On August 29th, while an inpatient in a psychiatric hospital, the 46 year old plaintiff was physically assaulted by his roommate, resulting in injuries to his head including facial bruising and lacerations. He was transferred to the local community hospital for evaluation and treatment. CT scans of the head, spine, chest, abdomen and pelvis were all negative. The patient was admitted for observation to a regular floor.
The plaintiff had a history of disturbed thinking since his youth. At the age of 14, he jumped from the roof of a multi-story building and sustained a fractured skull, requiring neurosurgery with metal plate insertion. He suffered with hallucinations, depression and declining cognition since then.

Two days after admission to the medical floor, on August 31st, the patient had an alleged unwitnessed fall. He was found on the floor of his room, in a sitting position and leaning against the wall. There was a large reddened area on his back. He was unable to speak about what had occurred. The patient’s medical status rapidly deteriorated and imaging studies showed a left intracranial hemorrhage. He developed respiratory failure necessitating intubation and a transfer to the ICU. After an intensive course, he stabilized and was eventually transferred to a long term psychiatric facility. The plaintiff’s family filed suit alleging that the standard of care was not met on August 31st, citing a failure to properly supervise the patient, resulting in the patient’s fall and brain hemorrhage.

The defense counsel assembled a team of experts and the case was brought to trial. Two issues of critical concern were identified: (1) Understanding the plaintiff’s unwitnessed fall and (2) Was the intracranial bleeding on the 31st of August related to the alleged fall or part of the process of a slow intracranial bleed from the traumatic assault?

At trial, the defense made the case that the patient’s fall risk was properly assessed and managed. The defense attorney read aloud to the jury, the detailed fall risk evaluation and fall prevention plan which was prepared by the nursing staff. According to their documentation, the patient was permitted to sit in a chair because of his ability to respond to basic questions and use the call bell for nursing assistance.

In response to the allegation that the in-hospital fall was the cause of the intracranial bleed, PRI secured an expert neuroradiologist. The neuroradiologist testified with self-assurance that the “negative” CT scan of August 29th in fact, showed three small foci of blood, indicating that the bleed had begun prior to the fall, indicating that the assault caused the intracranial hemorrhage.

**Although the disposition of this claim predates the formation of EmPRO, the management of the claim was handled by EmPRO’s management company (PRIMMA, LLC). To learn more about the EmPRO story, click here.