Nursing Home Staff Neglects Physician’s Orders

This case takes place in Florida and involves an elderly patient who suffered injuries resulting from a slip and fall accident. He was placed in a brace collar of his neck and discharged to the nursing facility where he lived. The physician ordered that the brace remain in place indefinitely until his next check up and office visit. Despite these instructions, a staff member of the nursing facility removed the collar without instruction to do so. The patient subsequently became paralyzed, allegedly the result of improper bracing. He is now incapable of using her lower and upper extremities, and the patient will require a lifetime of 24-hour professional care.

Question(s) For Expert Witness

1. Do you oversee a long term care facility that cares for elderly patients who are placed in brace collars of the neck and shoulder on a routine basis?

2. If so, do you have specific guidelines to ensure that patients are appropriately monitored and cared for - to avoid a misunderstanding like what's been described above (ie: inadvertent removal of a brace which has been ordered by an orthopedist)?

3. Have you ever been the target of a malpractice claim? If so, did the issue in question involve a similar claim to the case described above?

Expert Witness Response E-000387

Any rehab facility would have physician orders that are supposed to be followed by the nursing staff - that is a regulatory standard. Issues may include if it was Dr. orders were clear that the brace was not supposed to be removed (as opposed to being used indefinitely), whether it could be removed for bathing or other necessary interventions, if the resident had a fall or other contributing factor, for how long the brace was not properly placed. I am not able to comment on the medical effects, but only on nursing home policy and procedures, whether Dr. Orders were followed, quality improvement (or in this case quality assurance and supervision) and if care delivered met usual and acceptable quality standards. That being the case, it seems clear that good practices were not followed in this case if the removal of the brace led to such a significant injury.