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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Have you Ever Harmed a Patient?

Published October 25, 2010 11:45 AM by Jon Bassett
I read a post today that astounded me. As the father of a child who was born with an orthopedic issue -- developmental dysplasia of the hips, or DDH -- I still monitor a popular list serve devoted to the condition. Although DDH is usually correctible and my daughter is now fine, I like to keep up with the subject, listen to what other parents are dealing with, and offer advice and resources when I can.

(For those interested, I charted our family's journey in a 2005 cover story here.)

This post came across the list serve a few days ago:

Ashlyn broke her femur today at physical therapy. Ashlyn was trying to get away, the physical therapist yanked her back as Ashlyn twisted. Then Ashlyn started screaming like never before. We took her to the ER where they took X-rays and diagnosed her with a broken left femur. Her left leg is her leg that was operated on in February.

Luckily, the break is minor (well as minor as a femur break can be) so she doesn't need surgery or a spica. Although it is a possibility if it doesn't heal properly. She has a cast from the top of her left thigh down to her toes. It will remain on for 4 to 6 weeks. I have to call her ortho in the morning to make an appointment to follow up with him.

I'm beside myself and need help with ideas for what to dress her in. Do you think baggy pants will work? The cast is just on one leg.

Also I'm concerned about all the X-rays. She's already had a lot and tonight they took 9. They wanted to check her entire leg in various positions to be on the safe side. I know the X-rays are needed, but its worrying me.

So many questions came to my mind after reading this. Obviously it's an exceptionally rare occurrence. I've been covering the PT and rehab fields for over 10 years and have never heard of an instance even close to this.

But it raised the question in my mind -- Have you (or a colleague) ever caused serious harm to a client? Have you heard second-hand of any similar stories? What was the result?

What's the best way to proceed if something like this happens in a session? Is it taught in PT school what steps to follow if you're involved in a situation like this?

It also brings up a point about patient communication. Does it ever pose a risk if a patient can't verbalize whether something is hurting them, or if they're being pushed too far? Does this complicate the treatment of older patients, very young children, those with cognitive difficulty, people with sensory problems who might act aggressively or impulsively, clients who don't speak English, or patients with developmental disabilities that hamper their ability to communicate? How do you compensate?

And finally, for the PTs out there who also happen to be parents, what would you have done if this happened to your child? I'm looking forward to your thoughts.

posted by Jon Bassett


I thought I had.  I was doing home health, treating a patient with a total knee replacement.  Her range was very limited.  I was working with her on mobilization, when I heard a tremendous "POP."  It sounded like something broke.  We looked at each other with wide eyes.  She said it hurt for an instant, but then no pain.  When the shock wore off, we looked at her leg and it was past 90 degrees.  I called the doctor and explained the situation.  In retrospect I can hear him smiling on the phone.  We had broken an adhesion.  Turned out to be a good thing.  But that sound echoing in my memory, combined with the fright of potentially harming my patient, made me timid when doing joint mobilization for a while!  

Janey Goude October 26, 2010 10:25 PM

What a story Andrew, thanks.  Speaking candidly about these occurrences is a great learning experience.

Jon Bassett October 26, 2010 11:48 AM

While I have never been involved with a patient injury while in therapy, I was involved in a situation where a family member had a fall at the clinic I was working at which resulted in a humerus fracture.  The gentleman was trailing behing the treating therapist and his wife and came around a corner and slipped/tripped on a piece of equipment that was on the floor.  Despite the fact that the hospital paid all of his medical bills, (and billed nothing to Medicare), provided his wife with transportation to and from the hospital to visit and complete her therapy, the patient (at the urging of his adult children) still filed a lawsuit.  Any of us who were present in the clinic that day were called for deposition, which was not a fun experience.  In the end, the hospital settled with the patient (I do not know the amount).  The moral of the story is to make sure your clinics and gym areas are safe for both patients and family members.  In this case, the patient's husband was walking unescorted through our work hardening area, and fell on a piece of equipment that was not put away after a previous patient was done using it.  Obviously, policies were changed and the layout of the clinic and "public" walkways were modified following this incident.  It was an unfortunate incident.  Both the patient and her husband who was injured were well known to us.

Andrew, PT October 26, 2010 10:55 AM
Edgerton WI

Thanks Jason for sharing your story.  Was there any type of incident review process by the hospital or clinic (in the case of the patient falls)?  Does anyone else have a similar experience?

Jon Bassett October 26, 2010 10:30 AM

Jon, so much comes to mind.  I 've had patients fall during gait training, no serious injuries though.  But several others come to mind. My second job, acute care.  The aide and I were in the process of a transfer.  The large lady stood up and before we knew it she collapsed between us.  One hip broke.  The MD wrote in the notes "Secondary to osteoporosis patients hip broke then she fell to the floor."  Whew!

Another job, first week there.  I stand a lady in the parallel bars. She immediately collaspes right in front of me, yelling, "I told you I couldn't do this."   The patient was taken to the ER and the owner of the clinic didn't speak to me for awhile.  Not sure of the results.

The last one I will share was in a school.  I was covering for one of the best PT's I have ever learned from in that area.  The teacher and I were opening the gate that was used to keep the children in the class.  They would crowd around the door whenever someone new would show up.  When the gate was opened I saw a blur scurry past the teacher and me and turned sharply around a corner to the left then we hear a BAM and a cry.  The poor child ran smack into a wall.  Unfortunately it was the patient I was there to see.  About a two inch gash on the forehead, lots of stitches, etc.  Mom was irate yelling at everyone.  I spoke to Dad and he was okay.  He said accidents happen and for the next half hour we compared childhood scars.  

Jason Marketti October 25, 2010 11:14 PM

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