Nursing Home Aware Of Fall Risk For A Decade Allows Patient To Fall, Suffer Fracture; Nursing Home Settles

Admitted at 86 years old, a female patient was at the same nursing home for approximately 10 years. At all times relevant, the patient was known by the nursing home to be a fall risk due to a medical history that included dementia, incontinence, the use of assistive devices for ambulation, and the necessity for extensive assistance of nursing home staff for mobility.

On January 21, 2013, the nursing home permitted the 96-year-old patient to rise, stand, and walk to the bathroom, where she fell to the floor. The patient began screaming for help. The nursing home did not intervene to prevent the patient’s fall before it occurred, did not respond to the patient immediately after the fall, and was only alerted to the fall by the patient’s daughter, who arrived later to visit and found her mother on the floor laying up against the door/wall of the bathroom screaming for help. 

The patient was transported to the hospital, where she was diagnosed with a left humeral fracture and a right femur fracture. While she was recovering from surgery, the patient suffered from atrial fibrillation and hypotension, required intubation, and was placed in the hospital’s pulmonary intensive care unit. 

The patient remained in obvious pain after the surgery. She was documented to have been moaning “my leg, my leg” when moved, and she frequently grimaced, reflecting that she was in obvious distress. The patient required multiple narcotic and non-narcotic medications for pain: morphine, fentanyl, duragesic patches, Ultram/toradol, and acetaminophen injections. She also required Haldol for agitation and metoprolol for atrial fibrillation. 

When the patient was discharged from the hospital, hospital staff recommended that the patient be supervised 24/7 and receive physical assistance for her mobility and other activities of daily living, including eating. The hospital’s physical therapist was pessimistic about the patient’s ability to rehabilitate due to her confusion, agitation, acute pain, and limited weight bearing on her left arm and leg.

The patient returned to the nursing home facility on January 25, 2013. Upon her return, the nursing home required their staff, per the patient’s interim care plan, to place frequently-needed items within easy reach of the patient. Unfortunately, the patient was not provided with fluids or given easy access to her water pitcher. The patient’s daughter frequently observed that her mother’s bedside cart/table with fluids was left outside of the patient’s reach. The patient’s daughter would push the cart close to her mother’s bed and help her mother drink, only to find on her next visit that the cart with water had been pushed too far away from the patient. Unfortunately, the nursing home’s Dehydration Risk Assessment did not properly identify the patient as a high dehydration risk even though she required total care for feeding and drinking and was experiencing lethargy due to the narcotics she was receiving for pain. As the patient became more dehydrated and lethargic and less able to consume fluids by herself, the nursing home failed to reassess her dehydration risk.

The patient experienced similar challenges with eating, often consuming far less of her meals than before the fall and requiring total care from staff during meals. The patient ultimately became unable to assist at all with eating. She spent most of her time lying on her right side and continued to eat less and less. By February 7, 2013, the patient remained lethargic and still was not eating well. By February 10, 2013, she no longer wanted to eat. The patient’ daughter asked for her mother’s fentanyl dosage to be decreased due to her lethargy.

Three weeks after her surgery, on February 14, 2013, the patient’s daughter accompanied her mother to a follow-up orthopedic appointment for removal of her leg staples. The patient had to be transported to the orthopedist by ambulance on a stretcher because she was too weak to sit up in a wheelchair. In the ambulance, the patient’s daughter noticed the right side of the patient’s face was incredibly swollen and extremely painful to the touch. The nursing home never documented the facial swelling, did not assess the swelling for pain, did not notify the patient’s nursing home physician about the change in her condition, and had not earlier notified the patient’s daughter about her mother’s change in condition.

The patient’s daughter advised her mother’s orthopedist about the swelling. The orthopedist noted significant swelling on the right side of the patient’s face, which was exquisitely tender to the touch. The patient’s orthopedist recommended that she be taken immediately to the hospital and evaluated for parotiditis, an infection of the salivary gland usually caused by dehydration and malnutrition, for which the symptoms include swelling, dry mouth, a strange/foul taste in the mouth, and mouth/facial pain that manifests itself when eating or opening the mouth to chew. 

At the hospital, the patient’s mucous membranes were noted to be dry, and she had right-sided facial swelling, a hard, tender mass near the angle of the mandible, acute dehydration, acute parotiditis, and evidence of aspiration. The patient’s mouth infection had caused sepsis. Despite aggressive intervention, including IV pain medications, the patient remained in extreme pain.

The patient died a painful, septic death on February 21, 2013. During the last days of the patient’s life, she suffered significantly, often reaching her hand out to her family members and begging them to help her. 

The family contacted us to pursue claims against the nursing home for failing to provide proper fall prevention and treatment for injuries suffered from the fall. We were able to obtain a settlement award for the patient’s family.