Legal Review & Commentary

Failure to Safeguard Patient Leads to Plaintiff Verdict in Indiana

News: A 57-year-old nursing home resident with a history of dementia climbed out the open window in her room, falling 30feet to the ground below. The woman suffered severe injury as a result of the fall, and a jury awarded the plaintiff $276,164 in damages.

Background: At the age of 57, a woman with dementia became a resident at a nursing home facility. Due to the woman's diagnosis of dementia, she was housed on the second floor of a special unit at the nursing home, where the doors and elevators were kept locked. Evidence was provided that the windows on the unit were kept open.

On numerous occasions, the staff at the nursing home observed the woman attempting to open doors and windows in an effort to escape, so she could be with her family. Due to those previous escape attempts, the woman required constant monitoring.

Three years after becoming a resident at the facility, the woman made another escape attempt. On this occasion, two staff members observed the woman shortly after the attempt in what they took to be a calm state. The staff members then left the woman's room for a brief moment. During that brief moment, the woman made another attempt to escape from the facility. The woman climbed out the open window and promptly fell thirty feet to the ground below.

The woman survived her fall, but suffered from multiple fractures, dislocations, cuts, and bruises. Her medical expenses were close to $539,588. The woman was ultimately removed from the facility.

Through her guardian, the woman filed suit against the owner/operator of the nursing home, criticizing the company's failure to take adequate precautions to prevent her from trying to escape out the window. The plaintiff argued that in light of the woman's previous escape attempts, the windows should not have been left open, and the woman should not have been left alone even momentarily.

The defendants denied any wrongdoing, arguing that the staff did not believe the window was large enough for someone to maneuver through it.

The jury sided with the woman and returned a verdict in her favor in the amount of $276,164.

What This Means to You: Multiple research articles regarding dementia refer to the fact that nursing home residents with dementia are twice as likely to fall as those residents who do not have a diagnosis of dementia. Not only do people with dementia suffer from memory loss, but they also lose the ability to make sound judgments, failing to recognize dangerous situations. They become disoriented, have a tendency to wander (often with a specific location in mind), and they rarely ask for assistance. These factors, in addition to many other factors, increase the risk for falls and are but a few of the challenges caregivers face in providing and ensuring a safe environment for persons suffering with dementia.

In this case of the nursing home resident who fell from a second-story window of the facility, incurring multiple fractures, dislocations, cuts, and bruises, one might first question the wisdom of the special unit being located on the second level. The second level, in actuality, served in diminishing the ease of escape from a first-floor setting, where visitor traffic would be increased and the opportunity for wandering out the door enhanced. Measures were taken to secure the second floor unit by locking unit entrance doors and elevators. The issue then rests with the practice of keeping the unit windows open.

Because no statistics were provided by the plaintiff's legal counsel as to the history of any other falls from the windows of the facility, one can only presume there were no previous falls that had occurred in this manner. Nonetheless, given this resident's propensity for attempted escape via windows or doors "on numerous occasions," close monitoring of her activities was, without doubt, warranted.

Resident attempted escape before

At the time of the fall event, the resident had already been observed attempting to escape that day. In leaving the woman alone in her room, albeit "for a brief moment," it obviously was all the time she needed to climb out of the open window and fall. Regardless of assessing her to be in a "calm state" at the time of deciding to leave her alone in her room, it was the responsibility of the facility and its staff to ensure her safety. Closing and locking the window prior to leaving her alone would be as prudent as turning on a bed alarm and putting up side rails for an at-risk patient in an acute care setting prior to leaving that patient alone. In assessing the resident's desire to leave the facility in order to be with her family, and in understanding the resident's inability to make sound decisions or recognize dangerous situations due to her dementia, staff should have prudently secured the area prior to leaving her alone. The window in the resident's room could be re-opened whenever she was being appropriately and adequately monitored.

Whether it is Medicare, The Joint Commission, or a state agency, all regulatory and licensing bodies hold the health care provider responsible and accountable for the safety and well-being of their residents or patients. This is evidenced in rules and regulations, standards, licensure requirements, and Life Safety Codes. Whether or not the staff believed the window was too small to permit escape, the responsibility to ensure resident safety required they consider every possible option for harm within that environment of care. Although not specified in this case study, one must also presume the window size would have met state fire safety requirements, being of the appropriate size to permit escape via the windows in the event of a fire.

This case presents a failure to assess and monitor. Using as a defense what the staff thought in order to excuse or forego the responsibility of the nursing home facility to provide for the safety and well-being of its residents was futile, as the jury awarded for the plaintiff.

Reference

1. Circuit Court of Indiana, First Judicial Circuit, Vanderburgh County, Case No. 82C01-0506-CT 526