Legal Review & Commentary
Unattended, medicated patient falls, breaks hip: $835,335
By Pearl Schaikewitz, JD
Legal Consultant, Atlanta
News: A California jury awarded $1.3 million to a patient who fell and broke his hip while trying to get out of a chair. The award was reduced to $835,335, and the parties entered into a structured settlement for an undisclosed amount.
Background: The 59-year-old patient, a computer professional, underwent invasive surgery to remove a chest schwannoma, which was benign. After surgery, he was given Xanax and morphine sulphate orally. The surgeon had ordered Compa zine to be administered orally, but it was given intramuscularly. Between 8 p.m. and 9 a.m. on the second morning following surgery, the patient was taken out of bed and placed in a chair while hooked up to an IV. The nurses were changing the bed linens and preparing the patient for possible discharge. They left the room.
The patient tried to get up but fell and broke his hip. Surgery was performed, and his hip was pinned. During physical therapy, the patient was diagnosed with a benign brain tumor. He has difficulty walking and developed chronic pain syndrome as a result of the pins protruding into the soft tissue surrounding the hip.
The patient claimed the nurses negligently administered his medications and left him unattended. According to the plaintiff, he was overmedicated, and he was moved to the chair as soon as an hour and a half after receiving one of the medications. He also claimed that the chart was devoid of nurses' or physicians' entries from 8 a.m. or 9 a.m. until after 1 p.m. Therefore, the length of time the patient was left unattended could not be determined. Radiology records indicated the hip was X-rayed at 10:15 a.m. Later, the attending physician wrote that the patient had suffered a hypostatic event. Prior to leaving the hospital in the early morning, the patient's wife had expressed concern that her husband seemed "out of it." None of the five nurses whom the plaintiff's lawyer called to testify at trial could recall any of the facts surrounding the incident. The hospital denied negligence and argued that the patient's walking deficits were caused by brain dysfunction resulting from the tumor.
What it means to you: Virginia O'Malley, RN, director of risk management for Valley Hospital in Ridgewood, NJ, offers the following observations:
Fall prevention is a pervasive issue for all hospitals. The most common custodial injury is a fractured hip following a patient fall. From a risk management perspective, the concerns in this case clearly involve lack of documentation. Failure to document equates with failure to perform, which translates in this case to failure to assess, monitor, and prevent injury to the patient.
The first issue is assessment of the patient for any sensory or motor deficits that might place him at a greater risk for a fall. For example, did the patient have a documented walking deficit? Were there any indications that the patient had been behaving as though he were overmedicated? Was the patient assessed for this?
The second concern is the fall prevention measures that could have been implemented if the patient were identified as being a high risk for falls. The most important measure is giving the patient clear instructions not to get out of bed or the chair without assistance. Other safeguards include the use of barriers such as side rails, a call bell within reach, and a bedside commode that preempts a walk to the bathroom. Were such measures in place?
The final issue is the lack of documentation of the circumstances surrounding the actual fall. For example, when was the patient mobilized to the chair? What instruction was he given to call for assistance, and did he have a device within reach to do so? How long was he in the chair? What was the patient's behavior or sensorium? Was he alert and steady on his feet during the transfer to the chair? When was he found on the floor?
A strong high-risk screening program could be put in place, which might have assisted in the hospital's defense. Such a program includes early notification to risk management when there is an adverse patient event or injury. As long as the risk manager is brought in early enough, he or she can investigate the situation, conduct interviews, and examine the medical record to verify that it is documented as thoroughly, objectively, and accurately as possible. There is nothing more credible than contemporaneous documentation. Frequently, the medical record is the only piece of evidence available to help a facility survive medical malpractice litigation. It will last beyond the statute of limitations and the caregivers' memories.
In this case, the lack of documentation contributed to the nurses' lack of recall, resulting in loss of credibility and a significant adverse verdict. In the risk management education program at my facility, part of my job is encouraging caregivers to document the medical record thoroughly, objectively, and contemporaneously to the care rendered.
Reference
Burns v. Downey Community Hospital, Norwalk County (CA) Superior Court, Case No. BC 152 125.
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