As a former hospital administrator, I know that any time a patient falls, accrediting agencies such as The Joint Commission consider it as a sentinel event. In plain English, patient falls are never events because they should never happen.
The standard of care requires facility nursing staff to conduct careful fall assessments, identify fall-risk patients, advocate for physician orders and automatically undertake nursing interventions to prevent falls, and to perform regular patient reassessments.
In health care settings, it’s most common for patients to fall in hospitals and nursing homes. In fact, patient falls are always on the Top 10 lists of mandatory reports of sentinel events.
According to The Joint Commission, hundreds of thousands of patients fall in hospitals alone, with up to half of them sustaining an injury. Research has shown that a patient injured in a fall will have the hospitalization prolonged by around six days, costing an extra $14,000 or so.
Given the relatively high frequency of patient falls, it would be unusual for a hospital or nursing home to lack policies and procedures addressing fall prevention. It’s more common to see contributing factors to patient falls including poor nursing staff training, and inadequate or absent fall risk assessment by a nurse, poor communication among health care providers, the failure to follow policies and procedures, and problems in the physical environment in the hospital or nursing home.
Unfortunately, for some patients—particularly seniors—poor health care after a fall can lead to death.
Despite the fact that any time a patient falls it almost indicates clear liability on the part of the facility, many hospitals and nursing homes will fight tooth and nail to avoid accountability.
In a recent case, the Ganado Nursing and Rehabilitation Center unsuccessfully fought for a dismissal in a case where a patient died from a fall. Both the trial court and court of appeals ruled against the nursing home. The case is styled Ganado Nursing and Rehabilitation Center and TAG Mgt Services, LLC v. Amalia Poulton, Individually and as Representative of the Estate of Frances Garcia, and Jesse Gomez; No. 13-20-00097-CV In the 13th Court of Appeals, Corpus Christi—Edinburg.
The background facts of that case are sad. A 73-year-old woman was a resident of the nursing home. Around 5:00 a.m., a nurse found her kneeling on the floor beside the bed and noted in the medical record a large knot from the patient’s eye to the top of her right for head.
About 90 minutes later, the medical records reflected that the nurse called for a crash cart and 911. The resident was nonresponsive. By the time the emergency medical service (EMS) arrived at the bedside, the patient’s pupils were not responding to light. She was taken by ambulance to the emergency room at Citizens Medical Center.
When she got to the hospital, she was intubated and put on a ventilator for breathing support before being sent to San Antonio Medical Center for a neurosurgical consultation. She died two days later.
At the trial court level, this deceased woman’s grieving family alleged that the nursing home failed to properly provide timely medical treatment following the fall and that such negligence led to her death.
The nursing home defendant wasted no time in trying to get the case dismissed, which is its right under draconian provisions of Texas tort reform measures that became law in 2003. Codified at Texas Civil Practice & Remedies Code Chapter 74, this law requires medical malpractice plaintiffs to produce a report from a qualified expert within 120 days of each defendant filing an answer to a health care liability claim. These reports must be detailed, addressing the applicable standard of care, how was violated, and how such substandard care proximately caused harm to the patient.
Once there is a proposed expert report, the law allows a defendant 21 days to file an objection to the qualifications of the proposed expert or the substance of the report.
In the case before the 13th Court of Appeals, the defendant served an expert report by board-certified emergency medicine physician at a major academic medical center in Austin. The defendant nursing home filed a long list of objections to the qualifications of this highly-trained and skilled physician based on his lack of experience in a nursing home.
The court of appeals overruled all of the objections, noting that Texas Civil Practice & Remedies Code Section 74.402(b)(1) doesn’t require a physician expert be “practicing health in a field of practice that involves the same type of care or treatment is that delivered by” when the defendant is a facility, rather than an individual. That part of the statute only applies to individuals, such as physicians.
Therefore, the court discussed, the proper inquiry is not whether the plaintiffs’ propose medical expert has worked in a nursing home, but rather whether he possesses the knowledge, skill, experience, training, or education regarding the fundamental principles of the claim raised.
In this case, the illness, injury, or condition at issue is a fall resulting in head injury. The 13th Court of Appeals noted that the physician expert’s report discussed the significant overlap between emergency department care and nursing home care, particularly regarding head injury and who should be further evaluated. The expert also detailed help fall prevention, falls, and triage decision-making of who needs further evaluation are all part of any medical specialty the cares for patients in beds—in other words, almost any physician.
By ruling that the plaintiffs’ expert was qualified, and further finding that his report provided adequate details on the standard of care, how it was violated, and how those health care mistakes led to the death of the patient, the court allowed the case to proceed.
If you’ve been seriously injured because of poor hospital or nursing home care in Texas, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help with your potential case.
