Trial Attorney Blog

While reviewing cases involving falls in skilled nursing facilities our lawyers have determined that there are several causes of falls that we see frequently. The first involves patient’s characteristics. Dementia associated with “sundowner” syndrome or nighttime confusion is a common occurrence. In this situation, the patient may awake in the middle of the night not knowing where he or she is, experience a drop in blood pressure from arising too quickly, and have a momentary dizzy spell. This almost invariably leads to a fall.

Another frequent cause involves vision disturbance, where a patient simply cannot see well enough to guide his or her steps. Arthritis or other orthopedic problems that compromise the ability to walk also lead to falls. Old strokes can lead to weakness or partial paralysis which can in turn lead to a loss of balance resulting in a fall.

Many medications can cause drops in blood pressure, lack of positional compensation with rising, sleepiness, lack of awareness, and balance.

Our lawyers are frequently asked to review cases involving patient falls in skilled nursing home facilities. Due to the physical and mental conditions of many infirm and elderly patients, it is impossible to prevent all falls. However, in many instances falls can be prevented or greatly reduced by the implementation of proper procedures.
Patients who are long term residents in skilled nursing homes are by definition in a compromised state of health, usually from multiple chronic medical problems. These patients are often weak, are subject to lightheaded spells, become confused and have significant deficiencies of mobility and balance. Falling, sometimes frequent falling is thus a common occurrence for these patients.
The consequence of these falls can range from simple bruising to severe complications such as broken bones and brain injuries. Even relatively simple additional stresses imposed on an already debilitated patient can have severe long term effects on a patient’s overall medical condition. For example, statistics show that patients who sustain a fractured hip have much higher 6 month death rates even after the fracture has healed and baseline mobility has been re-established.

Mattel issued another major recall today involving Chinese-made toys which contain excessive amounts of lead. These include locomotive toys and accessories for the Barbie brand dolls.

The Consumer Product Safety Commission reported that Mattel is recalling almost 800,000 toys. Mattel reported that it discovered the use of lead-based paint as part of an ongoing investigation of toys it imports from China. The Company is recalling 675,000 Barbie accessories, 8,900 Big World 6 in-1 Bongo brand toys and about 90,000 Geo Trax locomotive toys. These products were sold from September 2006 until last month.

It has been proven that excessive amounts of lead are linked to behavioral and developmental problems in children. The Consumer Product Safety Commission bans paint with more than .06% lead.

Our lawyers have successfully litigated many cases involving defective household products which have caused fires and serious personal injury or death. Recently, the U.S. Consumer Product Safety Commission, in cooperation with GE Consumer & Industrial has announced a voluntary recall of 2.5 million GE Dishwashers. The recall advises consumers to stop using recalled products immediately unless otherwise instructed.

A defect in the dishwashers has the potential to allow liquid rinse-aid to leak from the dispenser onto the dishwasher’s internal wiring which can cause an electrical short and overheating, posing a fire hazard to consumers.

According to the recall, GE has received 191 reports of overheated wiring including 56 reports of property damage. There were 12 reports of fires that escaped the dishwasher. Fire damage was limited to the dishwasher or the adjacent area. No injuries have been reported.

There are two major organizations which crash test automobiles and report the results to the public. One is the National Highway Traffic Safety Administration, (NHTSA), an agency of the United States government. The other is the Insurance Institute for Highway Safety, (IIHS), a non-profit organization funded by auto insurers.

Both work to reduce the number of motor vehicle crashes, and the rate of injuries and amount of property damage in the crashes that still occur. They each conduct basic research and produce ratings for each model of vehicle.

The Insurance Institute’s frontal crash testing differs from that of the NHTSA New Car Assessment Program in that its tests are offset from the center. This test exposes 40% of the front of the vehicle to an impact with a deformable barrier at approximately 40 mph (60 km/h). Because only 40% of the vehicle’s front must withstand the impact, some contend it shows the structural strength better than the NHTSA New Car Assessment Program full-width testing does. Many real-life frontal impacts are offset.

The Associated Press has reported that an 86-year-old Providence Rhode Island man died three weeks after a neurosurgeon operated on the wrong side of his head. The patient, whose name wasn’t released, died Saturday, and the state medical examiner was determining the cause of death.The man underwent emergency surgery at Rhode Island Hospital on July 30 to treat bleeding in his brain A nurse practitioner for Dr. Frederick Harrington didn’t record which side of the man’s brain required surgery. When another nurse pointed out the missing information, Harrington allegedly relied on his memory without consulting a CT chart and began operating on the wrong side. Upon realizing the error during the surgery, the surgeon operated on the correct side.
The hospital has suspended Harrington’s surgical privileges, and he has agreed to stop performing surgery until an evaluation is complete. The incident marked the third wrong-side surgery error in the hospital’s neurosurgery unit in six years. Harrington also operated on the wrong side of a patient’s head during a surgery at Roger Williams Medical Center in September.
After reviewing that incident, the state Board of Medical Licensure and Discipline decided there were mitigating circumstances and opted to create a remediation plan for Harrington rather than publicly sanction him.

Last week, the Insurance Institute for Highway Safety released test results for side impact ratings of large cars. Three of six large car models tested earned the top rating of good, but one was rated marginal in the side impact crash tests. The Institute ratings of good, acceptable, marginal, or poor are based on a crash test in which a barrier designed to replicate the front end of a typical SUV or pickup truck strikes the tested vehicle in the side at 31 mph.

The best performers were the Acura RL, Kia Amanti, and Volvo S80, all 2007 models. The Volvo also earned the Institute’s 2007 TOP SAFETY PICK award for superior overall crash protection. The Volvo’s selection was based upon the fact that it rated good in the Institute’s front, side, and rear tests and has electronic stability control as standard equipment. The 2007 Cadillac STS and Mercedes E class earned acceptable ratings. The lowest rating was given to the 2008 BMW 5 series, which earned the second lowest rating of marginal for side impact protection.

These side impact tests are important because side impacts are the second most common fatal crash type after frontal crashes. About 9,200 people in passenger vehicles were killed in side impacts in 2005. In crashes with other passenger vehicles during 2004-05, 49 percent of driver deaths in 1-3-year-old cars and minivans occurred in side impacts, up from 31 percent in 1980-81. During the same time, the proportion of driver deaths in frontal crashes declined from 61 to 46 percent.

Our lawyers frequently review cases involving hospital acquired infections, many of which are fatal. New Medicare regulations have been enacted in an effort to prevent these all too frequent tragedies. Under new Medicare regulations, which will become effective in October 2008, hospitals will no longer receive higher payments for the additional costs associated with treating patients for certain hospital-acquired infections and medical errors. The new rules will give hospitals a powerful new incentive to improve patient care, according to Consumers Union, the nonprofit publisher of Consumer Reports. These new regulations are a giant step in the effort to save lives and money by holding hospitals responsible for their preventable negilgent acts which harm patients and cost taxpayers huge sums of money.

“Every year, millions of Americans suffer needlessly from preventable hospital infections and medical errors,” said Lisa McGiffert, Director of Consumers Union’s Stop Hospital Infection’s campaign. “These new rules are a good beginning for Medicare to use its clout to mobilize hospitals to improve care and keep patients safe.”

Under the rules payments will be withheld from hospitals for care associated with treating certain catheter-associated urinary tract infections, vascular catheter-associated infections, mediastinitis after coronary artery bypass graft (CABG) surgery, and five other preventable medical errors. These errors are bed sores, objects left in patients’ bodies, blood incompatibility, air embolism, and falls.

Each spring and summer our attorneys see an increasing number of injuries to children caused by lawnmowers. An estimated 9,400 children are injured each year. Many of the accidents result in amputations of legs, hands, fingers, feet, and toes. Experts say that the most serious accidents occur when operators back up rider mowers with the mower blades engaged and run over small children they can’t see.

According to the American Academy of Pediatrics, back over accidents alone account for 560 injuries to children each year. Statistics show that the overall rate of all types of injuries for both adults and children is 2.6 injuries per 1,000 involving ride-on mowers. That is a very high ratio of injury especially for a product used seasonally and not on a daily basis.

In 2003, the lawnmower industry adopted a voluntary industry safety standard requiring new rider mowers to have a “no-mow-in-reverse feature” to prevent the mower from backing up with the blades powered. But, the safety standard allows manufacturers to install a device that overrides the feature.

In the not too distant past, our lawyers’ experience had been that medical malpractice encompassed almost exclusively the negligent wrongs of physicians. However, as nursing has evolved into a sophisticated, technical, and specialized profession, nurses regularly assume roles previously in the exclusive domain of physicians. These include examinations, diagnosis, post-surgical monitoring, and treatments of patients. Sometimes this is done without any direct supervision from physicians. The nurse’s expanded role in patient care, the continual development of specialized and sophisticated medical technology, and the heightened emphasis on independent nursing practice have placed nurses into positions of increased accountability.
Generally, when the nurse’s negligence occurs in the scope of the nurse’s employment at a hospital or clinic, the nurse’s conduct can be imputed to the facility or the hospital. In certain cases, the nurse’s conduct may be imputed to the physician.
Most nursing negligence results from one or more of the five steps in the nursing process: Assessment, nursing diagnosis, care planning, intervention, and evaluation. More specifically, the allegations often focus on improper treatment, performance of treatment, failure to prevent injuries, failure to follow the chain of command, failure to monitor a patient’s condition, failure to communicate information to physicians, failure to follow hospital policies and protocols, and medication errors.