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Legal Review & Commentary: A fall on an escalator leads to a judgment
By Jan Gorrie, Esq.
Buchanan Ingersoll Professional Corp.
News: An 83-year-old man went to a hospital to visit his wife. He slipped and fell on an escalator, injuring his head. He was taken to the emergency department (ED) and classified as "nonemergent." Five and a half hours later, the patient underwent brain surgery for an intracranial bleed. He never regained consciousness and died 13 days later.
Background: The husband visited his wife at the hospital the evening she admitted. He lost his balance in an ascending escalator and fell backwards, hitting his head. The dazed man was quickly transported by wheelchair to the hospital’s ED at approximately 10:30 p.m. He remained in the triage area, visually observed for nearly four hours. It appeared to the triage nurse that he had only sustained minor cuts and bruises. At slightly after 2 a.m., he vomited, a sign of a possible cranial problem. An MRI was promptly ordered. Tests revealed a serious and expanding intracranial bleed. It was now 4 a.m., and the patient was in critical condition. Brain surgery was begun to relieve the bleed. Despite this direct intervention, the patient remained comatose and died 13 days later.
The deceased man’s estate brought suit against the hospital, claiming negligence in the treatment of the head injury he had sustained there. The estate maintained that upon presentation to the ED, an obvious head injury should have been promptly noted. The plaintiff averred that with immediately intervention the cranial bleed could have been successfully treated and contained. Instead, for some four hours, his critical condition went undiagnosed and unappreciated. He lacked even a precursory direct medical and physician examination. The triage nurse failed to complete a basic nursing assessment during this period, the plaintiff said.
The hospital defended on liability and causation. Its expert said the patient was immediately treated at the first demonstrable sign of a more severe injury. The defense expert neurosurgeon believed that the patient’s treatment was appropriate, and that his symptoms were treated well within the standard of care guideline of the eight-hour window of care. This expert also said earlier diagnosis and treatment would not have saved the patient’s life because the injury would have been fatal no matter what level or speed of intervention could have been provided to stabilize and rectify his condition.
A jury awarded the decedent’s estate $350,000.
What this means to you: Health facilities are often 24/7 businesses. Any time hospitals, nursing homes, and other health care facilities are open for business, they are generally open to all comers, including patients, employees, and visitors.
"We usually think of risk management activities being restricted to patient care, treatment, and safety as well as perhaps to employee safety, such as needlestick prevention. However, duties may also extend to visitor safety. Visitor slips and falls usually end up on the risk manager’s desk," states Cheryl Whiteman, clinical risk manager at BayCare Health System in Clearwater, FL.
Each facility presents its own environmental challenges based on design features and layout.
"Escalators present added risks to patients and visitors in comparison to elevators. Escalators do not have landings, as most elevators and even stairwells do. Anyone can misstep during a moment of inattention. Children are easily distracted and unaware of the danger a fall down a long length of moving escalator steps poses. As seen in this scenario, the elderly may experience balance problems, especially upon entering and exiting escalators. This conveyance placed the hospital at a higher risk for falls with injuries," observes Whiteman.
Given the inherent dangers, health facilities with escalators may be well advised to post additional signage relative to escalator safety. Patients and visitors may be distracted by pressing health care needs and decisions, which can lead to their failure to perform simple preventive measures, such as holding on to the hand rail. Appropriate sign may promote better, safer use of the escalator.
Once on-site injuries occur, risk managers may find visitors becoming patients — and then the risk management principles for patients should apply.
"In addition to the fall on the escalator, the elderly gentleman in this case also suffered from the inattention of the triage nurse. It appears that he was taken to the emergency department in quick response to his fall. Perhaps the triage nurse did perform a nursing assessment, however without substantiating documentation, this assessment never occurred," notes Whiteman.
Once this visitor became a patient, he fell victim to the common risk management error — the lack of adequate documentation. When a visitor becomes a patient, the risk manager’s assessment of the incident must change. This patient’s age and the fact that he was injured on site are factors the risk manager should have considered when determining how to proceed.
"Despite the expert testimony that the patient was cared for within the guideline of an eight-hour window and that the extent of the patient’s intracranial bleed made recovery unlikely, a jury would undoubtedly determine that the nurse fell below the standard of care and prevented any possibility of recovery for this unfortunate gentleman. As always, timely assessment with appropriate documentation is critical to patient care and to defense in litigation," concludes Whiteman.