A strict legal requirement in healthcare negligence cases is proof of proximate cause, that is, evidence linking the caregivers’ actions or omissions to the harm experienced by the patient. The proof is too tenuous in this case to support a judgment for the patient that failing to use a bed alarm was the cause of the patient’s fall. SUPREME COURT OF MISSISSIPPI September 13, 2018
After surgery to remove a portion of her large intestine the eighty-nine year-old patient was sent to a medical/ surgical unit of the hospital. Her nurse’s first assessment on the unit indicated the patient was awake, alert, aware, cooperative and oriented and her speech was clear and coherent. Nevertheless later that same day the nurse held a patient education session with her. The nurse went over the items on a fall prevention sheet and left the information with the patient.
The nurse charted expressly that the bed was in its lowest position with the top side rails up, that the patient’s personal items were within her reach and that she had been instructed to use her call bell for assistance if she needed to get up from bed. That afternoon the patient got oral Demerol and Toradol. Those were the last pain meds she got before she fell approximately thirty-six hours later. Throughout her stay her nurses saw to it that a yellow arm band and yellow dot sticker on the chart and room door were in use to alert caregivers to the patient’s fall risk. Nurses continued to assess the patient. They consistently found her to be awake, alert and oriented and not suffering from any apparent cognitive difficulties.
On her second day on the unit, after her catheter was removed, the patient was encouraged by her nurses and the occupational therapist to get out of bed and begin ambulating with a walker. The nurses and the therapist saw her quickly regain her prior baseline level of mobility. The therapist charted that the patient was alert and oriented and understood instructions.
Late at night going into her third day an aide found her on the floor. Her head was bloodied, but she seemed all right, until she lost consciousness later that morning. She had emergency surgery for a subdural hematoma, spent a few months in a nursing home and then returned to her home.
The patient’s nursing expert could fault the nurses only by stating that a bed alarm should have been in the plan of care and should have been in use. However, the Supreme Court of Mississippi upheld the trial judge’s ruling that the lack of a bed alarm was not the cause of the patient’s fall. The prevailing consensus is inconclusive as to the effectiveness of bed alarms in fall prevention. The hospital’s expert testified that a bed alarm would not have made any difference.
Cavalier v. Hospital, __ So. 3d __, 2018 WL 4403564 (Miss., September 13, 2018).