Assisted Living Patient Falls Repeatedly, Suffers Multiple Fractures; Case Settles

A 78-year-old female patient was admitted to an assisted living facility on Christmas Eve in 2015, with a history of having eloped from home on multiple occasions. While at the hospital, she was noted to be increasingly confused and, per therapy records there, required supervision for bed mobility and transfers. She remained a high fall risk patient for reasons that included poor safety awareness.

The patient was permitted to fall at the assisted living facility on 1/8/16, during which a LPN left the patient outdoors at the assisted living facility without any supervision to smoke a cigarette. When the nurse returned, she found the patient laying on her left side on the concrete patio. According to the incident report, the patient reportedly stood, began to lose her balance, could not catch herself, and fell to the ground.

The patient was taken to the hospital, where she was diagnosed with a right hip fracture, an impacted fracture of the right distal radius, and a fracture of the right ulnar styloid. She received intramedullary fixation surgery on 1/9/16 for the right hip fracture. Fractures of the patient’s right wrist were treated conservatively with a sugar tong splint. The patient was right-hand dominant. She remained a patient at the hospital until 1/12/16, when she was returned to the assisted living facility.

Following her return to the assisted living facility, the patient was documented to require total assistance with all of her ADLs. She was also noted frequently to attempt to get out of bed and walk without any supervision or assistance. The patient continued to complain of fracture-related pain at the assisted living facility. On 3/3/16, x-rays taken of the patient’s right wrist revealed displacement with early healing of her wrist fractures. The patient was placed in a cock-up splint until 4/27/16 to immobilize her right wrist. 

On 8/4/16, the patient was again permitted to fall at the facility. On that date, she was left alone in her room at approximately 6:20 AM by her aide. The patient started to rise from bed in the aide’s presence and announced to the aide her intent to “get up.” The aide had not yet toileted the patient that morning. The aide left the patient alone to check the shower schedule in a separate area of the facility. The aide stopped along the way to attend to another patient. When the aide returned to the patient’s room, she heard her screaming for help and found her laying on the floor of her bathroom.

Assisted living facility staff moved the patient after the fall from the bathroom floor to her wheelchair. Staff then attempted to assist her in the bathroom, but she had trouble standing and complained of pain. An x-ray was ordered shortly after the fall, but there appears to have been considerable delay before she received the x-ray. In the interim, the patient was documented to have been left in her wheelchair for breakfast and assisted to bed after breakfast. She took a two to three hour nap and woke complaining of left hip pain. Pursuant to a nurse’s note timed at 5:47 PM on the day of the fall, the patient had not yet been x-rayed, and the mobile x-ray company advised that x-rays probably could not be taken for another two to three hours. The facility advised the patient’s son of the delay, and she was sent to the hospital emergency room for evaluation.

From the hospital’s ER, the patient was transferred to another hospital. The patient was diagnosed at one or both hospitals with an impacted fracture of her left femur. She had open reduction internal fixation surgery on 8/6/16 and remained hospitalized through 8/20/16 for fall-related complications, to include anemia, chronic hypoxic respiratory failure, and encephalopathy due to the narcotic pain medication she received for fracture-related pain. The patient returned to the facility on 8/20/16. As late as 10/11/16, the patient was able to walk, but only with a front-wheeled walker and a wheelchair following. 

The family contacted us to pursue claims against the assisted living facility for failing to provide proper supervision and care to prevent her from falling. We were able to obtain a settlement award for the patient’s family.