The patient was a 68-year old chronically ill female with a

The patient was a 68-year old chronically ill female with a history of diabetes severe ankylosing spondylitis neuropathy myopathy chronic obstructive pulmonary disease obesity and falls. The physical therapist and the defendant physical therapist assistant (PTA) were employed by a home health agency and were providing home based physical therapy care to the patient following a recent hospitalization.The physical therapist evaluated the patient and her residence and initiated the prescribed home based physical therapy treatment which included all slide exercises. The defendant physical therapist assistant found the walls to be uneven and changed the wall slide exercise location to the hallway bathroom door.On one occasion the patients daughter requested that wall slides against the door be removed from her mothers therapy regimen because of her physical instability.Despite that request on the day of the incident the patient completed three successful slides using the bathroom door.During the fourth slide the door suddenly opened thrusting the patient to the tiled bathroom floor.The defendant PTA cautioned the patient to remain still and called 911 for assistance. The defendant PTA also notified her employer and the patients physician of the patients fall. Prior to EMS arrival and despite the physical therapist assistants caution the patient repositioned herself to a sitting position.The patient stated she had no pain or discomfort from the fall and was assisted to a standing position by EMS staff. She ambulated with assistance approximately ten feet sat in her chair stated she was fine and refused multiple recommendations for transport to the hospital for further evaluation.Because of the patients refusal to be transported and because she was home alone the insured attempted (unsuccessfully) to contact family members to come and stay with her. When the defendant PTA left the patients home the patient appeared to be in stable condition; had no complaints and stated she would be fine alone. Thephysical therapist assistant does not know when the husband or any other family member returned but she later learned that the family was upset that she had left the patient alone.Later that day the patient was transported to the hospital by her family with complaints of pain and the inability to move her lower extremities. She was admitted to the intensive care unit for five weeks where she continued to suffer pain and post injury paraplegia secondary to fracture of the third thoracic vertebrae with an extensive spinal hematoma. When it was determined that her condition would not improve and no longer required acute hospital care she was discharged home with 24-hour home care assistance. Her condition continued to deteriorate and she died two days after arriving home.The family expressed anger because the physical therapist assistant left the patient alone after her fall and ignored the daughters prior request to cease the wall slide exercises. The family requested that the home health agency take punitive action against the defendant PTA. The PTAs employer carried out an investigation of the incident and performed direct supervision to assess the quality of her work. Her techniques and practices were evaluated as being excellent and she was not terminated. Any actions by the employer to investigate the physical therapist are unknown.The patients husband sued the home health agency the physical therapist and the PTA for damages resulting in his wifes pain and suffering paraplegia and death and for his own loss when she died.1)What resolution should the agency undertake (monetary reimbursement settlements)2)Provide risk management recommendations and plan that would prevent future instances and occurrences like this

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