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Hospital Internal Policies and Patient Injury from Fall


A man who had previously suffered a stroke was admitted to a hospital. The nursing staff at the hospital assigned the man a fall risk assessment score of eight. The following day a hospital employee found the man on the floor. He had apparently fallen out of his bed. A subsequent CT scan revealed in acute subarachnoid hemorrhage, which was attributed to left frontal trauma.

 

The day after the man’s fall, a physician wrote an order for a sitter to remain at the man’s bedside. The man remained in the hospital for about two weeks. He was discharged to a rehabilitation facility where he remained for about five weeks before returning to his home. He died about two months after his admission to the hospital. The cause of his death was respiratory failure secondary to possible aspiration pneumonia and a cerebral vascular accident.

 

The representative of the man’s estates filed a medical malpractice lawsuit. The complaint alleged that the hospital was vicariously liable for the negligence of its nurses who purportedly breached their standard of care by failing to ensure that the bed rails on the man’s bed were in the appropriate position, failing to utilize a bed alarm, failing to request and independently initiate an order for a sitter, and failing to inform the man’s family that they had the option of remaining with the man to act as a sitter. Following the discovery requests by the man’s estate, and over objection from the hospital, the Wayne Circuit Court ordered the hospital to produce internal policies and procedures in effect at the time of the man’s fall that related to fall precautions at the hospital, including specifically the use of bedrails, bed alarms, and sitters.

 

The Court of Appeals of Michigan reversed. The court held that the hospital policies and procedures were irrelevant to the resolution of the medical malpractice claims at issue in this case and not reasonably calculated to lead to admissible evidence.

 

The hospital policies and procedures were irrelevant to the resolution of the medical malpractice claims at issue in this case and not reasonably calculated to lead to admissible evidence. The complaint involved only allegations of vicarious liability. The man’s estate did not advance any claims of direct negligence against the hospital. Because it was the standard practice in the community which dictated the standard of care, internal rules and regulations did not determine liability, and such materials may not be admitted at trial. The court reasoned that, given that the internal rules and regulations did not establish the nurses’ standard of care, the hospital’s internal policies and procedures could not be construed as relevant to a determination of the hospital's vicarious liability arising from the negligence of its nurses and such information could not be reasonably calculated to lead to admissible evidence. Specifically, the court noted that the requested information did not establish the standard of care, show whether the nurses' conduct in question was a breach of that standard of care, demonstrate whether the man suffered injury, or demonstrate whether the nurses' breach of the standard of care was the proximate cause of that injury. Because these materials were irrelevant to the issue of defendant's vicarious liability and not reasonably calculated to lead to admissible evidence, the trial court abused its discretion by granting the estate's discovery request.

 

The Court of Appeals of Michigan reversed the trial court’s order that the hospital produce certain internal hospital policies and procedures.

 

See: Melick v. William Beaumont Hosp., 2015 WL 1739980 (Mich.App., April 16, 2015) (not designated for publication).

 

See also Medical Law Perspectives, December 2013 Report: Thicker Than Water: Liability When Blood Clots Cause Injury or Death

 

See the Medical Law Perspectives March 2, 2015, Blog: Discovery of Hospital Incident Reports: Prepare for In Camera Review; Discovery Likely 

 

 

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