Nursing expert witness discusses fatal fall at assisted living facility

A nursing expert witness opines on a senior care case involving a resident of an assisted living facility who died from head trauma following a fall and lack of medical treatment for several days. This case concerns a seventy-year-old female who was in relatively good health. The woman’s husband passed away, prompting her to move to an assisted living facility, as it was deemed a safer environment for her than living independently. The patient tripped over a footstool whilst attempting to swap out her dentures adhesives, and sustained a severe blow to the head. She made authorities at the facility aware of her injury. Subsequently the senior living community brought the resident back to her room where she was left unattended for two days without medical treatment or anyone checking on her. During this time the elderly woman was not eating or drinking and was continually slipping in and out of consciousness. Two days following the accident a visiting family member found the woman unresponsive in her room and called 911. The woman was transported to a hospital via ambulance. Treating physicians found that the patient had suffered a subdural hemorrhage as a result of the fall and required emergency brain surgery.

Question(s) For Expert Witness

What are the proper monitoring procedures after a patient has fallen?

Expert Witness Response

I have unfortunately heard this story too many times. Assisted Living Facilities are not strictly monitored and therefore many accidents and deaths occur in this setting. The questions I would ask about this particular case would be:

1. Was the fall witnessed?

2. Did the resident report that she hit her head, or is she even able to express her needs?

3. Was the family and physician notified?

4. Were her vitals taken at the scene?

5. Was a Neurological Monitoring Tool used?

These are just some of the questions that I would need to know to make an informed opinion. If a resident falls and it is un-witnessed and they are not able to communicate what happened due to a cognitive impairment, then the family, physician, and EMS should be called. If it was a witnessed fall and the facility staff saw that the resident did not hit her head or did not hit it hard, then the vitals would be done and if abnormal, then EMS should be called. A Neurological Monitoring Tool should be started in both instances. This tool would initially test for any neurological abnormalities such as pupil dilation or dizziness, but it should be continued to be used to monitor the neurological signs and symptoms every hour for at least two days. Furthermore, the resident should not be left alone and if she is not drinking or eating, that is a major red flag that something is not right. Her vitals should have been taken at the scene, but many times the vitals are normal even though they may have a slow brain bleed. A facility should always err on the side of caution when it relates to head injuries, and always call EMS. The facility is responsible for the health and well-being of all of its residents. That is the reason for living in an Assisted Living Facility.