Patient Safety

Don't slip up with patient safety

A recent review of liability claims at Guild Insurance Limited has evidenced an interesting trend. While most physiotherapists look to treatment related areas as having the most potential to result in a claim, that is not currently the case. 

There has been an alarming increase in the number of claims against physiotherapists that arise from injuries sustained while entering or leaving the practice, or as a result of equipment failures or the inadequate maintenance of equipment. 

Legal liability can attach to the owners and/or occupiers of premises on which a person is injured. Essentially the occupation of premises gives rise to a duty of care owed to entrants to the premises and requires that reasonable steps are taken to ensure their safety. At law a person will be deemed to be an occupier if he or she exercises 'control' over the premises. The test is usually whether that person has the right to admit or exclude visitors. 

The occupier of premises must therefore eliminate dangers which could reasonably be foreseen to create a risk of injury to a person entering the premises. This duty extends to exercising reasonable control over the activities of patients that may endanger others on the premises. A similar 'reasonable person' test applies in relation to equipment located on the premises.

Learning from others mistakes

Guild Insurance has recently been notified of the following cases which can be useful when reviewing your practice for risks and in gaining an understanding of how the law works in this particular area: 

• A patient fell over a box of magazines in an aisle at a physiotherapist practice. It was alleged the box was difficult to see due to poor lighting. 
• A patient slipped and fell on wet tiles at the entrance of a physiotherapy practice. There were no warning signs and friction tests confirmed the tiles were inherently slippery when wet. 
• A patient was burnt with electrodes while receiving treatment for lumbar spine pain. The equipment had been malfunctioning for some time, a fact that had been known to employees of the practice  and yet no steps had been taken to alert the principal of the practice of this issue.
• A patient slipped and injured herself while getting off a treatment bed. The bed had castors and was positioned on a tiled floor. It hence had a propensity to move and was unstable.
• A patient suffered a back injury when a chair collapsed from under him.  The chair was unstable due to a missing bolt and the practice did not have any system of checking equipment.
• A patient suffered burns to his calf while undergoing interferential therapy. The machine did not spontaneously switch off after five minutes and had been malfunctioning for some time. 
• A patient tripped in a pothole located in the car park at the insured's practice and suffered a fractured leg and hip. The physiotherapist had been aware of the pothole for some time but had not taken steps to address the danger.
• A patient tripped on a weight belt left on the floor of the floor. The belt had been on the floor for some time and the practice did not have any system in place for cleaning the premises or putting equipment away.

Reducing your risk

The following is a list (albeit not exhaustive) of steps which can be taken by physiotherapists to reduce the risk of a claim: 

• Ensure there is adequate lighting within the premises including adequate lighting at all entrance/exit points. 
• Consider whether the flooring is in good condition or requires replacement—many accidents occur when people trip on old worn sections of carpet. 
• Avoid allowing equipment and other items to accumulate or be stored in corridors or access ways. 
• Warn customers (via the use of a sign) if the floor is slippery when wet and consider whether non slip treads should be installed. 
• Warn patients (via the use of a sign) if there is a change in height in the flooring within the premises. 
• Ensure that all equipment is regularly checked and maintained and if necessary replaced. 
• Ensure you have a system of cleaning in place which is adhered to. Ensure your staff are trained accordingly. 

Courts impose a high standard of care on occupiers of premises and a failure to act reasonably can result in a significant damages being awarded against the occupier. 

If you would like further information on reducing risks specific to your practice please contact Guild Insurance on 1800 810 213. This article was written by Paul Baker, Solicitor Director of Meridian Lawyers, on behalf of Guild Insurance, the referred professional indemnity insurer of the APA