The Importance of Preliminary/Screening Advice in Medical Negligence Cases

A 72 year old with Alzheimer’s Disease was admitted to a respite unit for several weeks so that his wife could go on holiday. At home he would sleep in his own bed although occasionally in the night he would get up and wander around. He did not require a stick and had no problems with his sense of balance. He was able to feed and clothe himself with minimal assistance.

The Respite Unit was part of a more general ward in a Community Hospital. He was in a four bed unit as part of a 24 bed ward which at night was staffed by two nurses and three nursing assistants. There were no bed rails on his bed and the floors were carpeted.

Ten days after admission he got out of bed at 3am as he wanted to go to the bathroom. He fell down beside the bed onto his left side. The noise of the fall attracted one of the nursing assistants in another bay. He was put back into bed and seen by a doctor. The following morning an x-ray of his hip confirmed a fracture.

The family instigated a claim on his behalf for medical negligence because of the fall. The lawyers involved obtained reports from an Orthopaedic Expert in relation to the fracture, a Geriatric Specialist in relation to some potential increase in his levels of confusion after the incident and especially in rehabilitation. The statement of claim indicated that the gentleman should have been more closely supervised and there should have been bed rails in place.

Unfortunately there was no initial report in relation to liability and causation. There was in fact no indication why this gentleman should have been subjected to any “special” nursing care over and above that which was available on the ward, nor was there any indication for the use of bed rails which in some circumstances could have served to increase his levels of confusion. It is of note that he did not have any bed rails in place at home.

The case was easily defended at a preliminary stage although unfortunately the legal firm had already incurred considerable expense in obtaining other reports for which they were not able to recover their costs from the family, who were of limited means.

This is an important lesson in case management. Any case which has a potential for a suit in medical negligence should have a preliminary screening report in order to ensure that the elements of duty, breach and consequential damage are likely to be in place, prior to commissioning any other costly specialist reports.

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