Patient Falls, Suffers Hip Fracture/Hematoma and Dies; Home Health Care Provider Settles

An 82-year-old patient became a patient of a home health care provider on November 21, 2014. At all times relevant, the patient was a high fall risk and required continuous, 24/7 supervision for safety. Specifically, the patient sustained a fall in August 2014 that resulted in a hip fracture, for which surgery was performed in October 2014. Following surgery, the patient suffered from confusion and limited mobility and was administered anticoagulants.

When the home health care provider began caring for the patient in November 2014, she was totally dependent on caregivers each shift for all activities of daily living, including bathing, toileting, mobility, and wheelchair use. The patient required constant supervision for safety based on her cognitive impairment, memory loss, and poor safety awareness. The home health care provider knew the patient was a high fall risk, and the patient frequently expressed that she was anxious about falling. The home health care provider also knew the patient required assistance and supervision when she was ambulating, which the patient sometimes attempted by herself, most often when confused. The home health care provider’s aides and others often interrupted, when the patient was attempting to exit her bed without supervision, “close calls” before they resulted in falls. While under the care of the home health care provider, the patient never required less than the in-person supervision of one aide when she was on her feet. Indeed, the home health care provider was specifically to ensure that at least one caregiver remained physically present with the patient around the clock for supervision, fall prevention, and safety.

In the early morning hours of January 5, 2015, the patient was permitted to rise from her bed by herself and fall. At the time of the fall, the patient’s 77-year-old caregiver, an aide employed by the home health care provider, was asleep. The home health care provider’s policies prohibited (or should have prohibited) its aides from sleeping on the job. When the patient fell, the room was dark. The aide claimed she awoke and heard the patient removing her C-PAP mask before the fall. The aide rose and turned on the light in the patient’s room, only to observe the patient laying in the floor. The patient’s fall would have been prevented if the aide had been actively supervising the patient and if the aide’s supervision had been supplemented with an in-bed, pressure-sensitive, fall alarm.

After the fall, the patient was transported to an urgent care facility for evaluation of pain from contusions to her head, shoulder, and hip. Because the patient was taking anticoagulants at the time of the fall, she was sent to a hospital emergency room for further evaluation. At the emergency room, the patient received a CT scan of her head, which revealed only that she did not have an active cranial bleed.

The patient returned home, where the home health care provider’s aides noted she was very sore and badly bruised, experienced dry heaves, needed Tramadol and Tylenol for pain, requested a heating pad for her stomach, and required ice packs for comfort/swelling. Attempts to transfer the patient at the time were difficult, even with the full assistance of the home health care provider’s aides. The patient complained of pain in her abdomen, shoulder, hip, and foot. By January 7, 2015, two days after the fall, the patient’s speech had become garbled. The home health care provider did not contact the patient’s doctor or nurse to report those symptoms.

The following day, January 8, 2015, the patient’s granddaughter visited the patient and noticed her condition had deteriorated markedly. The patient was transported to the hospital emergency room, where her blood pressure dropped to unsafe levels. The patient was intubated, administered fluids, and transfused for blood loss. Diagnostic testing revealed the patient’s hemoglobin was very low at 4.7, her INR was high at 9.68, her lactic acid was 13.4, and she was experiencing multi-system organ failure. Additional diagnostic testing revealed that the patient had sustained a pubic rami fracture as a result of the fall and that a hematoma, which was bad and getting worse because the patient was taking anticoagulants, had developed in the area of the fracture.

The patient’s critical, declining condition made clear that she needed a level of care the hospital was unable to provide. As such, the patient was airlifted on January 9, 2015 to another hospital, where she was placed in ICU with multi-system organ failure, septic shock, hypovolemic shock, acute respiratory failure, a fractured pelvis, shocked liver, acute blood loss anemia from the hematoma, acute kidney injury, encephalopathy, and pneumonia. The patient was unresponsive on arrival to the hospital and, despite extensive life-saving measures taken there, her condition did not improve. The patient’s family was advised that the patient likely would not survive, and her family elected at that point for the patient to receive comfort care only.

The patient died on January 10, 2015, less than one week following the fall at issue. Her death certificate lists her cause of death as hemorrhagic shock from complications of pelvic fracture and soft tissue hemorrhage, septic shock from the fall from bed, and respiratory failure.

As a result, the family contacted us to pursue claims against the home health care provider for failing to provide proper supervision and care to prevent her from falling and suffering injuries, leading to her death. We were able to obtain a settlement award for the patient’s family.