We recently obtained a very favorable settlement in the case of an 81-year-old female nursing home patient who was allowed by the facility to fall and sustain a hip fracture. She was also the victim of medication errors while a patient at the nursing home.
The patient was admitted to a Roanoke area nursing home on July 20, 2005 following hospitalization for a left hip fracture she sustained in a fall at home. On admission to the facility, she was a high fall risk because she had an unsteady gait, poor/impaired coordination, poor safety awareness, short term memory loss, dementia, bladder incontinence, and a history of falls. While a patient at the nursing home, she was allowed to fall on multiple occasions. Specifically,
- on July 22, 2005 at 4:00 pm, the nursing home's nurse’s notes reflected that the patient was found on the floor in her room "between the two beds in stocking feet". The nursing home's fall investigation documents reflect she was found lying on her back after staff responded to a loud noise and heard her yelling. Her wheelchair was found unlocked, her shoes had been removed, and she was attempting to get into her bed when she fell. The nursing home responded to the fall by recommending to staff that she be reminded regularly to ask for assistance;
- on July 23, 2005 at 6:15 am, the nursing home's nurse’s notes reflect the patient was found in the bathroom "on the floor after staff heard her yelling for help." The nursing home's fall investigation documents reflect the patient was getting off of the toilet without assistance when she fell. The nursing home's staff was instructed after the incident not to leave her unattended. The nursing home responded to this fall by recommending to staff that the patient be provided with a personal assistance device (PAD), which is a pendant worn by the patient that permits the patient to summons help after an emergency. A PAD is not a fall alarm;
- on July 25, 2005 at 4:30 am, the nursing home's nurses notes reflect the patient was found "on the floor" of her room. The nursing home's fall investigation documents reflect she said she "had to go to the bathroom and could not wait for help." The nursing home responded to this fall by recommending to staff that the patient be provided with a low bed and a fall mat at bedside. She was also provided with a motion sensor fall alarm for her bed. No fall alarm was provided for use while she was in a wheelchair;
- on August 6, 2005, the patient was allowed to fall again, this time at the nurse’s station. The nursing home's fall investigation documents reflect that the patient was in her wheelchair at the nurse’s station, stood up to use the phone, lost her footing, grabbed her wheelchair, and fell. The string on the patient's PAD was noted to have been untied and frayed at the time of the fall. As a result of the fall, the patient sustained a right hip fracture.
We contended the nursing home was negligent in connection with the August 6, 2005 fall by failing to supervise the patient while she was at the nurse’s station, by not equipping her wheelchair with a chair fall alarm, and by failing to ensure her wheelchair was locked.
With respect to supervision, the patient was observed before the fall only by a member of the nursing home's housekeeping staff, who saw her stand and observed her "talking on the phone in the hallway." The housekeeper took the time to ask the patient "what she was doing" and the patient responded that she was "trying to call her daughter." The housekeeper then took the time to tell the patient she "needed to sit down before she falls and gets hurt." According to the housekeeper, the patient then attempted to sit down, turned around, lost her footing, tried to break the fall by using the wheelchair, and fell to the floor. At no time during her lengthy interaction with the patient did the housekeeper summons help from nursing staff, and no one on behalf of the nursing home intervened to assist the patient safely back into her wheelchair.
With respect to the nursing home's failure to provide the patient with a fall alarm in her chair, the patient had been provided approximately two weeks before the fall on August 6, 2005 with a motion sensor fall alarm, but only for her bed. She had not before the fall been provided with a fall alarm for use in her wheelchair. As a result, the nursing home's staff was not alerted when the patient began to rise from her wheelchair at the nurse’s station or as the patient remained standing at the nurse’s station talking on the telephone before the fall occurred.
Finally, the patient's wheelchair had not been locked when she was left at the nurse’s station. Just prior to the fall, the nursing home's housekeeper observed that the patient was unable to stabilize herself when she turned to sit in her wheelchair. A member of the nursing home's staff later confided to the patient's family that no nurses were present to supervise the patient at the time of the fall, her wheelchair had not been locked, and the wheelchair rolled backwards when she attempted to sit in it. In addition, the nursing home's head of nursing told the patient's family the nursing home did not have enough staff to provide one-to-one supervision, the facility would make sure she was at the nurse’s station in her wheelchair so staff could supervise her appropriately.
As a result of the August 6, 2005 fall, the patient sustained a displaced right femoral neck (i.e. right hip) fracture. She was admitted on an emergency basis to a local hospital, where she underwent a bipolar prosthetic arthroplasty the day after the fall. She remained at the hospital through August 11, 2005, at which time she was transferred back to the nursing home for rehabilitation. She suffered significant pain and immobility as a result of the right hip fracture.
Upon the patient's return to the nursing home, the facility's staff administered the wrong medication to her in error. Specifically, the patient received Chlordiazepoxide (a drug with sedative and hypnotic properties) instead of Chlorthalidone (a diuretic) in error from August 14, 2005 through August 19, 2005. The nursing home explained the error by claiming the names of the two drugs had similar spellings. The nursing home's repeated medication errors caused the patient to suffer significant lethargy, from which she eventually recovered. The patient fell again at the nursing home on August 26, 2005, but thankfully sustained no injury. She died on August 31, 2005 for reasons unrelated to the fall.
The case was settled before trial for six figures. Specifics about the settlement were made confidential at the nursing home's request.
Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Martinsville, Charlottesville, and across Virginia
Posted on Sat, February 21, 2009
by Robert Carter