Articles Posted in Falls & Fractures

On Christmas morning, a certified nursing assistant (CNA) at Woodbriar Health Care in Wilmington, Massachusetts improperly placed a resident in a mechanical lift when transferring her from bed to wheelchair, causing the resident to slip out of the lift and fall, breaking both her legs. The CNA attempted the transfer alone in violation of an important safety rule related to mechanical lifts.

The resident, Mary Meuse, was visited by her youngest daughter on Christmas and told by a staff member X-rays showed no broken bones. As a retired nurse who once cared for the elderly, she did not want to be hospitalized during the holiday. However, the next morning she received a phone call saying her mother was in a lot of pain and needed to be taken to the hospital immediately; the family learned of her injuries upon arrival. Continue reading

On June 2, 2016, two nurses were indicted after being caught on video surveillance ignoring an injured patient at Peninsula Nursing and Rehabilitation Center.  The incident occurred in October 2015. A 51 year old disabled male patient fell in the hallway at the facility, injuring his head and jaw.

Nurses Funmilola Taiwo and Esohe Agbonkpolor can be seen on video ignoring the patient for over 10 minutes as the patient crawled on the floor in agony. After several minutes of watching, Certified Nurse’s Aide Emmanuel Ufot was seen dragging the patient by his arm into his room. 25 minutes later, the patient is seen crawling back into the hallway bleeding profusely from his head and jaw injury while Taiwo and Agbonkpolor stood by watching. Ufot is then seen dragging the patient to his room for a second time by the collar of his gown, twisting it around the patient’s neck. Continue reading

The Nursing Home Data Compendium for 2015 was published March 25, 2016 and showed the percentage of nursing homes with deficiency-free surveys is increasing; this data was collected by the Centers for Medicare & Medicaid Services (CMS). The Compendium includes data on nursing home characteristics, survey results and resident information which was gathered through the CASPER database for survey and certification information, population data from the U.S. Bureau of the Census, and the Minimum Data Set. Data based on nursing home surveys from 2005 -2008 found the likelihood of a nursing home receiving at least one health deficiency increased during that period, but reversed after that time.

Five years later, the percentage of nursing homes without deficiencies increased from 8.8% in 2009 to 10.2% in 2014. There has also been a decrease in the amount of surveys finding substandard quality of care from 4.4% in 2008 to 3.2% in 2014.  The compendium also includes a list of the most frequently cited health deficiencies found on surveys from 2005 to 2014. The top deficiencies were storing and cooking food in a safe and clean way, ensuring the facility is free of accident hazards, providing adequate supervision to prevent accidents, providing necessary care to improve resident well-being and having a program that investigates and controls the spread of infections. Continue reading

Holiday Manor Care Center, a nursing home in California, was fined $100,000 as a result of a resident’s death at the facility. The facility was found to have several deficiencies in the way the staff cared for the patient who had a known risk for falls.

The resident was admitted to the facility in August 2014 with diagnoses of confusion, impaired vision, and unstable balance.  She required assistance when walking. On September 8, 2014, the resident attempted to get out of bed on her own without supervision and fell.  A staff member noticed her on the ground and documented the fall.  The notation indicates she was found on the floor moaning with a bump on the right side of her head and a blueish discoloration.  Nine days later the resident died; she suffered a hemorrhage in the brain and the cause of death was blunt force head trauma. Continue reading

Woodbriar Health Center of Wilmington, Massachusetts faces up to $100,000 in fines following the death of a resident that resulted from a fall on Christmas day of 2015. The nursing home has been accused several times of poor care by the state and families of residents. An 83 year old resident, Mary Meuse, was dropped from a mechanical lift that caused her to break both her legs and led to her death 2 days later. The staff at Woodbriar did not notify Meuse’s family for 24 hours although they were aware of her condition at the time of incident. The nursing home is now facing fines of $250 to $3,000 a day in the wake of Meuse’s death; if the fines begin from December 25, 2015, the facility could face up to $100,000. Continue reading

The shift change is one of the most crucial times of day at a hospital or nursing home.  At its best, it is the time when nurses from the outgoing shift and the incoming shift communicate with each other to ensure they stay on the same page with respect to the patient’s needs and any changes in needs or behavior.   At its worst, it either does not happen at all or when it happens, the appropriate information is not exchanged, which can result in errors and oversights in care. The traditional shift change consisted of nurses conferring in the hallway outside of patients rooms or at the nurse’s station and in some instances, writing up a medical report for the next nurse to read; these methods can result in important information to be left out. Hospitals in Washington are implementing a new method of shift change in order to prevent these occurrences, called bedside shift reports.

bedside reporting

Studies have shown that bedside shift reports make patients feel safe, included, and satisfied. During bedside shift reports, both nurses meet with the patient to handover information from the previous shift. This method helps nurses to communicate better with one another, as well as the patient and the patient’s family. In addition, this method also helps to prevent falls and other injuries. Beverly Johnson, CEO of the Institute for Patient and Family Centered Care in Bethesda, Maryland stated this method is a simple way to ensure that accurate information is passed on and that both nurses understand the care plan for each patient. Continue reading

Two employees at Beechwood Homes, an Amherst, NY nursing home, were recently convicted for crimes committed while they were supposed to be caring for residents.  Kimberly Fay, a Licensed Practical Nurse (LPN), was convicted for stealing hydrocone.  Ms. Fay falsely documented discarding tablets of hydrocone in part of a residents’ chart.  Instead of discarding the narcotics, she took them for personal use.

Onjelque Harris, a certified nurse’s aide (CNA), failed to toilet a resident.  She then falsely documented she did provide the toileting care.  As a result of the resident not being toileted, she was found covered in feces with blistered skin.

Many of the cases our firm handles involve falls and fractures suffered by residents of New York nursing homes.  The causes of the falls range from the staff’s failure to answer a resident’s call bell, to failing to properly assess a resident for his/her need to be toileted, to failing to order the use of alarms in the bed or wheelchair, to failing to have enough staff.  While not all falls are preventable, we believe nursing homes should be held accountable in instances where the appropriate nursing practices are not carried out.

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Certified Nurse Assistant, Fiona Jennings, was arrested on charges of endangering the welfare of a nursing home resident at Schuyler Ridge Residential Healthcare. The resident was a 74 year old woman prone to falls due to her recent knee fracture. Jennings failed to properly care for the resident resulting in bruising and swelling to her forehead as well as two black eyes.
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A March, 2014 Certification Survey conducted by the Department of Health at Queens Nassau Rehabilitation and Nursing Center found that the facility failed to remain free of accident hazards. This failure resulted in actual harm for a resident of the facility.

The New York Administrative Code dictates that New York nursing homes must ensure that the resident environment remains as free of accident hazards as possible, and that each resident is adequately supervised to prevent accidents. The Department’s findings at Queens Nassau centered on a resident who was admitted to the facility with several diagnoses that would affect his ability to make his own determinations regarding his well-being. The resident, among other factors, had a seizure disorder, Stage IV pressure ulcer of the hip, and dementia. Queens Nassau recognized that the resident’s behavior placed him at risk for physical injury, and that he was entirely dependent on the staff of the nursing home for almost all activities of daily living.

In late October, 2013, a CNA on staff at the home entered found the resident’s leg stuck in a gap between his bed and the side rail that the facility had implemented. Several days later, after showering the resident, staff noticed swelling and tenderness to the man’s right thigh. He was taken to the hospital and examined. Following an x-ray, it was discovered that the man had suffered an Acute Comminuted Spiral Fracture of the Midshaft right Femur (a broken leg).

A Decision and Order issued by the Hon. Stanley Green in Bronx County Supreme Court in March, 2014 denied defendants’ summary judgment motion as to negligence and violations of NY Public Health Law in a Bronx nursing home negligence action. Judge Green did grant summary judgment for the defendants as to an assault and battery cause of action.

The facts surrounding the complaint involved a nursing home fall and the subsequent development of pressure ulcers. Plaintiff had been admitted to the defendant nursing home as a resident with a high risk for both pressure ulcers and falls. One particular morning several months into the resident’s stay, a CNA entered her room on her care rounds. After raising the bed and removing a nearby floor mat, the CNA left to prepare a wash cloth in the bathroom. Upon re-entering the resident’s room, the CNA found her on the floor with several cuts to the face. In addition to the fall, the resident developed several pressure sores during her stay at the defendant facility.

The nursing home moved for summary judgment on grounds that the fall was unavoidable, and that it had exercised all reasonable care with respect to the resident’s treatment. In addition, the defendant moved for dismissal of the Public Health Law cause of action as duplicative of the negligence cause of action.

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