

Patient’s Falls: Court Overturns Verdict On Legal Technicality.

  The Department of Public Health’s investigator’s conclusions which led to issuance of an administrative citation against the facility are not the final word in a civil lawsuit for professional negligence.  The jury was impermissibly and prejudicially swayed, and the jury’s verdict awarding damages for negligence cannot stand. CALIFORNIA COURT OF APPEAL November 4, 2013

  The patient was seventy-nine years old when he was admitted to a skilled nursing facility for rehabilitation.  He was alert at the time but had difficulty standing and walking and had a high risk of falling.   He fell nine times over a period of five weeks in the facility.  The last of these falls caused a subdural hematoma which required hospitalization for brain surgery. Then he had a stroke.  Prior to his death he was admitted to the same facility a second time and had two more falls.  The patient’s falls usually occurred when he tried to get out of bed to go to the bathroom.   After his first fall the patient was assessed as having poor safety awareness, poor judgment, unsteady gait and as attempting to function beyond his ability by climbing out of his bed or chair.

  The recommended interventions were to lower the bed to its lowest position, start a two-hour toileting program and review his medications.  After his second fall he was assessed as being forgetful and impulsive and poor at using safety devices.  The plan was to keep his walker within his reach.  After his third fall a self-release belt and a bed alarm were added.  However, two days later he fell twice on the same day.  That led to a bedside commode with a urinal being provided as well as a tab alarm in bed.  Since he had been losing his balance while unzipping his pants the family was urged to get him pants with a Velcro fly closure.  After his sixth fall padded pants were recommended but he refused to wear them.  At that time it was noted that he was very adamant about transferring and ambulating without assistance.  The bedside commode was discontinued because he refused to use it.  After his seventh fall he was noted to be confused.  A wheelchair alarm was added.  He was supposed to be visually monitored around the clock, yet his room was not visible from the nurses’ station.   He fell again two days later.

  The last fall occurred around 1:00 a.m.  After his bed alarm sounded a nurse did not get to the room for two minutes and he was already voiding in the bathroom. While a nurse was standing in the doorway he lost his balance and hit his head on the wall while he fell.  This injury required brain surgery for a subdural hematoma.  

  The jury awarded the family more than $4,000,000.  The California Court of Appeal, however, threw out most of the award on the grounds that the jury was improperly swayed by being informed that a citation was issued against the facility by the state Department of Public Health, which in a civil lawsuit is not dispositive of the issue whether the facility was guilty of negligence.   The Court rejected the facility’s arguments that the jury should have been read state and Federal regulations that strictly limit the use of restraints.   That is, the fact that restraints require a physician’s order and cannot be used for punishment or staff convenience and that side rails are considered a form of restraint did not mitigate the facility’s responsibility to give better consideration to restraints, as argued by one of the family’s experts. Nevarrez v. San Marino Skilled Nursing, __ Cal. Rptr. 3d __, 2013 WL 5883460 (Cal. App., November 4, 2013).

Patient’s Fall: Safe Patient Transfers Require Nursing Assessment And Care Planning.

  The nursing facility’s argument is not valid that patient transfer assessments and care planning were the sole province of physical therapy.  A care facility cannot control the standard of care simply by having a certain department, rather than the law, select the standards applicable to activities undertaken by its caregiving employees. SUPREME COURT OF ALABAMA June 28, 2013

  The eighty-five year-old patient had a stroke in the late 1970’s that resulted in left-side paralysis.   She was admitted to a nursing facility in 1992 after she fractured her ankle in a fall in her daughter’s home.  In 2006 she was being helped out of bed by a lone CNA when she lost the strength in her legs and either fell or was lowered to the floor.  Her left leg was bent backward.  When she complained of pain she was sent to the hospital where she was treated for a leg fracture.

  She sued the nursing facility for negligence.  The Supreme Court of Alabama ruled she was entitled to her day in court.  That is, the lower court judge was wrong to disallow the expert testimony of a registered nurse offered by the patient’s lawyers and instead to rely only on the testimony of the facility’s physical   therapy staff.  The Court expressly overruled the nursing facility’s argument that it was solely up to its physical therapy department to assess the patient and determine how the patient was to be transferred.   The physical therapist had not written orders for a mechanical lift or a gait belt or for more than a single caregiver to participate in this patient’s transfers.   The Court ruled instead that the legal standard of care for a nurse or nursing assistant caring for a patient is not determined by a facility’s physical therapists.   Thus in this case the standard of care for this patient should have been explained to the jury by the testimony of the registered nurse offered as the patient’s expert witness.

  The patient’s nursing expert had an extensive background caring for infirm elderly patients in long-term care and extensive experience supervising non-licensed staff in that care-giving environment, which qualified her as an ex-pert on the nursing standard of care.  According to the patient’s nursing expert, the patient should have been assessed by the nurses as needing a mechanical lift.  If the CNA went ahead without using a lift she should at least have used a gait belt and brought in another staff person to help her, the patient’s nursing expert went on to say.  It was not relevant to the outcome of the lawsuit, the Court said, that the facility’s general nursing guidelines did not expressly call for two-person transfer assistance.  The CNA should have known not to go it alone. Hill v. Fairfiled Nsg. & Rehab., __ So. 3d __, 2013 WL 3242867 (Ala., June 28, 2013).

Patient’s Fall: Before And After Nursing Assessments Ruled Inadequate, Verdict Given To Patient’s Family.

  Fall risk is an essential element of nursing assessment at the time of admission to a nursing facility.  Confusion, incontinence, gait and balance problems, hypertension and medication side effects are factors pointing to high fall-risk.  Fall risk mitigation can include bed and chair alarms, padding on the floor near the bed and a consistent toileting routine to minimize the patient’s need to get up on his own without assistance.

  If a patient does fall, a thorough nursing assessment must be done to evaluate fully the extent of injury so that appropriate medical care can be obtained in a timely fashion.  Failure to assess and care for a high-fall-risk individual before and after a fall is grounds for a nursing negligence lawsuit. COURT OF APPEALS OF MISSISSIPPI February 21, 2012

  The elderly patient was admitted to a nursing facility for physical therapy and rehab after hospitalization for injuries from a fall at home.  The patient was in a state of general physical decline.  He suffered from generalized weakness, had problems with his gait and had difficulty standing without assistance.  He needed help with most of his activities of daily living including bathing, showering, eating and transferring.

  He was found on the floor near his bed shortly before midnight his fifth day in the facility.  He had broken his hip in the fall.   Almost two years later, after the patient had passed, his family sued the nursing facility for negligence.  The Court of Appeals of Mississippi upheld a jury verdict of $25,000 against the facility in favor of the family.  

  A nursing assessment and care plan were generated for the patient the day he was admitted to the facility.   However, in the opinion of the family’s nursing expert, the assessment and care plan failed to address adequately his high risk of falling.   In fact, there was no express mention of fall risk in the paperwork that was generated for the patient’s chart at the time of admission.   The admission nursing assessment should have identified the patient’s confusion, incontinence, troubles with gait and balance, hypertension and the side effects of his medications as factors pointing to a high fall-risk.   Failure to assess and plan for fall risk is a deviation from the nursing standard of care and grounds for allegations of negligence in a civil lawsuit after the fact when a patient has fallen and been injured.

  The care plan should have included bed and chair alarms to alert the nurses when the patient was attempting to rise and padding on the floor near the bed to soften the impact from a fall that might occur.  The patient should have been on a toileting schedule involving routine assistance to the bathroom to minimize his need to get up on his own when staff were not in the room to assist him.  He should have been checked on frequently.

  After he fell the patient should have been given a head-to-toe exam which should have focused on the hips, rolled from side to side to check the hip alignment and given frequent follow-up neuro checks, the expert said.   The hip fracture was not detected until his physical therapy session the next day.  Had it been detected earlier, in the expert’s opinion, the damage could have been lessened and the outcome improved. McComb Nursing Ctr. v. Lee, __ So. 3d __, 2012 WL 540577 (Miss. App., February 21, 2012).

Fall: Court Allows Patient’s Case To Go Forward.

  An orthopedic expert is not required to prove that the patient’s tibia and fibula fractures were caused by the fall and were not pathological fractures related to her osteoporosis. APPEALS COURT OF MASSACHUSETTS July 26, 2012

  The fifty-three year-old patient was 5’ 3" tall and weighed 200 lbs.  Her medical diagnoses included the brain disorder leukodystrophy, dementia, seizures and significant osteoporosis.  She was in the nursing facility for physical rehabilitation with the goal of restoring independent ambulation with a walker.  She was a high fall risk, according to her admission nursing assessment, and her care plan expressly called for two per-sons to assist her with transfers.

  When her daughter came to visit she found her mother sitting on the toilet in her bathroom.   She had her mother pull the string to call for help.  The aide who responded told the daughter the aide assigned to the patient had gone to lunch.  The aide tried to transfer the patient to her wheelchair.  The patient landed on the floor with her leg twisted in front of her.  The aide got another person and the two of them finally got her into her wheelchair.

  The Appeals Court of Massachusetts stated that the aide deviated from the applicable standard of care in three ways:  Trying to do the transfer alone when two aides were required by the care plan; Failing to use a gait belt; and Failing to lock the wheels of the wheelchair.

  The Court ruled the lower court judge erred directing a verdict in favor of the facility.  The patient did not call an orthopedist to testify as an expert but she did not need an expert to prove the fall caused her tibia and fibula fractures. Pitts v. Wingate, 82 Mass. App. Ct. 285, __ N.E. 2d __, 2012 WL 3023983 (Mass. App., July 26, 2012).

Repeated Falls: No Review Or Modification Of The Care Plan.

  State nursing-facility regulations require residents to be provided with nursing services in accordance with their needs which must include:  Development of a written plan of care for each resident to provide nursing services as part of the total rehabilitation program;  Periodic reevaluation of the type, extent and quality of services and programming; and Modification of the resident care plan as needed, in terms of the resident’s daily needs.

  Failure to notify the consulting RN of the patient’s repeated falls, and the resultant failure of the RN to investigate them mounts to failure of the facility to provide the resident with nursing services in accordance with her needs.  The facility had an adequate initial care plan for this resident, but it was not updated as necessary to address her problem with falling which was becoming a pattern with her.  The facility failed to provide adequate care and that failure directly resulted in injury to the resident.  The penalties and other sanctions were appropriate. APPELLATE COURT OF ILLINOIS June 12, 2012

  A sixty-three year-old woman with diagnoses of Down syndrome, Alzheimer’s disease and osteoporosis was a resident of an intermediate care center for developmentally-disabled adults.  Her cognitive level was that of a twenty-three month-old child.  Over a four-month period she fell in the facility at least eleven times, sustaining various bruises, hematomas and abrasions.

  A complaint led to an investigation which resulted in citations for violations of the state’s Nursing Home Care Act as well as the facility’s operating license being placed on probationary status.  The Appellate Court of Illinois upheld the penalties and other sanctions imposed on the facility.

  In accordance with state law, the facility had a policy which required staff on duty when a resident sustained an injury to make observations and take appropriate action to obtain basic information necessary for nurses and physicians to make further clinical judgments and notify the house manager or administrator so that the house manager or administrator could, in turn, notify the nursing staff.  On numerous occasions the resident was seen falling or found on the floor or in between items of furniture.  Her vital signs were taken and/or she was visually looked over, but no one else was notified so that a medical evaluation could be obtained.  Further, when a resident falls repeatedly it is necessary, pursuant to state regulations, for the multidisciplinary quality assurance committee at its regular meetings to review the patient’s medical, nursing, medication and pharmacy records with a view toward making appropriate modifications of the care plan.

  In addition, bruising found on a patient’s body on an ongoing basis is an incident which must be reported to the Department of Public Health.  The occurrence of repeated injury from falling can be considered abuse or neglect, which is a violation of nursing facility standards itself and the failure to report abuse or neglect is a separate violation, the Court said. UDI No. 2 v. Dept. of Public Health, __ N.E. 2d __, 2012 WL 2108491 (Ill. App., June 12, 2012).

Falls: Care Plan Not Updated, Jury Finds Negligence.

  The patient fell five times before the last fall in which he broke his hip.  Each fall created an opportunity and an obligation to reevaluate his condition and reassess his needs. SUPREME COURT NEW YORK COUNTY, NEW YORK June 29, 2010

  The fifty-one year old patient was placed in a nursing facility following a below-the-knee amputation necessitated by his diabetes.  His medical diagnoses included kidney failure and liver disease.  He also had issues with balance and a short-term memory deficit which translated into problems remembering what he was told by the nurses by way of patient-safety teaching.  He spent his time mostly in his wheel-chair.  Sometimes he was able to ambulate with a prosthesis and a cane.

  The patient passed away nine months after open reduction and internal fixation surgery to repair his four-part intertro-chanteric hip fracture from the last fall.  The family’s nursing expert testified that each of his prior falls required more than a progress note in the chart documenting the bare fact that he had fallen.  His balance problems and short-term memory deficits should have been reevaluated and attention given to new safety equipment like wheelchair tipping guards, bed brakes and sitting pads.  Merely reminding him to ring his call bell for assistance when he needed to transfer or to ambulate was not an effective safety measure, given his ongoing memory problems, the family’s nursing expert went on to say.  The jury in the Supreme Court, New York County, New York awarded the family $275,000 for the patient’s pain and suffering. O’Dea v. Cardinal Cook Care Ctr., 2010 WL 3232844 (Sup. Ct. New York Co., New York, June 29, 2010).

Fall: Assisted Living Facility Found Guilty Of Negligence.

  The patient was admitted to the assisted living facility without a complete nursing assessment after being in the hospital for a broken hip and a stroke. He was partially paralyzed on one side and had significant problems with short-term memory.  The physical and occupational therapists in the hospital had recommended stand-by assistance for any and all movements.  

  The patient was not examined, assessed or evaluated by the facility’s nurses on admission.  Nor was any effort made to obtain his records from the hospital where he came from, even though the discharge recommendations would have been particularly important.  The patient was simply assumed to be independent in ambulation and in need of no assistance for routine activities of daily living.  

  The patient fell only a day or two after entering the facility.  That incident did not lead to review and modification of his care plan.  Nor was his physician contacted for input as to his care needs and recommendations for fall precautions. CIRCUIT COURT PORTAGE COUNTY, WISCONSIN May 3, 2010

  The eighty-three year-old patient fell at home and had to be hospitalized.   While in the hospital he suffered a stroke which left him partially paralyzed on his left side.  The effects of the stroke created major problems for him with ambulation and also seemed to have affected his short-term memory.  Before discharge from the hospital the hospital’s physical and occupational therapy departments recommended for his placement following discharge that he be given stand-by assistance with ambulation.

  When the patient was transferred to an assisted living facility the nurses reportedly just assumed he was a fully independent self-care patient, without examining, assessing or evaluating him and without obtaining and reviewing his discharge paperwork from the hospital.   After the patient fell the first time, a day or two after arriving, no effort was made to reassess his needs and change the care plan to include fall precautions.

  The patient was housed on a wing of the facility for independent residents where only one aide was on duty during the night.  A fire started in the boiler room.  It was put out quickly by the automatic sprinkler system, but the fire set off the fire alarm facility-wide and created a significant amount of smoke.   The one aide on duty assumed he was fully independent, that is, aware of the need to evacuate and capable of doing so on his own, and did not even try to help the patient out of his room.  While trying to exit on his own in response to the fire alarm and the smoke which was filling his room the patient fell and dislocated his hip.

  The incident was the beginning of a downward spiral in his health status which the family’s lawsuit alleged led to his death.   The jury in the Circuit Court, Portage County, Wisconsin awarded the family $915,397 from the assisted living facility. Turner v. North Haven, 2010 WL 3603994 (Cir. Ct. Portage Co., Wisconsin, May 3, 2010).

Fall Care Plan: Documentation Was Missing That Plan Was Carried Out.

  An eighty-six year-old Alzheimer’s patient fell in a nursing home and fractured her hip.  The patient’s family had placed her in this particular facility because it had a philosophy against unduly restraining Alzheimer’s patients, even those prone to injury from falling due to physical infirmity, mental confusion and memory loss.  

  The patient’s lawyers complimented the facility for its no-restraint philosophy, but argued that the nursing and medical staff still should have seen the need for a bed alarm, a lower bed and/or cushioned mats on the floor near the bed to reduce the risk of injury from a fall.  The facility countered that it had a perfectly good fall-care plan, that is, the doctor’s orders in the patient’s chart required staff to check on her at least every two hours, yet the facility did not fully explain how checking her every two hours would have prevented her from falling .

  Nevertheless there was no documentation in the chart that the fall-care plan, such as it was, was being implemented, that is, there was no documentation of the two-hour patient checks ever being done by her caregivers.  Incomplete nursing documentation sends a message to a jury that the patient’s care needs are being neglected, even if there is no direct, concrete cause and effect relationship between the care that cannot be documented and the actual injury to the patient which resulted in the lawsuit.  The patient’s lawsuit in the Court of Common Pleas, Philadelphia County, Pennsylvania resulted in a $500,000 jury verdict in her favor. Logan v. New Court-land Elder Services, Inc., 2007 WL 2491724 (Ct. Com. Pl., Philadelphia Co., Pennsylvania, June 19, 2007).

Patient’s Fall: Nursing Documentation Inadequate, Verdict For The Patient.

  United States courts are divided on the issue whether simple routine care like assisting a post-surgery patient to walk to the bathroom involves an exercise of professional judgment by a caregiver.  In general, if a patient files a lawsuit for injuries resulting from negligent exercise of professional judgment, the patient has to come forward with expert testimony or face dismissal.  If the injuries in the lawsuit did not arise from errors or omissions in professional judgment, the jury hears the facts and makes a decision based simply on their own common sense and everyday life experiences.

  The issue in this case was not the professional standard of care for ambulating a patient; there was no question whether a gait belt should have been used.  The issue was whether the gait belt was used; the jury decided it was not.  It would beg the question to allow the facility’s nursing expert to testify that using a gait belt fully meets with the standard of care.  COURT OF APPEALS OF IOWA July 12, 2006

  The patient was transferred to the facility for skilled rehab following hip-replacement surgery.  One afternoon weeks after her admission she rang her call bell for assistance to go to the bathroom and a CNA responded.  On the way to the bathroom the patient fell and was injured.

  The CNA testified he walked into the room, opened the bathroom door and helped the patient sit up in bed.  He placed a gait belt around her waist, helped her stand up and gave her her walker.  When she stood up he asked her if she was dizzy and she said, "No."  As they walked to the bathroom the patient lost her balance, so he helped her slowly and gently to the floor.  After the incident the patient said she was all right.

  The patient testified the CNA came in and brought her her walker.  The CNA had his arm around her waist as they started walking to the bathroom.  As the CNA reached out to yank open the privacy curtain she fell hard and her walker landed on top of her.

  A nurse testified she could not remember if the patient had had a gait belt on when she came to the room after the fall.  She said the patient said the CNA was not holding on to her and let her fall.  A second nurse actually documented the incident with a late entry in the patient’s chart.  The chart entry made no mention of a gait belt and the nurse could not remember later in court whether a gait belt was involved.

 The Court of Appeals of Iowa ruled the jury had heard all the relevant testimony and had the right to decide what and whom to believe.  The jury’s verdict against the facility for an unspecified sum was upheld. Davis v. Montgomery County Memorial Hosp., 2006 WL 1896217 (Iowa App., July 12, 2006).

High Fall Risk: Patient Left Alone On Commode, Court Finds Nursing Negligence.

  The nurse on duty at 3:15 a.m. who answered the resident’s call light and assisted her to the bathroom testified she did not know the resident had been assessed as a high fall risk.  The nurse testified if she had known the resident was a high fall risk it would have been wrong to leave her unattended on the commode, and she would not have done so.  The resident was classified as a high fall risk on admission to the facility, due to multiple medical problems including congestive heart failure and renal failure.  Despite her high-risk classification and a fall-prevention care plan, she did fall three days into her stay at the facility.

  The nurse should have known that special precautions were necessary, that is, remaining with the patient to assist her back to her bed.  The nurse should have known it was not appropriate to leave the patient with instructions to ring her call bell when she was ready. DISTRICT COURT OF APPEAL OF FLORIDA January 19, 2005

  A nurse left a nursing home resident on the commode in her bathroom with instructions to press her call light for assistance when she was ready to return to bed.  Instead of ringing for assistance the resident tried to go it alone, fell, sustained a closed-head injury and died.  

  The jury gave $220,000 verdicts to each of the resident’s nine adult children and found the patient herself 5% comparatively negligent and to that small extent responsible for her own injuries.  However, the judge then threw out the verdicts because adult children under Florida law are not entitled to compensation for the deceased’s pain and suffering.  Although the judge agreed there was nursing negligence, the judge limited the verdict to $9,000 for post-injury medical, funeral and burial expenses.   The judge also ruled there was no reckless, outrageous or malicious conduct by the nurse to justify punitive damages, which would have benefited the adult children.  The Court of Appeal of Florida agreed in all respects.

  This resident was a high fall risk, due to the medical problems with which she was admitted and due to the fact she fell in the nursing home three days into her stay.  The facility’s standard care plan for a high-fall-risk patient called for caregivers to stand by while the patient was on the commode, to offer assistance as needed while on the commode and to be present to assist the patient immediately when the patient was ready to return to bed.  A caregiver is required to know and follow the care plan.  Even without a care plan a caregiver should know a patient like this is a high fall risk and should not to leave the patient alone and vulnerable on the bathroom commode, the court said. Estate of Williams v. Tandem Health Care of Florida, Inc., __ So. 2d __, 2005 WL 94505 (Fla. App., January 19, 2005).

Patient Falls: Court Sees It As Malpractice, Dismisses Case.

  The act of assisting a patient in this patient’s condition, i.e., recovering from a head injury and bedridden for a prolonged period of time, to stand or to move from a bed to a chair, re-quires training and the exercise of professional judgment, both to minimize the patient’s discomfort and to guard against further injury. COURT OF APPEALS OF MICHIGAN  December 2, 2003

  A nurse stood the patient on her feet while assisting her to get dressed so that she could be discharged from the facility where she had been undergoing rehab from a head injury.  The patient fell and fractured her leg.  She sued for negligence.  The local county circuit court judge dismissed her case.  The Court of Appeals of Michigan agreed, in an unpublished opinion.

  A nurse is not necessarily negligent just because a patient falls.   While a patient at the rehab facility there were physician’s orders for the nurses to have the patient get out of bed, have her sit in her chair, have her learn to ambulate with a walker and have her resume her own self-care.  In assisting the patient to stand and dress the nurse was performing a professional nursing intervention.  Therefore, there must be expert witness testimony as to the nursing standard of care and breach of the standard of care by the nurse.  The patient in this case was unable to provide an expert so the case had to be dismissed. Lewandowski v. Mercy Memorial Hosp. Corp., 2003 WL 22850024 (Mich. App., December 2, 2003).

Patient Falls: Lawsuit Will Go Forward.

  The family of the deceased obtained a letter from a doctor stating his expert medical opinion.  His expert medical opinion was that the nursing home staff breached the acceptable standard of care, which caused her fall, which contributed to her premature death. They knew she required supervision walking due to an unsteady gait and noncompliance with walker usage, and because she fell at home before admission.  There was a legal duty to use a Posey vest restraint to keep her in bed and to observe her more closely. The nursing staff needed and should have sought a medical order for restraints, for the resident’s safety. APPEALS COURT OF MASSACHUSETTS December 8, 2003

  The family members of an eighty-one year-old deceased nursing home resident appealed from the ruling of a medical review panel that exonerated the defendants from liability for the deceased’s fall in a nursing home.   She was found by her bed with a broken hip.  The Appeals Court of Massachusetts, in an unpublished opinion, overruled the review panel and said the family will get their day in court to present their evidence before a judge and jury and ask for an award of damages in their favor. Danna v. Marina Manor, Inc., 2003 WL 22888936 (Mass. App., December 8, 2003).