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By Mark K. Delegal, Esq., and Jan Gorrie, Esq. Pennington, Moore, Wilkinson, Bell & Dunbar, PA Tallahassee, FL
News: After arthroscopic knee surgery, a patient rose from her bed in the recovery room to walk and fell on the knee that had just been operated on. A jury returned a $175,000 verdict of negligence against the hospital.
Background: The patient, a 51-year-old woman, went to the hospital for minor arthroscopic surgery on her right knee. She had chondopathy, which is the loss of cartilage. Several hours after the procedure, she was recuperating in the recovery room. She asked a male hospital staff member to raise her right leg. The staffer did so, placing her right foot in his hand. The patient later recalled that the staff member announced, "She’s ready." Moments later, she was assisted in rising to stand on both feet. She said she took one step, immediately fell forward, and landed on her right knee. She said she felt no pain from the fall. The patient was immediately helped up off the floor by staff who were present.
Several hours later, numbness from the anesthesia faded, and she reported intense pain in her right knee, the knee that had just been operated upon. One month later, she underwent a second corrective knee surgery on her right knee. Additional medical bills of $7,686 were incurred in the subsequent surgery.
The plaintiff brought suit against the hospital, claiming recovery room staff personnel failed to adequately or accurately establish her level of recovered neurological functioning, which led to staff allowing her to stand too soon. The plaintiff introduced expert testimony from an internal medicine specialist who emphasized that, given the patient’s period of anesthesia, she had not been properly assessed prior to being instructed to stand. The expert concluded the failure to assess the patient’s neurologic recovery prior to insisting that she was ready to stand and walk constituted negligence. The same expert linked the reinjury to the fall. The plaintiff testified that she cannot place full weight on the injured right knee and that the knee would often lock up. The hospital denied liability, saying that the patient said she was unable to walk or stand by herself so the staff gently eased her to the floor. The defense introduced expert witness testimony of a hospital liability analyst, who supported the hospital’s interpretation of events. Further, according to the hospital, the event was so minor it was not charted in the plaintiff’s hospital medical record chart. The hospital’s expert concluded the assessment and monitoring by the hospital recovery room staff was adequate and proper, and that staff noticed no sign of injury.
When asked about the plaintiff’s report of pain in the right knee several hours after the fall, the defense expert linked this pain to the surgery performed earlier that day.
The jury sided with the patient and awarded her $175,000 in damages.
What this means to you: When a patient falls in the hospital, particularly in a well-staffed recovery room, there is a presumption that the incident could have been avoided. And when patients fall on a spot where they have just had surgery, the presumption is strengthened, especially when the occurrence has not been documented one way or the other.
"Protocols should be in place for assessing all patients following surgery, whether the surgery is being performed as an outpatient or inpatient procedure," observes Ellen L. Barton, JD, CPCU, a Phoenix, MD-based risk management consultant. "These protocols should address which of the staff has responsibility for specific tasks and what the objective criteria are for those tasks based on the type of surgical procedure, type of anesthesia, length of time in recovery, as well as patient specific measures as individual cases may merit. In addition, protocols should specify how patients are to be assisted in standing for the first time, such as the minimum number of minutes a patient should sit in an upright position prior to standing with assistance. Unfortunately, it appears from the incident and lack of any documentation to the contrary, that if such protocols were in place, the staff did not follow them.
"Given the number of staff seemingly present at the time of the untoward event, it is likely that the patient may have not actually fallen, but buckled at the knees. Regardless of how or why the patient fell or touched the ground, the hospital still had the responsibility to properly document the event. If the patient had indeed been unable to stand or walk without assistance, the fact should have been recorded. The documentation might also have given the hospital a leg to stand on when arguing its version of the facts. Saying that the event was so minor that it did not merit documenting simply did not vindicate the hospital of its responsibility to track the care provided to its patient. Everything about a patient’s condition should be documented. Even if the postoperative patient had jumped off the table and waltzed, the moment should have been recorded. In addition to documenting the event, staff would have been well-advised to mention the incident to the next-of-kin or the person responsible for driving the patient home. If the patient had been prone to buckling, then the next person to whom her care was entrusted should be made aware of the potential situation," adds Barton.
"In summary, staff education cannot be emphasized enough. Knowledge of and exposure to the protocols and procedures designed to maximize patient care should be one of the risk management program objectives, as should be touting the merits of appropriate, adequate documentation," states Barton.
• Brown v. St. Margaret Mercy Healthcare, Lake County (IN) Superior Court, Case No. 45D01-9712-CT-1261.