Law Office of Steven J Karen
702-382-9307 2810 West Charleston, Suite 82 Las Vegas, Nevada 89102
PATIENT FALLS OUT OF BED WHILE TRYING TO GO TO THE BATHROOM RESULTING IN ABOVE THE KNEE AMPUTATION. FALL RISK PROTOCOLS WERE VIOLATED BY HOSPITAL AND NURSING STAFF. GUARD RAILS WERE NOT RAISED AND THE NURSING STAFF IGNORED CALL LIGHT.
CONFIDENTIAL SETTLEMENT
Patient was admitted to a Rehabilitation Hospital Corporation for 6 weeks of antibiotic therapy. He was classified upon admission as a high risk for falls because of his amputee status. ).
He was assigned as a patient to Nurse P. Nurse P administered 15 milligrams of Lortab to Patient. The nurse testified at her deposition as follows:
Q. What was his condition when you left?
A. He was fine, he was resting and he was all right.
Q. Was the patient, restrained in any manner?
A. No.
Q. Were guardrails up on the bed?
A. Not in the daytime.
Q. Were the bed wheels locked down?
A. I do not remember that. (Nurse P).
Q. Do you know whether or not the guardrails were raised on his bed ever?
. . ..THE WITNESS: Yes
Q. When were they raised on his bed?
A. Well, that morning I did not see the guardrails raised on his bed. I do not exactly remember.
Q. How about when you left his room and when you administered drugs at 1300, 1;00, were the guardrails raised then?
A. I believe one side was up and the other side he has a table in front of him.
According to the director of nursing the Hospital terminated Nurse P for poor performance. "I swear to God that I terminated this young lady . . ." (
At approximately 3:00 p.m. Patient was discovered lying on the floor next to his bed by the nursing supervisor, nurse S. . . . I was doing my round when I went by and saw that he was on the floor.@ (Nurse S. A
". . . I went down with all my strength and my stub just splattered it was like somebody dropped a watermelon, blood went all over the walls and stuff. And I started screaming for help." Patient
Nurse S discovered that the bed had rolled away while Patient was attempting to transfer himself from his wheelchair to his bed. . . . He told me that he went to go to bed and the bed rolled away from him. That=s why he fell.@ (Nurse S).
Q. Had the bed rolled like he said it did?
A. Yes, because I did check the bed. Yeah the bed rolled
Q. . . . And was the bed in a position that was consistent with what he told you?
A. Yeah, the bed rolled.
Q. It does roll?
A. Yes.
Q. And did you see that it had rolled away from where his chair was?
A. Yeah. (Nurse S).
Patients wife arrived at the Hospital and discovered him still on the floor. ". . .I went directly to his room and he was on the floor. There was blood smear on the floor. There was two or three nurses in the room standing around. He was in terrible pain." "His bed was pushed to the . . . other side of the room."
Nurse S did not inspect the wheels on the bed to see if they were locked. However, she did push the bed and the bed rolled). Patient fell during a change in the nursing shift. (Nurse S) ". . . he was bleeding through his stump." (Nurse S).
If the person is in bed and they're high risk for falls both side rails are supposed to be up. (Nurse S). Nurse S testified that if she would have seen that one of the side rails on the bed was not raised while he was in bed she would have told nurse P to raise the siderail. ". . . if I see that it's down, I would." (Nurse S).
According to the nursing Director, Patient was allowed to transfer himself as desired before his fall at the Hospital.
A. Well, here it says that he was alert and oriented, up in wheelchair to bathroom as desired.
Q. Okay. Does that mean he's allowed to get up out of his bed and go to the bathroom anytime he wants to?
A. It would appear that way.
Q. It does. So, he would not be noncompliant for getting up out of the bed himself.
A. It does not look this way.
You said a moment earlier he was allowed to get up and go to the bathroom as desired so wouldn't you agree that would lead him to believe that he was able to get up and out of bed as desired as well to go to the snack bar or get up and out of bed as desired?
A. I would assume that, yeah.
The Nursing Director agreed the, bed wheels should have been locked at all times. "That is standard protocol in any facility you work on so the beds don't move. The beds are on wheels. You want to make sure they're secure."
Q. Would you expect a bed to roll away if the bed wheels were locked and somebody pushed on the bed?
A You would expect that it would not . .
The care plan was changed after his fall.
Q. . . . What changes were made, what modifications were made?
A. In addition to the initial one which stated elevated rails especially at night, all light within reach, and position of bed at normal level, they added keep wheels locked at all times and encourage patient to cal for assistance to transfers.
Following the fall Patient was transported by ambulance to a full service Hospital. Patient described his pain as "terribly painful". Surgery was then performed. According to the operative report "The patient's left leg was prepped and draped in the usual manner. The 15 cm defect which the traumatic wound dehiscence had caused was carefully scrubbed out and old hematoma was removed. There was no evidence of infection. Cultures were taken. The flaps were then slightly debrided and then reclosed with 32 monofilament nylon sutures. Dr. S characterized the fall as major trauma to the stump.
Patient was unable to sleep for weeks following surgery due to the pain. He was basically confined to his bed during this period. According to Dr. S everything was done to try to save his knee and nothing worked.
A knee disarticulation was performed by Dr. S. According to Dr. S the loss of the knee resulted in a loss of mobility . ". . . One thing he has lost is his ability to control that knee. So if it involves, for instance bending or crouching down, he may have more difficulty with those types of lifting maneuvers."
Expert witness Dr. H explained why Patent lost his knee as follows:
He had his revision by Dr. S. He had an uneventful recovery and one week later was discharged . There is no evidence that he was having anything more than the usual and customary postoperative pain in the stump at that time.
He sustained the fall, three days later, ten days after the original surgery. At that time, he broke the wound open, contused the end of his stump, and he had quite severe pain from what I understand from the records, had to have it irrigated and closed again. .
So for, a period of five months, he has had three operations on his stump and an operation on his hip. That's an awful lot of trauma to an area. So it doesn't surprise me at all that he was having the degree of pain he had.
It's also my opinion that there was a degree of reflex sympathetic imbalance in this extremity, and that was due to the trauma he had sustained in that leg from hip to knee, so that doesn't surprise me too much= especially the fact that there was a crushing injury to the stump, because crushing injuries or explosion-type injuries tend to have a higher incidence of reflex sympathetic dystrophy. So that's my opinion on why he had the pain and why he had the knee disarticulation.
After the fall at he could not stand up more than one hour at a time. He fell down four times in front of people at work. He could no longer functions at work. He had several falls on the job. He was told no other positions were available for him. He decided to resign.
After he lost his knee and his job he became very depressed.
After reviewing the entire chart, the director of nursing, testified in her deposition on this particular instance in this particular chart there was not adequate charting done..
Q. So, it's below the hospital protocol for charting?
A. In this particular instance it doesn't meet the standard, you're correct.
Throughout the chart there were numerous places where the nurses were supposed to document that the side rails in the bed were placed up. Yet these portions of the chart were left completely blank.
Q. And those were all supposed to be filled out, right?
A. Yes.
"A form is supposed to be filled out and by not filling it out it means it wasn=t done . . .
The patients care plan for was not checked off by the assigned nurse as having been reviewed.
Q. The fact that this is blank, not signed, initialed, or anything else, that=s not standard operating procedure?
A. I would have to say yes, she should have reviewed that section. Is that your question?
Q. Yes. That=s my question. Not to do is not the standard operating procedure of the hospital, right?
A. No. She should have reviewed her care plan. .
According to the Director, ". . . we had not had a good fall policy." " . . . I couldn=t find anything in writing about a fall policy".
A . . .I thought we needed to have a good fall restraint policy because I didn't find anything like that when I first got there.
Q. So you decided to implement new fall prevention protocol policies and did that after {this} fall, right?
a. It just happened because I was reviewing all the policies and procedures many of which were not what I thought were not what I thought were acute enough that we needed to look at because of my background and so I went through the quality manager and our committee to say we need to improve on this process and have a policy.
Q. Right. And you also had somebody fall in the hospital and get hurt?
a. Yeah.
Q. Shortly after the hospital opened up?
a. I also had just taken over that job as well and as part of my duty to preview policies and procedures and start to begin to implement because this facility was not being run as an acute care facility. It should have been. There was a lot of nursing home type mentality there. We were getting sicker and sicker patients there and we needed to have policies and procedures.
Q. What do you mean it should have been as an acute type facility to paraphrase your words as best as you can?
a. Of the philosophy of admission to this facility it=s a different licensure. It=s called a long-term acute facility. When you use the term long-term care, many people assumed that long-term care meant like a nursing home would be and it was not.
We were taking acutely ill people out of intensive care and so a lot of policies and procedures needed to be looked at and that=s why I was hired because my predecessor was not looking at those particular areas when she first came she was only there one month and then I took the position.
They had many forms just protocols that were meant like real nursing home type stuff and rehab stuff and that=s not what we were and I needed to get back to that acute care 24-hour nursing care so I was in the beginning process of starting to change those things not just because he fell and I was getting - -
Q. Well, you say not just because.
a. That's the indication I got from you.
Q. You already said you believed the prevention policies were not adequate and you had a fall in the hospital so certainly that was an additional cause or reason for revamping the policies.
a. I would agree with that, yes.
Nurse P the assigned nurse on did not review the patients care plan on that day. Patient was allowed to transfer himself as desired even though he was high risk for falls because of his amputee status and the fact he was taking narcotics. This was a violation of their own policy. The bed wheels were not locked down on the bed. The bed wheels were supposed to be locked at all times. Both the side rails on were not raised to prevent him from self transferring. This was another violation of the Hospitals own policy.
Q. Well, if the guard rails are both up, that discourages the patient obviously from getting in and out of bed on their own.
a. Absolutely.
Q. So, obviously that could have prevented him from self-transfer?
a. It would, yeah. He couldn't get out of bed if the side rails - - I wouldn't think he could being an amputee.
The Hospital allowed an amputee under the influence of a large dosage of narcotics to self transfer at will. They did not lock the wheels down on his bed. This caused the bed to roll away and Patient to fall on his stump. They did not keep the side rails on the bed raised up. This would have prevented self transferring and would have prevented this tragic fall.
Specialist repeatedly fails to investigate the cause of 41 year old womans low iron anemia. The doctor never did a sigmoidoscopy or a colonoscopy. That was medical malpractice and the cause of her untimely death.
CONFIDENTIAL SETTLEMENT
A 41 year old woman died from metastatic colon cancer. She sought medical attention from a gastroenterolgist, where she received numerous abnormal lab results indicating she had anemia and low iron anemia.
Low iron anemia is a red flag warning sign for colon cancer. Iron is needed to make hemoglobin, the protein that delivers oxygen to tissues throughout the body. A deficiency can be caused by all sorts of conditions that are not cancer, including heavy menstrual periods, ulcers, and a diet that is too low in iron. Because since iron-deficiency anemia can also be evidence of colon cancer, it is essential that doctors take steps to find out the specific cause.
As a specialist, the gastroenterologist and his medical staff should have picked up on the significance of her symptoms, particularly her low-iron anemia. He should have done a proper investigation and examination. A specialist acting within his or her specialty is held to a higher standard. Specialists are "expected to exercise that degree of skill, learning and care normally possessed and exercised by the average physician who devotes special study and attention to the diagnosis and treatment" of diseases within that specialty.