Hospital Fall Risk: Understanding the Legal Landscape

Hospital falls are a significant patient safety issue, leading to injuries, head trauma, extended hospital stays, and substantial costs. These incidents also carry important legal implications for healthcare facilities and patients. This article provides an informational overview of the legal aspects surrounding hospital fall risks, including contributing factors, regulatory standards, and liability considerations. 

What Are Hospital Falls?

Hospital falls can occur when patients are left unmonitored, lose their balance and fall, often resulting in injuries such as bruises, fractures, or head trauma. According to The Joint Commission’s Sentinel Event Alert Issue 55 (2015), hundreds of thousands of patients fall in U.S. hospitals annually, with 30–50% resulting in injuries. These falls can extend hospital stays by an average of 6.3 days and cost approximately $14,000 per fall with injury. Patients of any age or physical ability can be at risk due to factors like medical conditions, medications, surgeries, or diagnostic procedures that cause weakness or confusion.

In Charleston, a hub for healthcare with facilities like MUSC, Roper St. Francis, Trident Medical Center,, falls are a pressing issue due to the city’s aging population and high volume of tourism. Legally, hospital falls raise questions about negligence, standard of care, and liability, often involving allegations of failure to prevent foreseeable harm.

Legal Framework for Hospital Falls in South Carolina

Standard of Care and Negligence

In medical malpractice law, hospitals and healthcare providers are expected to meet a standard of care, which refers to the level of care a reasonably prudent provider would provide in similar circumstances. When a patient falls and sustains injuries, courts may evaluate whether the hospital met this standard by implementing adequate fall prevention measures.

Negligence claims in hospital fall cases typically involve:

1. Duty: The hospital’s obligation to ensure patient safety, including fall prevention.
2. Breach: Failure to meet the standard of care, such as not conducting proper risk assessments.
3. Causation: A direct link between the failure and the patient’s fall-related injuries.
4. Damages: Measurable harm, such as medical expenses or prolonged recovery.

For example, failure to use a standardized fall risk assessment tool or to implement interventions like bed alarms could be scrutinized in legal proceedings.

South Carolina Statutes

South Carolina’s legal framework for hospital falls includes several key statutes:

South Carolina Code § 44-7-250 and § 44-7-260(A)(1)

These sections establish and enforce minimum standards for hospital licensure, including patient safety measures like fall prevention. The proposed amendments to Regulation 61-16 (Minimum Standards for Licensing Hospitals) aim to align with current state laws, updating requirements for staff training, patient care, and safety protocols.

South Carolina Code § 15-3-545

This statute sets a three-year statute of limitations for medical malpractice claims, including hospital falls, starting from the date of injury or when the injury was discovered. Exceptions may apply, such as cases involving foreign objects left in a patient’s body, which allow an additional two years from discovery.

South Carolina Code § 15-79-125

Requires plaintiffs to file a Notice of Intent to File Suit and an expert affidavit before initiating a medical malpractice lawsuit, ensuring claims are supported by professional opinion.

South Carolina Tort Claims Act (S.C. Code § 15-78-10 et seq.)

For falls in public hospitals, such as those operated by the Medical University of South Carolina (MUSC), claims against government entities must be filed within two years, extendable to three years with a verified petition.

Joint Commission Standards

The Joint Commission, a key accrediting body for healthcare organizations, establishes standards that address fall prevention. These standards are often referenced in legal contexts as benchmarks for reasonable care. Key requirements from Sentinel Event Alert Issue 55: Preventing falls and fall related injuries in health care facilities include:

• Provision of Care, Treatment, and Services (PC.01.02.08): Hospitals must assess and manage fall risks, tailoring interventions to the patient’s needs and setting.
• National Patient Safety Goal (NPSG.09.02.01): Hospitals are required to assess fall risks, implement interventions, educate staff and patients, and evaluate program effectiveness.
• Human Resources (HR.01.04.01): Staff must be oriented on safety protocols, including fall prevention, with documentation of completion.
• Leadership (LD.04.01.07): Hospitals must maintain policies supporting patient safety.

Non-compliance with these standards may be cited in legal cases as evidence of inadequate care, though compliance does not guarantee immunity from liability.

Contributing Factors to Hospital Falls

The Joint Commission identifies several factors contributing to hospital falls, each with potential legal implications:

1. Inadequate Assessment: Not using validated tools like the Morse Fall Scale or failing to conduct individualized assessments may miss critical risk factors.
2. Communication Failures: Poor hand-off communication, such as not sharing a patient’s fall risk, can lead to preventable incidents.
3. Non-Adherence to Protocols: Ignoring safety practices, like not using assistive devices, may be viewed as a failure to meet care standards.
4. Staffing and Training Issues: Inadequate staff training or staffing levels can contribute to falls, with Joint Commission HR standards emphasizing documented orientation.
5. Environmental Deficiencies: Hazards like slippery floors or poor lighting may lead to falls, raising questions about facility maintenance.
6. Lack of Leadership: Insufficient organizational commitment to fall prevention can result in systemic issues.

The South Carolina Department of Health and Environmental Control (DHEC) estimates that one-third of adults over 65 fall each year, resulting in 7,000 hospitalizations and 25,000 emergency room visits statewide. These statistics underscore the local relevance of these contributing factors.

Charleston-Specific Considerations

Charleston’s healthcare landscape, with leading facilities like MUSC, adds unique context to hospital fall risks.

• Aging Population: Charleston’s growing senior population increases fall risks, particularly for patients with conditions like osteoporosis or dementia.
• Medical Tourism: As a healthcare destination, Charleston hospitals treat diverse patients, requiring robust fall prevention to accommodate varying risk profiles.
• Regulatory Oversight: The SCDPH oversees hospital licensing in Charleston and in South Carolina., enforcing standards under Regulation 61-16. 
• Certificate of Need (CON) Laws: South Carolina’s CON laws, overseen by SCDPH, regulate hospital expansions, which can impact facility design and safety features like non-slip flooring or grab bars.

Liability Considerations in Hospital Fall Cases

Patients injured in hospital falls may explore various legal avenues, though this article does not provide legal advice. Common considerations include:

• Medical Malpractice: Allegations that the hospital or staff failed to meet the standard of care, potentially leading to compensation for medical costs or pain and suffering.
• Premises Liability: Claims that unsafe conditions, like slippery floors, caused the fall.
• Regulatory Actions: Falls reported to SCDPH may lead to investigations or penalties, especially if hospitals violate licensing standards.

Hospitals may defend claims by demonstrating compliance with Joint Commission standards, arguing falls were unforeseeable, or citing patient actions. South Carolina’s modified comparative negligence rule reduces compensation if the patient is partially at fault, but only if their fault is 50% or less.

Fall Prevention Strategies

Hospitals can reduce fall risks by adopting strategies outlined in The Joint Commission’s Sentinel Event Alert Issue 55: Preventing falls and fall related injuries in health care facilities

1. Awareness Campaigns: Educate staff on fall risks, ensuring compliance with HR.01.04.01 documentation requirements.
2. Interdisciplinary Teams: Include diverse stakeholders to address fall risks comprehensively.
3. Standardized Assessments: Use tools like the Hendrich II Fall Risk Model and conduct individualized risk evaluations.
4. Tailored Interventions: Implement patient-specific measures, such as bed alarms or patient education.
5. Post-Fall Analysis: Conduct huddles to analyze falls and reassess patients to prevent recurrence.

These measures enhance patient safety and align with regulatory expectations.

Key Takeaways for Patients and Families

Patients and families may benefit from understanding hospital fall risks:

• Inquire About Protocols: Ask about the hospital’s fall prevention measures.
• Report Concerns: Notify staff about hazards or changes in condition, such as dizziness.
• Document Incidents: Record details of any fall, including staff responses, for future reference.

Conclusion

Hospital falls remain a critical patient safety and legal issue, with implications for healthcare providers and patients. Regulatory standards, such as those from The Joint Commission, set expectations for fall prevention, while negligence principles and case law shape liability outcomes. By understanding contributing factors, regulations, and prevention strategies, stakeholders can better navigate the complexities of hospital fall risks. 

Gain clarity on your situation with a free consultation from Kahn Law Firm, LLP. Our Charleston personal injury attorneys, with over 100 years of combined experience, are dedicated to helping you understand your options. Contact us today at (843) 920-5690 to schedule your no-obligation case review and take the first step toward addressing your concerns.