Legal Review & Commentary: Fall from a nursing home window leads to a $1.39 million settlement in Maryland

By Jan Gorrie, Esq.
Buchanan Ingersoll Professional Corp.
Tampa, FL

News: Although a nursing home was aware of a male patient’s general disorientation and history of self-destructive behavior, the man opened a fifth-floor window and fell to the pavement. He sustained multiple injuries and fractured most of his lower extremities. His recovery time, including hip replacement, required extended hospitalizations. The case against the nursing home was settled for $1.39 million.

Background: The 52-year-old man with a history of mental confusion, disorientation, and self-destructive tendencies was admitted to the nursing home for convalescent care and treatment. He transferred to the nursing home following an inpatient hospitalization. His hospital records clearly outlined that he required restraints to prevent self-injury. His brothers visited the nursing home before admission and explained his condition in depth to nursing home representatives. The siblings later claimed they specifically said the patient was extremely disoriented, had a propensity for attempting to harm himself, and required restraints and close surveillance.

Nursing home officials repeatedly assured the family that the facility was a safe and appropriate place. Nursing home employees also indicated to the family members that the windows were locked and secured.

The siblings signed the necessary documents and authorized their brother’s transfer from the hospital to the nursing facility. On the day of admission, the patient was found wandering about the institution. He was also observed to be agitated and he refused his medications. The patient was neither restrained nor carefully observed or confined. For the next three days, he continued to be disoriented, remained incoherent, refused care, and acted abnormally.

Around 10 p.m. on the third day, the patient was agitated and pulling the linens off of his roommate’s bed. No restraints were used, no physician was contacted regarding the change and deterioration in his condition, and no intervention was made. One hour later, the patient’s family members were contacted by the nursing home and told that their brother had been found on the pavement in the alleyway behind the facility.

The patient survived the fall but sustained multiple injuries. He was transported to a hospital and underwent 12 hours of surgery. His injuries included, but were not limited to, fractures of the ankle, kneecap, and hip (which required a hip replacement), a fractured pelvis, fractures of the left leg and left arm, and multiple internal injuries. He required extended hospitalization at a rehabilitation center for two months. After being discharged from that facility, he was transferred to a long-term care facility, where he remains in custodial care.

The plaintiffs brought suit against the nursing facility, claiming it failed to properly care for the patient and allowed him to cause significant injuries to himself. Prior to trial, the nursing home settled for $1.39 million.

What this means to you: When seeking custodial care, family members want their loved ones to be in a clean, safe environment. Family members may be able to readily assess a facility in that regard, but other items may be beyond their ability or consideration.

"My first impression upon reading this case study was, Why were the windows able to be opened in the first place?’" queries Patricia Specian, MSN, JD, risk manager at Columbia Hospital in West Palm Beach, FL. "Most nursing homes have their share of confused, demented, and disoriented residents, and it should be a basic security measure to make sure that all exits, including windows, were hazard-free. The likelihood of a confused patient opening a window obviously exists, as demonstrated in this scenario."

A patient’s medical history as well as medical, physical, and mental assessment should be performed upon admission to a new facility and an appropriate plan of treatment and care devised.

"It is difficult to presume that the nursing home staff was not put on notice by the family when they were made aware of the resident’s condition, the prior use of restraints, his history of self-destructive behavior, and the actual identification of windows and balconies as a potential danger to this person," says Specian.

Even if the family assessment was not noted in the medical records or never occurred, the patient’s behavior, once admitted, was corroborated in his progress notes.

"One could argue that restraints are not indicated or appropriate since this would not be the least restrictive means available; however, there is no indication that other less restrictive means were implemented. The patient was observed to be a wanderer, agitated, and refusing medications. Again, an argument could be made against the need for restraints even at this point, however, no other interventions are cited, such as an increase in safety checks, moving the patient’s room nearer [to] the nurses station, use of a Geri-Walker or use of a sitter," adds Specian.

The nursing home has a duty to provide a safe environment for its patients as well as to adapt the environment to the special needs of patients, especially when put on notice, as it so clearly was in this situation.

"Additionally, the escalating behavior of this patient indicates that the potential for self-harm and destructive behavior, as identified by the medical history and the family, was evident and observed. Again, despite being put on notice, no interventions were instituted to ensure the patient’s protection or at a minimum, decrease the potential for self-harm," notes Specian.

"I would advise the nursing home to review the restraint policy in place, to review its preventative maintenance program (i.e., when was the last time the window locks were checked for security and proper functioning), provide education for fall precautions to its staff, and instruct its nurses on key interventions to utilized prior to resorting to restraints. I would also encourage more communication with the family. It is quite possible the family would have considered spending more time with the patient, which may have caused some stabilization of his orientation status."