A nursing home will be fined after a resident fell within 24 hours of being admitted and later died from untreated injuries from the fall.
The nursing home has a history of
problems and fines by the state inspection authorities.
In this incident, the resident was admitted to the facility about noon.
The resident and spouse both indicated the resident had a recent
history of falls. A care plan identified the problem and listed
interventions that included a bed alarm and a body alarm.
At 9 p.m. that night, one of the resident's alarms sounded as the
resident attempted to get out of bed.
At 4:25 a.m. the following morning, an alarm sounded again. The resident was
found on the floor, which was wet with urine, when staff members
responded. The first staff member to arrive said in an interview
later that the resident fell head first. She failed to tell the
nurse that the resident had hit their head.
Staff members did bandage a small wound on the back of the
resident's hand. Another staff member did an assessment of the
resident's mobility and asked whether the resident was hurt and
about what happened. The resident responded "no" to the question
about being hurt.
The staff member could not recall for sure if she asked if the
resident hit their head. She did not check the resident's pupils or
perform any neurological checks.
The resident, the staff member reported, seemed to be doing all
right, and was talking with another resident. The resident received
morning medications, breakfast and went to the restroom.
At 9:20 a.m., the resident complained of hip pain. Staff gave the
resident a pain medication. No assessment was done at the
At 10 a.m., family members noted that the resident "became restless
and agitated, looking for cigarettes. The resident complained of
having a headache above his/her right eye." Upon returning to the
room, the resident was unresponsive. The resident was taken to the
In a later interview, the resident's physician said the facility
did not inform him about the fall. "The physician stated staff
frequently contacts him for things much less severe than a fall.
The physician added that he would have expected a telephone call at
the time of the fall, 4:30 a.m."
However, the doctor said it was "likely the resident could not have
been saved if they were notified at the time of the fall. However,
but not notifying the physician, the physicians did not even have
an opportunity to try." For more, read the story.
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, Charlottesville, and across Virginia.