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Unattended Patient in Pennsylvania Hospital Falls off Table and Dies from TBI

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The Pennsylvania Department of Health (PDH) fined Carlisle Regional Medical Center $12,000 in relation to a complaint filed in July.

According to The Patriot News, a nurse left a patient unattended and the patient fell off the table. The patient had just undergone a radiologic procedure that required intravenous narcotics. The patient sustained a traumatic brain injury and had to be flown to another hospital for treatment but the injury proved fatal. 

The patient was in the hospital’s intensive care unit after falling at home, and PDH concluded that Carlisle Regional didn’t follow its own policy regarding patients who are at risk for falling.

It also cited numerous other failures, including failure to record this and two other patients’ vital signs before the same radiologic procedure and failure to properly document the incident or report it to the Pennsylvania Patient Safety Authority as required by law.

As a result of the report and fine, the hospital reeducated its employees about patient safety. It now requires patients to be secured with safety belts when possible and be attended by a nurse at all times. It released a statement that reemphasized its commitment to patient safety.

Carlisle’s remedial measures may save a patient from being the victim in the future, but it’s too late for the patient who fell off the table and died as a result of its employees’ failure to follow basic procedures. If the patient’s family hasn’t been compensated for the loss the hospital caused they should be.

The failure to properly document and report hospital mistakes indicates a systemic problem within our healthcare system. Each new study conducted on hospital error seems to come to the same conclusion: hospitals make too many preventable mistakes. In North Carolina, a 2010 study published in the New England Journal of Medicine reported that medical care harmed patients admitted to a hospital 25% of the time. That is just mind-boggling.

What will it take to decrease the number of preventable hospital errors? The answer is actually very simple: an honest commitment to patient safety on the part of every hospital employee. This means taking the extra seconds – and it only takes seconds – to verify that the correct arm is being operated on; that all the sponges were removed from a chest cavity; that at-risk patients are never left unattended on a table.

Hospitals can enact as many “safety protocols” as they can muster, but until every medical professional takes those protocols to heart, they are just words on a page.

For more information, see our firm’s articles about preventable hospital mistakes and the alarming frequency of so-called “never events”.

AM

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