$75,000 VERDICT - HOSPITAL NEGLIGENCE - FAILURE TO KEEP BEDRAILS :RAISED AND PROMPTLY RESPOND TO CALLS FROM WEAKENED PATIENT - FALL DOWN DURING AITEMPT TO WALK TO LAVATORY

Monmouth

FRACTURED HIP REQUIRING. OPEN REDUCTION.This was a nursing malpractice action.in which the plaintiff contended that as a resUlt of the negligence of the defendant nurses, who failed to place the guardrail in an upright position, the 72 year old decedent, who was suffering from a myriad of preexisting debilitating complaints, fell as she was attempting to walk to the lavatory in the early morning hours; sustaining a fractured hip and a fractured humerus. The plaintiff further contended that the defendant negligently failed to maintain a nursing care plan for the patient which would have included an evaluation of the decedent's chances of falling and the care necessary to prevent such an occurrence. The decedent, who had been admitted for congestive heart failure. rheumatoid arthritis, anemia, malnutritionand arterial sclerotic disease, had died some 6 months after the fall subsequent to the throwing of an embolism. The plaintiff, who presented expert testimony linking the death to the surgery perfonned on the hip, did not present any damages evidence relating to the wrongful death and the case revolved around the pain and suffering experienced during the decedents final 6 months of life.

The decedent's son maintained that the decedent had infonned him that she awoke in the middle of the night felt the need to visit the lavatory that the bed mils were down and that she fell as she was attempting to walk to the bathroom. The decedent's hospital roommate had died sometime after the incident and the plaintiff presented an individual who had visited the roommate shortly after the incident occurred, who maintained that the roommate had indicated that the jecedent attempted to summon the nurses, but that the nurses did not respond and that the decedent then attempted to walk to the bathroom. The plaintiff further presented an expert thoracic surgeon specializing in the care of elderly patients who maintained that proper standards would require that the nurses keep a nursing plan which would include evaluating the propensity of the patient to fall and the expert maintained that such a plan would be required by the hospital accrediting authorities. The plaintiff maintained that in view of her prior condition, the plaintiff was at high risk to suffer a fall and that as a result of the failure to keep such a plan, the defendant failed to ensure that the bed rails were raised at all times. The plaintiff further contended that since the decedent had been given diuretics which would tend to render a nocturnal trip to the lavatory likely, the failure to keep the bed rails raised and promptly respond upon the plaintiffs request for assistance was egregious.

The defendant maintained that it did maintain a nurses care plan relating to the decedent's care in the form of index cards. The plaintiff countered that since the nurses could not specifically recall having read the particular card and since the defendant could not produce the card in question, the defendant's position should not be given much weight. The defendant further denied that the bedrails were lowered and maintained that since the bed sheets at the foot of the bed were in significant disarray, it was highly likely that the decedent climbed over the bedrail at the foot of the bed. which was pennanently affixed and stable. The plaintiffs expert maintained that in view of the decedent's preexisting debilitating condition, she would have had great difficulty in leaving the bed if the bedrail had been raised and that even if she had been able to accomplish this maneuver, her weakened state probably would have resulted in the fall occurring as she left the bed rather than after walking to the other side of the room where the fall occurred. The nurses notes related that after the incident, the rails were noted to be raised and the plaintiff argued that since this entry constituted the only mention of bedrails during the entire preincident 6 days of hospitalization. the validity of the record made after the incident should not be accepted.

The decedent's treating physician maintained that the decedent suffered a fractured hip and a fractured humerus in the fall. The physician maintained that the fractured hip required an open reduction and that the decedent was unable to walk for the remainder of her life. The Court dismissed the death action and the jury, who found for the plaintiff, awarded $75,OOO. Plaintiffs expert: Heibert V. Swindell, thoracic surgeon and expert in care of the elderly from Punta Gorda, Florida. Defendant's expert internist: Hillel Ben- Asher from Morristown. Briers vs. Point"Pleasant Hosp., et al. Docket no. L-088789-83; Judge William Wichman, 11-21-85. Attorney for plaintiff: Douglas B. Hanna; Attorney for defendant: Herbert Kruttschnitt, III

COMMENTARY:

The defendant had denied that the bedrails were left in a lowered position and argued that the incident occurred when.the decedent attempted to climb over the bedrails. The decedent and her hospistal roommate had died prior to the institution of suit and the plaintiff argued that based upon the testimony of the son and a visitor, to the effect that the decedent summoned the nurses, obtained no response, that the rails were lowered and that the decedent left the bed, which was admitted following a rule 8 hearing, it was obvious that the defendant's position was inaccurate. Additionally, the plaintiff significantly attacked the record presented by the defendant,which supported its position that the rails were noted to have been raised immediately after the accident, by pointing out that no other entries relating to the position of the bedrails were made during the 6 days of hospitalization which preceded the incident, and that the only mention of position of the rails was entered after the incident occurred. In this regard, the plaintiff strenuously argued that although nurses often prepare records at the close of their shift, it was probable that since no mention of the position of the bedrails was made during the previous 6 days of hospitalization, and since the only mention was prepared after the incident, the records should not be given much weight. The plaintiff further argued that since the decedent was in an extremely weakened state prior to the incident, it was highly unlikely that she would be able to climb over the bedrails if they had been raised.

The plaintiff had further contended that the hospital deviated in failing to maintain a nurse's care plan relating to the treatment of the patient and that as a result, her status as a high risk patient for falling was probably not addressed. The defendant had countered that it did, in fact, prepare such a plan and the defendant's case was undermined by the failure of the defendant to present records supporting this position. Regarding damages, the widowed decendent had not been employed and the son had provided extensive care for her prior to the incident. Although the plaintiffs physician actually related the death from the embolism to the open reduction necessitated by the fractured hip, the plaintiff avoided the potential appearance of overreaching by declining to present any evidence relating to a loss of guidance and advice. The award, therefore, revolved around the pain and suffering occasioned by the injury only and the plaintiff argued that the previously weakened condition of the decedent rendered her less able to deal with the trauma sustained in the instant accident during the final months of her life.