Articles Posted in Falls in Nursing Homes

Earlier this month, an appellate court in Mississippi issued a written opinion in a personal injury case that illustrates an important point for those considering filing a Maryland medical malpractice case. The issue presented in the case was whether the plaintiff should have had an expert prepare an affidavit in support of her claim, as is required under that state’s law.

The case is important to Maryland plaintiffs because Maryland law requires medical malpractice plaintiffs to obtain a similar affidavit from an expert in the field. As was the case here, a plaintiff’s failure to comply with this strict rule may result in the dismissal of an otherwise meritorious case.

The Facts of the Case

The plaintiff was the representative of a resident of the defendant nursing home who was admitted to the facility with a diagnosis of dementia. One day, a nurse checked on the resident, and all seemed to be fine. Then, just 20 minutes later, the same nurse returned, and the resident was sitting on the bathroom floor with a laceration on her head.

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Earlier this month, an appellate court in Georgia issued a written opinion in a premises liability lawsuit brought by a woman who slipped and fell in a nursing home while rushing after her husband as he was wheeled through the facility. In the case, Pipkin v. Azalealand Nursing Home, the court determined that the plaintiff’s proffered evidence was sufficient to survive the defendant’s summary judgment motion, and the lower court was wrong to grant the motion when there were two competing versions of the facts.

The Facts of the Case

Mr. Pipkin was transported to the defendant nursing home by ambulance. As the emergency medical technicians were wheeling Mr. Pipkin down the hall through the facility, Mrs. Pipkin was trying to catch up. The evidence suggested that she was walking quickly and possibly with a cane. As she passed the shower room, Mrs. Pipkin slipped and fell.

There was conflicting testimony as to the condition of the floor immediately prior to Mrs. Pipkin’s fall. She recalls slipping on something “slick.” Her son, who immediately came to his mother’s assistance, recalls that as he knelt beside her, his knee got wet and that he then realized his mother was lying in a puddle of clear liquid.

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Earlier this month in nearby West Virginia, a woman filed suit against the nursing home that was in charge of caring for her sister after she discovered evidence that led her to believe the nursing home was negligent in her sister’s care. According to a report by one local news source, the woman is seeking compensatory damages for the injuries her sister sustained, including compensation for her sister’s pain and suffering, mental anguish, inconvenience, physical impairment, and loss of capacity to enjoy life, as well as the aggravation of existing diseases and physical defects. She is also seeking compensation for the medical expenses her sister incurred as well as for her sister’s premature death.

According to the article, the woman’s sister was admitted to the nursing home in November 2012, and she stayed there almost a year before passing away. During that time, the woman claims, the nursing home exhibited several lapses in care, including:

  • Failure to monitor her sister’s worsening skin condition;
  • Failure to implement a treatment plan for the breakdown of her sister’s skin;
  • Failure to turn and reposition her sister while she was in bed;
  • Failure to implement measures to prevent her sister from falling; and
  • Failure to keep her family informed of her sister’s worsening overall condition.

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Earlier this month in southern Minnesota, an elderly woman died as a result of injuries she sustained when she fell out of her wheelchair in a local nursing home. According to a report by one news source, the woman’s care plan included the use of footrests for her wheelchair. However, at the time of the accident, the footrests were not installed on the chair.

Evidently, the footrests were lying behind her bed, out of sight of the nursing home staff, and were not installed on the woman’s wheelchair. As she was being pushed to the dining area, the woman’s foot got caught under the chair, and she was thrown from the chair. As she fell off of the wheelchair, she struck her head on the floor, sustaining serious head and neck injuries. Specifically, she suffered a bleeding in the brain, a fractured vertebrae in the neck, and a dislocated and broken shoulder.

After the accident, the woman was admitted to Hospice care, and she passed away two days later. When asked about the oversight, the nursing assistant told the nursing home director one thing and fellow employees another. First, she told the director that the wheelchair footrests didn’t fit on the woman’s chair. However, later she told fellow employees that she forgot to install the footrests.

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A study involving researchers affiliated with Harvard and other academic institutions, intended to look into prevention of hip fractures, actually may have exposed over 1,300 participants to increased risk of hip injury. The Office of Human Research Protections (OHRP), part of the U.S. Department of Health and Human Services, ordered investigators to send notifications to the participants, who are elderly nursing home residents, detailing the risks to which they were exposed during the 2002-06 study. This concludes a year-long investigation by OHRP.

The Hip Impact Protection Project (HIP PRO) investigated the effectiveness of padded undergarments known as “hip protectors” in preventing injury to elderly nursing home residents. The study involved thirty-seven nursing homes, testing the efficacy of a type of undergarment that contained a hip pad on either the right or left hip. The researchers found that the single-side protective garments “may have caused unanticipated changes in behavior” among participants. The researchers concluded that hip protectors offered no significant protection against hip fractures. The study was published in the August 2008 issue of Clinical Trials, and it was also included in a 2007 issue of the Journal of the American Medical Association.

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A nationwide study, led by a researcher at the University of Southern California, recently reviewed the rates of falls among short-stay nursing home residents. This was the first major study to analyze falls among newly admitted patients. Numerous studies have reviewed fall rates among long-term nursing home residents, and those risks are generally well understood. The study’s findings may help nursing home administrators and staff identify short-term patients who are at greater risk for falls and help take precautions to protect them from injury. Putting staff on notice of important risks faced by residents is an important step in preventing nursing home negligence and keeping residents safe.

The study, which was published in the May 2012 issue of the Journal of the American Geriatrics Society, focused on Medicare or Medicaid patients during their very first nursing home admission. Researchers analyzed clinical assessments prepared by the Centers for Medicare and Medicaid Services, known as Minimum Data Sets (MDS), from 2006 for over 230,000 individuals residing in more than 10,000 nursing homes located around the U.S. The MDS assessments provide a comprehensive overview of a patient’s “functional capabilities” in order to assist nursing homes in determining a patient’s needs. The study also looked at how different nursing homes are organized, with particular attention to the professional composition of the homes’ nursing staffs.

During the first thirty days in a facility, the study found, twenty-one percent of new nursing home residents will sustain at least one fall. This is critically important because falls are associated with greater risks of health complications and death, even among short-stay residents. The study proposes several possible causes for the increased fall risk. Nursing homes with high ratios of certified nursing assistants (CNA’s) to patients appeared to have a lower risk of falls. This suggests that the “hands-on patient care during high-risk activities” offered by CNA’s reduces the risk of falls.

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A nursing home in Iowa must pay a $15,000 fine for failing to provide needed treatment to a resident who fell and suffered a head injury. The resident reportedly lay on the floor for almost an hour while staffers attended a holiday party nearby. Nursing home administrators say they plan to appeal the state’s order, and they dispute the state’s interpretation of the video, saying that investigators viewed it “out of context.”
The incident occurred during the afternoon of December 23, 2011 in the dementia unit at All-American Restorative Care in Washington, Iowa. According to state investigators who viewed footage from the facility’s video-monitoring system, a female resident stumbled backwards and fell while walking down a hallway at 2:51 p.m. No one on the staff witnessed the fall, but within seconds, two employees reportedly appeared at a nurse’s station with a view of the fallen woman. Although the woman was “barely moving,” neither staffer appears to have offered her assistance. One of the staffers reportedly told investigators later that she called to the woman to ask if she was alright, and that the woman said “Yes.” The second staffer reported that this particular resident being on the floor was a “recurring situation.”
The resident remained on the floor for another thirty minutes on the video, and then a third staffer appeared. This staffer did not offer any assistance to the resident, according to investigators. A fourth employee appeared on the video at 3:37 p.m., forty-six minutes after the fall. Three staffers enter the video two minutes later and lift the woman up, reportedly without first assessing her neurological condition, and take her to her room. One of these staffers later told investigators that the woman was “pretty out of it” at this point. Nursing home staffers took the woman to the hospital at around 5:00 p.m. for a head wound. She had a cut on the back of her head that required four staples.

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Suffering from dementia and confined to a wheelchair, 94 year-old Florida nursing home resident Elvira Nunziata needed near-constant supervision. Still, she managed to pass through a door that should have been locked, falling down a stairwell and sustaining fatal injuries in 2004. Her son, Richard Nunziata, knew someone at the nursing home had made a fatal mistake.

Nunziata filed suit against the nursing home for wrongful death, claiming that negligent supervision by staff led directly to his mother’s death. We reported last month in this Maryland Nursing Home Lawyer Blog that a jury awarded him $200 million in damages. There was one major problem with the verdict, however: no one showed up to defend the suit at trial. This case demonstrates how the law holding nursing homes liable for injuries has not caught up with the way nursing homes are owned and managed.

For-profit nursing homes, which have surged in the past decade or so according to the Tampa Bay Times, often split ownership of a nursing home among several different business entities. Each company would own different parts of the nursing home operation or handle responsibility, and liability, for different parts of the business. One company might own the building housing the nursing home, while another company owns the equipment and yet another handles payroll and personnel. If one part of a nursing home operation runs into legal trouble, a parent company can dissolve that business entity and create a new one. This process has little to no transparency. In this environment, it can be exceedingly difficult for someone seeking to make a claim for an injury to even identify which business is liable. It is even difficult for state and federal regulators to determine where to put liability for regulatory infractions.

In Nunziata’s case, Pinellas Park Care and Rehab Center, the home where his mother last lived, was owned by one company and operated by another. Trans Health Management, Inc., the home’s operator, reportedly had its corporate status revoked by the state of Florida by the time Nunziata sued in 2005. A forensic accountant testified at trial that Trans Health’s business was sold in 2006. Three separate companies each bought or “inherited” Trans Health’s operations, management contracts, and liabilities. The company that ended up with its liabilities, Fundamental Long Term Care Inc., also lost its corporate status and no longer exists. The accountant testified that most of these companies existed for the sole purpose of shuffling Trans Health’s assets and liabilities around. Nunziata’s best bet, for which there may be some precedent, is to go after the private equity companies that put all these businesses together in the first place.

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A jury in Pinellas County, Florida rendered a $200 million verdict against the parent company of a nursing home. The lawsuit stemmed from the 2004 death of a resident who fell down a flight of stairs in a wheelchair. The case is particularly interesting not only because the verdict might be the largest in Florida history, but also because no one appeared at trial on behalf of the defendant.

In October 2004, 92 year-old Elvira Nunziata “slipped away” from a group of residents at Pinellas Park Care and Rehabilitation Center, according to the Tampa Bay Times. She entered a stairwell and, still strapped into her wheelchair, fell down about ten stairs. Staff did not notice her absence for at least an hour, and she died soon after the paramedics arrived. Former employees testified that the door to the stairwell should have been locked, but that staff would often leave the door unlocked so they could use it for smoke breaks.

The nursing home reportedly had a history of citations by the state for various violations, as well as complaints for abuse. Former aides said that the nursing home was often understaffed. Testimony at trial also indicated that Nunziata, who began living at the nursing home in August 2003, had a history of illnesses, falls, and other injuries, and was beginning to experience symptoms of dementia. Staff was allegedly aware of Nunziata’s tendency to wander off and did not adequately monitor her. She reportedly had alarms on her wheelchair and clothing that should have alerted staff of her whereabouts.

Nunziata’s son filed suit on behalf of her estate in 2005. The nursing home was managed by Trans Health Management, Inc. The company no longer manages the home, and is now defunct. Its parent company, Trans Health, Inc., is currently subject to a Maryland receivership. This led to interesting questions of liability during the course of the lawsuit. An attorney representing the management company tried to delay the trial on behalf of the receivership, but the trial judge denied the motion.

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A fourth nursing home abuse and negligence lawsuit has been filed this week against the owners of a Kentucky nursing home complex, after a resident allegedly suffered from inadequate care when her healthcare rights and safety were reportedly threatened.

According to a news development from the Richmond Register that our Maryland nursing home attorneys have been watching, Viola Fields was a resident of Kenwood Health and Rehabilitation Center from the end of October until the beginning of December in 2010. James Rutherford, Fields’ guardian, claimed that Fields, who is incapacitated and not of a sound mind, did not receive the minimum standard of healthcare that should have been available to her as a vulnerable nursing home resident. Rutherford claims that the home violated her nursing home rights as a long-term care resident.

The lawsuit accuses Kenwood of nursing home negligence for failing to provide Fields with timely and accurate nursing home healthcare and medication assessments, proper resident supervision, necessary medical intervention, and from failing to prevent accidental injury. Kenwood is also being accused of medical and corporate negligence.

Rutherford claims that the nursing home’s wrongful conduct caused the rapid deterioration of Fields’ health and physical condition, and led to the direct development untreated pressure ulcers, wound infections, sepsis, pneumonia, urinary tract infections and weight loss. The lawsuit accuses the home of acting with fraud, malice, gross negligence and reckless disregard for the health and safety of Fields and her rights as a nursing home resident. Rutherford claims that because of these injuries, Fields experienced physical impairment, and suffered embarrassment, along with incurring significant medical expenses.

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