The Illinois Department Of Health has cited and fined Radford Green when a resident suffered a left hip fracture due to improper handling during a mechanical lift transfer. It took the facility nearly a week to finally discover the full extent of the injury and transport the resident to the emergency department for evaluation and treatment.
The resident in question is described as having severe cognitive impairment and requiring maximum assistance with bed mobility and transfers. Her diagnoses include fibromyalgia, atrial fibrillation, congestive heart failure, and dementia.
The incident in question occurred during a shower transfer using a sit-to-stand lift. According to a Certified Nursing Assistant, the resident became agitated and resistive while he was attempting to place the lift sling under her arms. Despite this, the CNA proceeded with the transfer alone, violating the facility’s policy requiring two staff members for mechanical lift transfers. During the transfer, the resident began to slide out of the lift sling.
A separate CNA provided a more alarming account of the incident. She reported hearing yelling from the shower room and upon investigation, found the resident “hanging from the sit to stand lift sling with her arms raised high and her legs dangling near the ground.” This CNA stated that the resident “was not bearing any weight on her legs at the time” and that the original CNA manipulating the lift “was just standing there looking at the resident with a shocked look on his face.”
The intervening CNA instructed the Aide to support the resident’s weight from behind while she lowered the lift arm and detached the sling. They then lowered the resident to the ground. Notably, the intervening CNA mentioned that the leg band was not secured around the resident’s legs, which is a critical safety measure for this type of transfer.
The facility failed in several key areas following this incident:
1. Timely Assessment: The facility did not ensure the resident was assessed immediately after being lowered to the ground. An Advanced Practice Nurse stated, “when the resident was lowered to the ground on the day of the incident, it should have been reported to the nurse right away so an assessment for injuries could have been performed.”
2. Physician Notification: The facility failed to notify the resident’s physician in a timely manner about the incident.
3. Ongoing Assessments: There was a lack of ongoing nursing assessments from the time of the incident through the following week, when the resident was finally transported to the emergency department.
4. Delayed Medical Evaluation: An Orthopedic Surgeon emphasized the severity of the situation, stating, “the resident had a bad injury, and she should have been sent out to the emergency department after the incident for x-rays and treatment.”
The consequences of these failures were severe. The resident’s left hip fracture went undiagnosed for a week, potentially causing unnecessary pain and complicating her recovery. The hospital emergency department report noted that the resident’s “left leg was swollen with tenderness and bruising noted to the back of the leg and painful range of motion.”
This case highlights critical failures in resident care, safety protocols, and post-incident procedures. It underscores the importance of adherence to transfer protocols, immediate incident reporting, thorough assessments, and timely medical evaluations in ensuring the safety and well-being of vulnerable residents in care facilities.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
