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Expert Standard of Care Witness Required for Fall from Hospital Bed


A man suffered from a brain aneurysm leaving the man paralyzed on the right side. The man also had a history of congestive heart failure, kidney disease, high blood pressure, high cholesterol, COPD, and anemia. The man lived in a residential care facility.

 

Approximately three years after the man’s admission to the residential care facility, the man was admitted to the hospital for extreme weakness and fatigue. The hospital deemed the man to be at high risk for falling. A red band was placed on the man’s arm to alert hospital staff of the high risk for falling. The man’s care plan required all four bed rails to be in the up position. The man’s care plan also required that the man only leave bed with the assistance of two people.

 

On the man’s second day in the hospital, between 7 PM and 2 AM, the man fell from the hospital bed. The man wounded the forehead and abraded a knee. A nurse discovered the man on the floor beside the bed bleeding from the head wound. The nurse noted that the man was alert and oriented to person, place, and time. The nurse notified the charge nurse, who immediately went to the man’s room where she saw the man on the floor. The man talked with the nurse and the charge nurse and answered their questions while being helped back into bed. According to the charge nurse, all four bed rails were in the up position when the charge nurse entered the man’s room.

 

Approximately 30 minutes after the man was discovered on the floor, the man’s wife was notified by telephone of the fall. The man’s wife spoke to the man on the telephone. The man said that the man guessed the man was okay.

 

A plastic surgeon sutured the wound on the man’s forehead. Another doctor examined the abrasion on the man’s knee. A CT scan revealed no intracranial bleeding or other abnormality.

 

Approximately three days later, the man was discharged to the residential care facility in good condition. The man later died of unrelated causes.

 

The man’s estate sued the hospital for negligence. The complaint alleged that the hospital fell below the standard of care by allowing the man to fall from the bed. All four rails were not up as required by tbe man’s care plan.

 

In support of its claim, the estate named the following witnesses: the plastic surgeon, a cardiologist who treated the man both before and after the fall, and three hospital employees who treated the man and would testify that, prior to the accident, the man was incapable of climbing over the bed rails when raised. None of these individuals was offered as an expert on the applicable standard of care.

 

The hospital identified as potential witnesses several doctors who treated the man. One of them was a family medicine practitioner who also worked with geriatric patients and was the hospital’s chief medical director. The doctor treated the man both at the hospital and at the residential care facility. The doctor was not involved with the hospital stay at issue. When deposed, this witness described the man as generally oriented to the moment with occasional confusion and forgetfulness. The doctor was confident that the man knew the man’s limitations and could converse with people. After the fall, the family medicine practitioner noticed no changes in the man’s condition. The man’s head wound healed adequately. This witness was the only medical professional to be asked about or to express an opinion about the standard of care applicable to the hospital. The doctor testified that he found no deviation from the standard of care in the staff’s handling of the man’s high risk of falling.

 

The hospital moved for summary judgment. The motion argued that this was not a slip and fall case, but rather a medical malpractice case due to the nature of the claims: the hospital staff negligently failed to provide the minimum standard of care. The hospital maintained that expert testimony was required to establish the degree of care and skill expected and that the man fell because hospital staff deviated from the expected standard of care. None of the expert witnesses identified by the estate were to testify about the standard of care. There was no proof any hospital staff actually caused the man to fall.

 

Responding to the summary judgment motion, the estate argued that no expert witness was required because this was a res ipsa loquitor case. It was sufficient that the man’s wife testified that the man had limited mobility and could not get over the bed rails had the rails been in the upright position.

 

The Boyd Circuit Court granted summary judgment in the hospital’s favor.

 

The Court of Appeals of Kentucky affirmed. The court held that expert testimony was needed to establish the hospital’s expected standard of care, breach, and resulting injury.

 

Expert testimony was needed to establish the hospital’s expected standard of care, breach, and resulting injury. The doctrine of res ipsa loquitor did not apply. Determining whether the man was at a high risk of falling required an exercise in professional judgment. Professional judgment was also exercised to determine whether the four bed rails should have been in the up position and the man should have ambulated only with the assistance of two people. Professional judgment was also exercised to determine whether even more precautions were needed. Jurors would not automatically know of other options and whether they were advisable. The depositions of the charge nurse and family medicine practitioner indicated the hospital had implemented adequate precautions and the hospital staff had carried out those precautions. The court reasoned that whether more measures—other than those routinely applied to all patients—should have been used to protect the man required professional judgment and, consequently, expert testimony. The trial court did not abuse its discretion in granting summary judgment to the hospital.

 

The Court of Appeals of Kentucky affirmed the trial court’s entry of summary judgment in favor of the hospital.

 

See: Chamis v. Ashland Hospital Corp., 2017 WL 4558459 (Ky.App., October 13, 2017) (not designated for publication).

 

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See also Medical Law Perspectives Report: Risks in Caring for Patients with Cognitive Impairments: Alzheimer’s Disease and Dementia

 

See the Medical Law Perspectives Blog: Medical Expert Testimony Not Necessary to Establish Standard of Care for Failure to Communicate Cancer Diagnosis

 

 

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