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Houston Court of Appeals rules against hospitalist physician in Houston Methodist Hospital fall case

Hospitalists must give appropriate fall prevention orders and instructions to nurses

Everyone who works in healthcare should know that patient falls should never occur in a hospital or nursing home setting. That’s why they’re called sentinel or never events.

A recent opinion entered by Houston’s 14th Court of Appeals illustrates how fall prevention is a responsibility shared by physicians and nurses. The case is styled Dhruti B. Patel, MD v. Michael Baker, Individually and As Representative of the Estate of Deanne Baker; No. 1421-00177-CV, 14th Court of Appeals. You can read the opinion here.

The patient went to Houston Methodist Hospital’s emergency room because she was experiencing generalized weakness. While at the hospital, she was examined by Dr. Dhruti Patel, a hospitalist physician. Dr. Patel documented a history and physical, noting her orders that the patient could have activity as tolerated and could get up with assistance. Two days later, Dr. Patel discharged the patient from the hospital with orders to ambulate (walk) with assistance or an assistive device.

In the process of being discharged, the patient used a walker to get up from the bed and move into a wheelchair. In doing so, she lost her balance, fell, and fractured her pelvis and hip. Her condition deteriorated and less than two weeks later she died of cardiac arrest.

The patient’s husband filed a medical malpractice wrongful death lawsuit against Houston Methodist Hospital and Dr. Patel.

As with any Texas state court medical malpractice lawsuit, the plaintiff had to comply with tort reform requirements to produce medical expert reports early in the litigation. These reports must establish the applicable standards of care, who violated the standards of care and how, and how such conduct proximately caused harm to the patient.

If adequate expert reports aren’t served by the plaintiff within 120 days of the defendant filing an answer in the lawsuit, the trial court must dismiss the case and order the plaintiff to pay the defendants attorney’s fees. The same is true if the court ultimately determines that expert reports served by the plaintiff are inadequate to represent a good faith attempt to comply with the statute.

At the trial court level, Dr. Patel objected to the adequacy of a medical expert report served by the plaintiff, contending that it wasn’t sufficient in its description of the standard of care, how it was breached, and proximate causation. The trial court overruled the objections and denied the motion to dismiss. As allowed by Texas law, Dr. Patel kept the trial court proceeding on hold while he pursued an interlocutory appeal to the Houston Court of Appeals on the sole issue of whether the plaintiff’s expert report was sufficient under the tort reform law.

The appellate court agreed with the trial court, and sent the case back for further proceedings. In other words, this was a victory for the plaintiff and the patient’s family.

Having reviewed thousands of medical expert reports over the course of my legal career, it came as no surprise to me that the plaintiff won this legal challenge. 

The plaintiff’s medical expert report written by Benny Gavi, MD, a clinical assistant professor of medicine at Stanford University. Dr. Gavi, like the defendant physician, is a hospitalist physician. Here are some excerpts of his report:

• The patient had multiple risk factors indicating that she was at a high risk for falls.

• Dr. Patel, the hospitalist, was obligated to identify the patient is a high fall risk and communicate appropriate orders for condition, including fall precautions. 

• Dr. Patel breached the standard of care by placing orders that the patient was permitted activity as tolerated, and only required “up with assistance" (help in getting up). This failed to take into account the patient’s particular susceptibility to falls and direct staff to provide her greater assistance with transfers, and it was a breach of the standard of care. This also effectively contradicted and minimized any notion that the patient was a serious fall risk and failed to take into account the patient’s particular susceptibility to falls, while directing staff to provide her greater assistance with transfers. 

• Dr. Patel did not specify that the patient should receive assistance with transfers from appropriately trained personnel, and the records and her unfortunate fall show that she did not receive such assistance. The hospital, operating without direction from Dr. Patel, put no such precautions into place.

• The patient’s fall would have been prevented if Dr. Patel had given the nursing staff appropriate orders and instructions for the patient’s condition.

• The hospital staff had an obligation to develop protocols and appropriately implement those protocols, to ensure that patients who are at high risk for falls, and have appropriate interventions to prevent falls. The hospital staff had an obligation that appropriate measures were in place to prevent high risk patients from falling. This would include personal assistance from trained personnel to assist the patient in transferring from bed to wheelchair that includes personnel remaining at the patient’s side at all times until she is safely situated in a chair or wheelchair.

• It wasn’t sufficient for the emergency physician to recommend fall precautions for the patient. A recommendation does not amount to an order, and another physician’s recommendation could not discharge the duty of Dr. Patel, the hospitalist physician. Further, when a hospital simply places some fall precaution measures in place, it does not relieve the admitting physician of his duty to make the appropriate orders to ensure patient safety. Dr. Patel needed to provide specific orders regarding transfers, namely, that they should be properly assisted by appropriately trained personnel.

• The patient’s cardiopulmonary arrest and death were consequences of severe deconditioning following the patient’s fall and pelvic and hip fracture.

With this level of detail, there’s no doubt in my mind that the expert report fulfilled the two-full purpose of the statute: (1) it informed the defendant of the conduct in question; and (2) demonstrated to the trial court that the claim has merit.

If you’ve been seriously injured because of poor hospital or nursing home care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.

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