Unattended Elderly Patient Is Injured During Physical Therapy Session

    Hip Replacement Surgery ExpertThis case involves a 76-year-old female patient who suffered an injury during a physical therapy session. The patient was in the midst of recovering from a hip replacement surgery and was required to use a treadmill as part of her physical therapy regimen. While she was on the treadmill, the patient was monitored by her physical therapist or an assistant. The staff member monitoring her would start and stop the machine for the patient and would remain within a 2-3 feet distance while the patient was in motion. The patient had never stopped the machine herself during the course of her physical therapy and had never been taught how to do so by the defendant physical therapist. During one session, the patient was left unattended on the treadmill. When she became tired and needed to stop, she reached for the stop button leaving only one hand to steady herself. The patient then lost control and fell when the treadmill jolted to a halt causing her to break her leg and her collarbone. The patient required several painful corrective surgeries following the incident.

    Question(s) For Expert Witness

    • 1. Do you routinely work with elderly patients in a physical therapy center?
    • 2. Can you describe the standard of care for monitoring patients when they are using equipment such as a treadmill?
    • 3. What precautions should be observed in order to prevent injuries while using such equipment?

    Expert Witness Response E-050590

    I have treated 100+ patients and study participants in my time as a physical therapist. My background and research are specifically in the area of hip fracture and hip replacement. I am currently employed as a full-time faculty researcher, so I do see research participants who have had a hip replacement. The standard of care for monitoring patients on any equipment is 1) the patient to be taught how to use the equipment by the physical therapist or physical therapy assistant – not the aide 2) after the patient is familiar with the treadmill, “sufficient monitoring” depends on the patient’s level of cognition and level of functional status. For example, an individual who is cognitively impaired may need constant supervision. The same is true of an individual who requires moderate or maximum assistant for most functional activities. It is not uncommon to have a patient, as you describe, unattended with the physical therapist checking in on them every 5-10 minutes. This would really depend on the specifics of the case. Precautions of treadmill include any severe cardiac disease (CHF), severe balance disorders (if using Berg Balance scale below 42/56), vertigo, impaired cognitive function (moderate to severe), documented poor functional status that requires the assistance of 1 or 2 people at a moderate level.

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