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News: While hospitalized for pneumonia, an elderly patient fell twice. One fall was attributed to a commode breaking underneath her, and the second occurred when her bedrails were left in the down position. Injuries from the successive falls resulted in the need for her to be placed in a long-term care facility after discharge from the hospital. Even though she had no recollection of the second fall, a jury awarded $670,000 to the patient.
Background: The plaintiff, an 87-year-old widow, was admitted to the hospital for treatment of pneumonia. Prior to admission, the plaintiff had lived independently in an apartment for 26 years, despite blindness in her left eye from a childhood injury. Upon admission, she was assessed as being a high risk for falls due to generalized weakness from her pneumonia, partial blindness, and a history of falls.
The plaintiff was being assisted in using a bedside commode when the leg of the commode broke, causing her to hit her head and fall to the floor.
In the course of hospitalization, the patient also began to suffer from intestinal bleeding, which lead to her need to be catheterized while sedated. Following one such procedure, upon returning to her room, an EKG technician arrived and asked the family to leave so that she could perform the EKG. After the EKG, the technician left the bed elevated in the highest position and left the two lower side rails down.
About an hour later, a nurse went to the room and found the plaintiff lying in a pool of blood on the floor. The plaintiff was cleaned up and put back in bed.
The plaintiff had no memory of the second fall, but she apparently fell out of bed while unattended. As a result of the fall, the ocular globe in her right eye was ruptured. Since her left eye had been injured in a childhood accident, this rendered her essentially blind. The patient alleged negligence in providing an unsafe commode for patient use and for leaving her unattended with the bed two of the four side-rails down. The plaintiff, independent before the accident, moved into a long-term care facility.
The defendant argued there was no credible evidence that the plaintiff fell out of bed. The defendant hospital argued the position of plaintiff’s body on the floor suggested that she had gotten out of bed and then fallen. The defendant said the plaintiff’s deteriorating health would have eventually necessitated long-term care. The defendant also argued the plaintiff failed to mitigate her damages through physical therapy and potentially corrective surgery.
The jury awarded the plaintiff $670,000 in damages.
What this means to you: There is a basic rule in patient care: Take the patient as you find them. This is certainly the case with elderly patients. With specific-need elderly patients, different rules often apply.
"Although this patient had been living independently, which would normally indicate a mobile, but albeit, elderly patient, she was assessed at admission as being high-risk for falls," says Ellen L. Barton, JD, CPCU, a Phoenix, MD-based risk management consultant. "If the system for assessing her as high risk was in place, it stands to reason that there were protocols in place for handling patients once they were labeled; otherwise, there would be no need for the label. Once deemed high risk, protocols should at a minimum address the use of equipment and communication among staff when the patient’s care is transferred from one person to another.
"Decisions regarding equipment may be critical in the care of a high-risk patient. Someone probably should have assessed whether it was safer to use a bedside commode or have the patient assisted to the bathroom. Perhaps this was done, but regardless once someone made the decision to use the bedside commode, the hospital bore the responsibility for maintaining and servicing the piece of equipment as well as assuring that staff members charged with the use of the equipment knew how to operate it and should have recognized when something might be wrong with it. This generally involves staff training in the use and operation of equipment as well as an regular equipment safety check by the hospital engineering department," adds Barton.
"Further, when a high-risk patient is transferred from staff to staff, the present caregiver should notify the other of the patient’s condition. In this instance, this would have included the charge nurse passing along the information to the EKG technician and sharing with the tech the need to raise the bed rails and keep the bed in the lowest of the positions. When a patient has been identified and labeled as high risk, it generally means that additional precautions must be taken and those aware of the potential should be a position to communicate that fact to others involved in the patient’s care," concludes Barton.
• May Henry v. San Angelo Community Medical Center, Tom Green County, TX District Court, Case No. C-99-0457-C.