No Fall Precautions in Hospital Resulting in Subdural Hematoma and Death
The Acennso Case
In this case, we represented the Estate of Mrs. Wilda Acennso, age 86, who died from a traumatic brain injury – a subdural hematoma – following a fall at a hospital.
Prior to her admission, Mrs. Acennso lived with her daughter and son-in-law until May 16, the day prior to her hospital admission. On May 16, Mrs. Ace was temporarily admitted to a nursing home for respite care because her daughter was fighting breast cancer.
On May 17, the nursing home staff recognized that Mrs. Acennso’s right leg was swollen and sent her to the hospital for evaluation and treatment. At the hospital, Mrs. Acennso was admitted for a suspected blood clot in her right leg. The ER history & physical described her as very pleasant, using a walker, admitted to a nursing home due to gait instability, and that she was alert and oriented to time, place, and person. It is also noted that she had a fall on May 12, one week prior to admission, injuring her right leg, and that Mrs. Acennso had a fall/gait abnormality.
Mrs. Acennso was initially admitted to a monitored bed on the third floor, Room 322, and ordered anti-coagulation therapy. A “Fall Risk” armband was placed on her.
On May 18th, a Fall Risk Assessment noted that Mrs. Acennso had poor balance, used furniture for support, and was unable to walk without assistance.
A May 19, a progress note documented “frequent falls/gait abnormality.”
On May 22nd, a progress note again documented “frequent falls/gait abnormality”; yet, Mrs. Acennso was transferred to an unmonitored bed on the second floor (Room 296).
On May 23rd, Mrs. Acennso was taken to the Operating Room where she underwent placement of a Greenfield filter. Post-operatively, she returned to Room 296 to recover. Physician orders for activity were “bed rest for one hour and may shower. “
On May 24th at roughly 2:00 am, a laboratory technician found Mrs. Acennso face down in a pool of blood on the floor of her room. The technician alerted the nursing staff. Nursing documentation notes that a physician was called at 2:20 am. The Nurse Supervisor was also notified at 2:25 am. There were no physician’s or nurse’s notes detailing the incident and/or the response to the incident until the next morning.
The physician ordered a CT scan of the head and neck which showed a moderate amount of subarachnoid hemorrhage bilaterally involving the right frontal lobe, the left superior frontal lobe, and the left temporal occipital region.
As a result, Mrs. Acennso had a decreased level of consciousness with some response to simple commands. She was not able to ambulate. She experienced severe epitaxsis and a large area of ecchymosis of the right side of her face and head. She also sustained a bruised right hip. Mrs. Acennso was transferred to ICU.
Despite these events, no family members were informed until Mrs. Acennso’s daughter received a phone call around 7:00 am (five hours after the fall). After the call, the daughter immediately went to hospital and spoke to a Nurse Supervisor. The Nurse Supervisor told the daughter that she had no information about this incident since the overnight staff was gone.
After still receiving no information from anyone at the hospital, on May 27, the daughter called and left three voicemail messages for the hospital’s Risk/Quality Manager. When the Risk/Quality Manager finally responded, she told the daughter that she still had no information to provide (now three days after the incident).
Tragically, as a result of the hospital staff’s failure to ensure Mrs. Acennso’s safety, she ended up with a traumatic brain injury, facial injuries, decreased mental status, aspiration, aspiration pneumonia, inability to swallow, and an inability to talk.
Due to her deteriorating condition, Mrs. Acennso was transferred back to the nursing home’s hospice unit and died on June 4, eleven days after the fall.
The County Coroner’s office performed an autopsy which concluded, “Wilda Acennso, an 86-year-old white female, died as a result of subarachnoid hemorrhage of the brain due to blunt force trauma of the head due to a ground level fall. ” The Death Certificate also lists the cause of death as: (1) subarachnoid hemorrhage of the brain; (2) blunt force trauma of the head; and (3) ground level fall.
On June 30, the daughter was told by the hospital’s Risk/Quality Manager that a staff nurse admitted that she did not set the bed alarm. The hospital’s Risk/Quality Manager also told the daughter that Mrs. Acennso was found lying in the doorway of her room with all four side rails up and that no bloody fingerprints were found on the room floor.
Mrs. Acennso was retired at the time of her death. She previously worked for GC Murphy Company, Alltel Wireless Company, and until age 79, worked in the crafts department at the local Wal-Mart. Following Wal-Mart, Mrs. Acennso taught crafts at her church with her daughter. Prior to her deceased husband’s death, he worked manufacturing rail cars for Pullman Standard.
Prior to this admission at issue, Mrs. Acennso was independent with activities of daily living and enjoyed frequent traveling to visit family and friends. She was also active with a group of friends who met once a month for 40 years to knit. Any night until her death Mrs. Acennso could be found playing dominos or cards with friends and family members.
Mrs. Acennso was survived by her two adult children, both from the Kittanning area, a son-in-law, three grandchildren and one great grandchild.
After obtaining the medical records, on behalf of Mrs. Acennso’s family, we wrote a demand letter to the hospital’s risk manager to determine if the hospital was interested in settling before suit was filed. In response, an insurance adjuster from the hospital’s insurance company contacted our firm, advised that she needed months to look into the matter, and as a result, could not settle the case. In response, we immediately filed suit, moved forward with written discovery, and sought to take the videotaped depositions of the individuals involved in Mrs. Acennso’s care. Shortly thereafter, the case settled for a substantial amount.