83-year-old sustained brain injury in fall from hospital bed.

CASE ON POINT: Williams v. Notami Hospitals of Louisiana, Inc. 2005 WL 2898069 So.2d--LA

ISSUE: Were the nurses in this case responsible for injuries sustained by an 83-year-old patient who fell out of bed?

CASE FACTS: On January 1, 2000, 83-year-old Franklin Williams presented to the Emergency Room at Louisiana Regional Medical Center (LRMC), with complaints of fever, weakness, and diarrhea. The patient was treated in the ER by Dr. Robert Limbaugh. The patient reported a medical history of seizure disorders, angioplasty, and Chrons Disease. The patient was admitted to the hospital under the care of Dr. Roy Saguiguit. On admission, it was noted that the patient was confused and disoriented, and therefore, a fall prevention program was implemented. The patient was placed in a hospital room furnished with a bed equipped with an alarm system that would notify hospital staff if the patient attempted to get out of bed. On January 2, 2000, at approximately 12:34 p.m., a nurse observed the patient sitting up in his hospital bed eating his lunch. At approximately 2:00 p.m., a nurse found the patient lying in diarrhea on the floor of his hospital room with an abrasion on his head. On January 13, 2000, it was discovered that the patient had sustained a brain injury as the result of his fall. On December 18, 2000, the patient and his wile filed a complaint with the Commissioner of the Division of Administration requesting that a Medical Review Panel (Panel) be convened in order to review claims of medical malpractice by LRMC, Dr. Limbaugh, and Dr. Saguiguit. The Panel issued its opinion that the evidence did not support the conclusion that the those named in the complaint did not meet the applicable standard of care. The patient and his wife brought suit against those named in the complaint. In discovery proceedings the defendants inquired as to what expert testimony the plaintiffs intended to introduce at trial. The plaintiffs replied that they had not yet engaged an expert witness. However, the plaintiffs stated that they had the patient's medical records reviewed and were advised that the nurses were negligent in not having the bed rails up and/or the bed alarm on. The defendants filed a motion for summary judgment. The trial court allowed the plaintiffs sixty days within which to name an expert, subject to the condition that if they failed to do so their complaint would be dismissed. The defendants appealed.

COURT'S OPINION: The Court of Appeal of Louisiana affirmed the judgment of the trial court. The court concluded that LRMC failed to show that the defendants' argument of prematurity was viable. The court held, inter alia, that at the Panel stage, the plaintiff is not required to set out the appropriate standards of care and specifically delineate every breach of the applicable standards of care, but rather need only present sufficient information for the Panel to make a determination as to whether the defendant health care provider is entitled to the protections of the Medical Malpractice Act.

LEGAL COMMENTARY: In this case the plaintiffs' complaint and submission of evidence presented sufficient information for the Panel to make a determination regarding whether the defendant health care providers failed to meet the applicable standards of care regarding the fall sustained by the patient during his January 2000 stay. The Panel specifically determined that Dr. Limbaugh's emergency room treatment was appropriate. Moreover, the Panel specifically determined that Dr. Sanguiguit's evaluation and treatment for multiple problems was appropriate, and that treatment did not fall below the applicable standards of care. The court noted that the patient had an "unexpected event," but was not a candidate for restraints. Further, the court noted that subsequent neurological changes were properly identified, documented and reported. After thoroughly reviewing the record, the court found that the administrative remedy required to address the allegations made in the plaintiffs' supplemental and amended petition had been exhausted, and that LRMC failed to show that any administrative remedy remained available to the plaintiffs. The court held that the plaintiffs' first supplemental and amended petition for damages was not premature and that the defendant's dilatory exception raising the objection of prematurity was properly overruled by the trial court. Accordingly, the court affirmed the judgment of the trial court.

Editor's Note: The case, as reported by the court, fails to address why the patient was able to get out of his bed without the alarm going off Was it disconnected? Why didn't the court make satisfactory reference to this as well as whether the side rails were down?