Latest Question

(These are actual questions asked by physicians at risk management seminars. The answers are general guidelines only and are not intended to be a comprehensive treatment of very complex subjects.)

"An 87 year old patient is admitted for gallbladder surgery and is consistently noted to be oriented X 3, calm and cooperative. She walks with a walker for support. During the first post operative night she is "found on the floor". The side rails are noted consistenly to be up, the bed is noted to be in the low position and the call bell is in reach. She fractured her hip and had a rocky course that resulted in a significant decline in function. Is the hospital liable for the fall? No restraints were ordered on this patient until after the fall. Is every fall automatic liability for the hospital?"

Your question was referred to Jeff McClure, partner with the law firm of Mayor, Day, Caldwell and Keeton in Houston. His response:

The hospital is not liable for every hip fracture or fall. There has to be a violation of the hospital or nursing standard of care. From your description, the hospital/nurses could not have done more without a physician's order. You cannot restrain a patient who is oriented and competent without a physician order and the physician must have good reasons for doing so with a patient such as this. Some experts may argue that upper rails should be up and lower rails down, so that the patient is able to get out of bed on his or her own. Others will refute that argument. In the final analysis, there must be a violation of the standard of care for the patient in a particular situation.

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