Risk Management

Hip fracture in 90-year-old female patient following fall in exam room

RYAN BUCSI, OMIC Senior Litigation Analyst

Allegation

Failure to monitor/assist an elderly patient resulting in a fall.

Disposition

Settled for $100,000. OMIC’s contribution was $50,000.

Following a dilated eye exam, a 90-year-old patient began to get up from the examination chair. In the process, she scuffed her shoe on the floor, which caused her to twist and fall to the ground. An ophthalmic technician was in the room and was able to catch the patient’s upper body protecting her head from injury. When the OMIC-insured ophthalmologist reentered the room the patient stated that she had “lost her balance or something” and complained of right hip pain. Minimal assistance was required to help her into a wheelchair and she was taken to her automobile, which was driven by her daughter. The patient did not want emergency medical attention so she was advised to use Tylenol for pain and to call her family doctor should discomfort persist. The following day the patient was taken via ambulance to the emergency room for right hip pain. An orthopedic surgeon diagnosed a nondisplaced subcapital right hip fracture and noted that the left hip had screws that were placed after a prior fracture. Moderate to advanced degenerative joint disease was also diagnosed in both hips. The fracture required surgery during which three cannulated screws were placed under fluoroscopic guidance. The patient was discharged from the hospital to a convalescent home, where she spent 45 days. She was then discharged to her home with progressive weight bearing allowed. At her last visit with the orthopedist, she described occasional right hip pain. Passive range of motion caused no discomfort.

Analysis

OMIC’s defense counsel retained an orthopedic expert who opined that the patient experienced a spontaneous or indirect traumatic subcapital hip fracture that caused her to fall. She had suffered a broken left hip approximately one year prior to this incident when she fell while boarding a bus. The bus driver caught her, but she still fractured her left hip. In our expert’s opinion, no matter how attentive the technician was, she would not have been able to prevent the fall and in fact did a good job of breaking the fall enough to prevent a serious cranial injury. The patient testified at her deposition that she was blind and could not see as a result of the dilated exam. She claimed that she called out to the ophthalmic technician for assistance, but the technician did not respond so she decided to get up on her own. The issue in this matter was whether the ophthalmic technician had a duty to escort the patient to the lobby and out of the building, and if so, whether she was negligent in performing this duty. Plaintiff counsel brought two claims in this case. The first was a medical negligence claim against the OMIC-insured ophthalmologist and the second was a general negligence claim against the OMIC-insured entity that employed the technician. Therefore, OMIC and the premises liability carrier jointly represented the entity. Unfortunately, the county in which this fall occurred was known to be a plaintiff-friendly venue. Although our defense counsel was confident about our chances for a defense verdict, he did advise that a plaintiff verdict could result in a $250,000 to $400,000 award. This case was therefore taken to mediation where a settlement of $100,000 was negotiated. OMIC and the premises liability carrier agreed to spilt the settlement 50/50. The settlement was negotiated on behalf of the entity since the ophthalmologist was not even in the room at the time of the fall. The OMIC insured was dismissed from the lawsuit and no report to the National Practitioner Data Bank or state medical board was required.

Risk management principles

During the claims investigation, it became clear that this particular patient had many risk factors for a fall. She was 90 years old and had fallen and broken her left hip the previous year. She also had just had her eyes dilated during an ophthalmic examination. The Hotline article provides a quick screening tool of questions that help determine who might need assistance. Knowing about this patient’s recent fall and hip fracture would have alerted the technician to stay with the patient and assist her in standing up and walking back to the lobby where relatives or other caregivers could take over assisting her back to the car.