Allegation
The patient alleged the home care agency and its employee were negligent by failing to provide training in the use of a Hoyer lift resulting in a patient fall and subsequent surgery.
Case Details
The patient was an obese, wheelchair-dependent 51 YOM (6’0”, 235 lb) with a primary diagnosis of inclusion body myositis. Inclusion body myositis is an inflammatory muscle disease characterized by slowly progressive weakness and muscle wasting most apparent in the arms and legs. The patient had been non-ambulatory for many years due to this condition.
The defendant home care agency provided care for the patient including assistance with activities of daily living. This service included the use of a Hoyer lift to transfer the patient from his bed to his wheelchair in the morning and back into bed in the evening. The patient had received home care services from the agency for several years before the defendant certified home health aide (CHHA) began working with the patient. The defendant CHHA provided care on Sundays only in the morning and evening for a total of four hours. The patient and his spouse provided instruction on use of the lift to the CHHA on several occasions.
Several months after starting this assignment, during routine care, the aide positioned the patient in the Hoyer lift in order to take him out of bed and transfer him to an electric wheelchair. The aide claims that he moved the legs of the Hoyer lift apart, locked the legs in place, and slid the legs underneath the patient’s bed. After placing the sling under the patient and attaching it to the overhang with bars, he turned the machine on and lifted the patient out of bed. He then pulled the machine backward to position the patient so he could lower him into the wheelchair. As he pulled the machine back, the legs wobbled and were not fully spread apart. As he moved the lift back toward the bed, the lift leaned and tilted before falling over. The patient fell onto the floor on his left hip.
As a result of this fall the patient suffered bilateral femoral neck fractures. Each of the femoral neck fractures appeared to be displaced. He underwent percutaneous screw fixation of the right and left femoral neck fractures using Stryker cannulated screw systems with 8 mm diameter screws. The operation was performed and according to the medical records, the left hip fracture appeared to have healed in proper alignment. However, the right hip fracture collapsed at the fracture site with some displacement. More specifically, a radiology report indicated that x-rays of the right hip showed a diffuse osteopenia present throughout the right hip along with medial and inferior displacement of the femoral head relative to the femoral neck.
The patient claimed that his right hip ached constantly but with varied intensity. He further claimed that the left hip ached occasionally with sharp jabs running down his left leg. The fractures allegedly caused the patient problems with using his hips as an anchor in his wheelchair to support himself for movement.
Expert Testimony
The plaintiff filed suit. A nurse expert witness for the plaintiff alleged that the home care agency violated the standard of care in several instances. She opined that the only training the aide received was from the plaintiff and his wife, which was probably good training but did not comply with the home care agency’s standards. She further testified that the home care agency was negligent for failing to provide a caregiver to the plaintiff that could safely care for him. The defendant aide had not been provided with any training on the use of the Hoyer lift by the agency, and they placed an aide in a patient’s home with no experience or formal training in the use of a Hoyer lift.
The director of nursing for the defendant home care agency did testify that there was a breach of policy and procedure by failing to have the aide trained. According to the home care agency’s policies and procedures, on the first day of care the CHHA should have been accompanied by a nurse supervisor in charge of the case. The nurse supervisor’s role was to orient the new aide to the client’s home, the care to be provided, and any special equipment to be utilized. This would have included instructing the aide on how to use the Hoyer lift. Due to miscommunication among administration at the home care agency there was no orientation for the CHHA by a nurse supervisor.
Resolution
After two mediation sessions the case was settled.
Risk Management Considerations
It can be difficult to defend not following policy or procedures and not documenting staff competency.
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