Nursing home fall expert witness

Falls are the most commonly litigated event in long-term care, and they are also the easiest for a facility to defend badly. A resident who falls is not evidence of negligence by itself. The question an expert answers is narrower: did the facility identify this resident's fall risk, build a care plan that matched the risk, deliver the interventions it wrote down, and respond correctly when the fall happened?

Most fall cases turn on documentation gaps rather than on the fall itself. An unwitnessed fall with no neurological checks, a care plan that was never updated after the second fall, an alarm charted as in place on a shift when the resident's bed had none, a CNA assignment sheet showing one aide covering two halls. Those are the findings that move a case, and they only surface when someone who has run a facility reads the chart against the staffing records.

Federal surveyors evaluate these facts under F689, which requires the facility to keep the resident environment as free of accident hazards as is possible and to provide each resident with adequate supervision and assistance devices to prevent accidents. An expert applies the same framework a surveyor would, then explains it in terms a jury can follow.

Records to request

Fall risk assessments on admission, quarterly, and after each fall
MDS Section J (falls) and Section G or GG (functional status)
Comprehensive care plan and every revision, with dates
Incident and accident reports, including the facility's internal investigation
Post-fall neurological check flow sheets, especially for unwitnessed falls
Nurse notes and CNA ADL flow sheets for 72 hours before and after
Physician and family notification entries and times
Orders for alarms, floor mats, low beds, bolsters, or assistive devices
Therapy evaluations and restorative nursing notes
Daily staffing assignment sheets and Payroll-Based Journal data for the shift
Facility fall prevention policy in effect on the date of the fall
CMS Form 2567 survey results for the 3 years before the incident

Screen this case Request CVs

Federal requirements experts apply

Tags from the CMS State Operations Manual Appendix PP, with the 42 CFR Part 483 citation. Whether a regulation establishes the standard of care is a question for your venue.

Tag	Requirement	Citation
F689	Free of accident hazards, supervision, devices	42 CFR 483.25(d)
F656	Develop and implement comprehensive care plan	42 CFR 483.21(b)
F657	Care plan timing and revision	42 CFR 483.21(b)(2)
F580	Notify of changes (injury, decline, room, etc.)	42 CFR 483.10(g)(14)
F700	Bedrails	42 CFR 483.25(n)
F725	Sufficient nursing staff	42 CFR 483.35(a)

Appendix PP is revised periodically. Confirm the version in effect on the date of the incident.

What counsel should investigate

Was a fall risk assessment completed on admission and repeated after the first fall?
Did the care plan change after each fall, or does it read the same from admission to injury?
Were the ordered interventions actually charted as delivered on the shift in question?
For an unwitnessed fall, were neuro checks started and continued on schedule?
How long between the fall and the physician call, the family call, and the transfer?
What were the staffing levels on that hall, on that shift, compared with the facility assessment?

Which expert fits

Licensed nursing home administratorSupervision systems, staffing adequacy, policy compliance, and what the facility told surveyors.
Director of Nursing or long-term care RNNursing standard of care: assessment, care planning, post-fall response, and notification.
Physician or geriatricianCausation, whether the fracture or head bleed is consistent with the described mechanism, and medication contribution.
Physical therapistTransfer technique, gait and balance findings, and whether the therapy plan matched the resident's ability.

Panel members who work these cases

Matched from the publicly profiled ECS panel. Availability and conflicts are confirmed on the call.

Larissa J. Lucas

Physician, Registered nurse

Nicole Fulton

Licensed administrator

Natalie McGonagle

Registered nurse

Tammy Starion

Registered nurse, Licensed administrator

For the paralegal handling this

Send the complete chart from admission through the fall plus 30 days, the incident report, and the staffing sheets for that shift. If you only have the hospital records, say so on the screening call. An expert can usually tell within 20 minutes whether the facility chart is worth chasing.

Paralegal resources Records checklist