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Critical Care Expert Opines on Fatal Patient Fall Caused by Negligent Use of Bed Rails

Joseph O'Neill

Written by
— Updated on September 28, 2017

Critical Care Medicine Expert WitnessThis case involves a female patient who had been admitted to a rehabilitation center in order to recover from a systemic bacterial infection secondary to the implantation of a medical device. During her stay, she began to suffer from heart palpitations, and was consequently transferred to a nearby hospital. While at the hospital, the patient’s husband noted that the nursing staff was leaving the rails down on his wife’s hospital bed. In addition, the patient was favoring one side of her body due to wounds remaining from the implantation of her medical device. The husband expressed his concerns to hospital staff, who assured him that this was standard procedure for working with patients in his wife’s condition. Shortly after this exchange took place, the husband had gone home, at which point he received a call from the hospital informing him that his wife had fallen from her bed, and had died as a result.

Question(s) For Expert Witness

  • 1. Do you frequently encounter and treat patients similar to this case?
  • 2. Have you encountered a patient with similar complications?
  • 3. Have you ever lectured or published on this subject?

Expert Witness Response E-021185

I am the Vice Chairman and Professor in the Department of Critical Care Medicine at a major university hospital. In my capacity as Vice Chair, I am involved in creating clinical protocols for the ICUs across the university health system, including the fall prevention guidelines. I actively take care of critically ill patients in ICUs at my hospital and have gained clinical experience at multiple health systems in the U.S. I also frequently treat ICU patients admitted with these symptoms- and my clinical approach is very different from the care that transpired in this case, in which routine, well-accepted precautions were not taken to prevent patient harm. This is a troubling occurrence because fall prevention has been a major focus of quality improvement efforts in ICUs for over a decade- and there are well-accepted practices that likely would have prevented this bad outcome. The actions noted in the summary (leaving the bed rail down while not directly engaged in patient care) is well below the standard of care, especially for a patient admitted with these symptoms. Ascertaining the extent to which the fall contributed to the patient’s death will require more clinical data from the time period surrounding the event, but it is likely that the fall was a causal factor. It appears that this hospital did not undertake routine, well-accepted precautions to minimize fall risks in critically ill patients.

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