Rehab hospital patient was at risk due to cognitive deterioration – $1,150,000 Verdict

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Plaintiff’s decedent was 69 years old, working successfully as a stockbroker and independent in all activities of daily living. On Nov. 1, 2010, the decedent was admitted to the hospital with complaints of double vision, dizziness and unsteady gait. Although a cause was never determined, the double vision and dizziness improved over the next seven days, and the decedent was discharged to a rehabilitation hospital for therapy to work on his unsteady gait. On his second day of admission at the rehab hospital, the decedent became confused and disoriented, which progressed over the next day to a degree that put him at great risk of falling. By the end of Nov. 10 and the beginning of Nov. 11, this neurological deterioration had manifested itself with the decedent repeatedly attempting to get up from bed unassisted. The nurse providing care to the decedent during that overnight shift testified the decedent’s continuous attempts to get up required her to sit outside his door so that she could do one-on-one supervision. However, at 7:00 a.m. when the shift change was occurring, the decedent was left unsupervised. The evidence showed that a bed alarm went off, bringing a nurse supervisor and an assistant to the decedent’s room to take him to the bathroom. However, once that was completed, they again left him alone in his room and within 30 seconds the bed alarm went off and he was found lying on the floor in severe pain. The decedent broke his hip during the fall and required surgery, which was performed at another facility the following day. During the hip surgery, the decedent suffered multiple strokes, which left him dependent on 24-hour care and ultimately led to his death approximately six weeks later.

Plaintiff’s nursing expert opined that although the decedent was considered at high-risk for a fall upon admission because of his unsteady gait, there were significant changes during the days of his stay before the fall that placed him at even higher risk. Mainly, there was a substantial change in his mental state and cognition that required more than universal fall interventions. It was the plaintiff’s expert’s opinion that the standard of care required that, in addition to the universal fall precautions, the decedent needed continuous one-on-one supervision because he had deteriorated cognitively and was unable to appreciate and protect himself.

Plaintiff also had an expert testify about the standard of care for rehabilitation hospitals in terms of the policies and procedures required for fall risk assessment and fall precautions.  It was the expert’s opinion that the rehabilitation hospital deviated from the standard of care because they did not have policies and procedures in place for the use of one-on-one supervision for a cognitively impaired patient. The defense argued that one-on-one supervision was not required, that the fall precautions that had been utilized met the standard of care and that the rehab hospital had the appropriate policies and procedures in place.

In attacking the damages, the defense argued that the decedent was suffering from vascular dementia, which explained his cognitive decline at the rehab hospital. Defense further argued that decedent would not have been able to return to work or his normal life activities even if he had not fallen. However, the evidence at trial showed that the decedent had been followed by two neurologists for more than a year, and neither had documented any significant cognitive problems or concern about dementia. Further, the decedent’s supervisor testified at trial that the month before his admission, the decedent remained the top producer in their office as a stockbroker. Plaintiff’s internal medicine expert opined that the decedent’s cognitive impairment while at the rehab hospital was not caused by vascular dementia, but was related to a phenomenon known as sundown syndrome. This condition is marked by recurring confusion and increasing levels of agitation with the onset of late afternoon and early evening, particularly for older patients in new surroundings such as an acute rehab facility, and that the delirium he was suffering was temporary.

Plaintiff also had a neurology expert testify that the multiple strokes seen on MRI on Nov. 12, 2010, were directly caused by the decedent’s fractured hip and/or the surgical repair of his hip.  The perioperative strokes caused devastating cognitive, motor and language deficits, which were not present before he fractured his hip. Plaintiff’s expert did testify that given the decedent’s medical history of mild CLL and paraneoplastic neuropathy in 2009, that he would have had a slightly reduced life expectancy and probably would have only lived another 10 years.

Plaintiff and decedent had been married for 35 years. In addition to claiming mental anguish, plaintiff claimed future lost income and loss of household services in the amount of $800,000.

[14-T-180]

Type of action: Medical malpractice
Injuries alleged: Wrongful death
Court: Loudoun County Circuit Court
Tried before: Jury
Judge: Thomas D. Horne
Date resolved: July 14, 2014
Verdict or settlement: Verdict
Amount: $1,150,000
Attorneys for plaintiffs: Charles J. Zauzig and Melissa G. Ray, Woodbridge