Preventable Patient Falls Continue to Rise: Legal Implications for Medical Malpractice Practitioners

In 2024, the Joint Commission released its Sentinel Event Data Annual Review, revealing a troubling statistic: traumatic patient falls reached the highest number ever recorded, representing 49% of all sentinel events. For the fifth consecutive year, patient falls topped the list of the most frequently reported sentinel events in healthcare. The trajectory is unmistakable—falls in hospitals, rehabilitation centers, and long-term care facilities are increasing, despite clear evidence that many are preventable.

For medical malpractice practitioners, these data trends underscore both a growing area of litigation and a crucial opportunity to hold healthcare systems accountable for preventable harm.

Falls as Sentinel Events

A “sentinel event,” as defined by the Joint Commission, refers to a patient safety event resulting in death, permanent harm, or severe temporary harm. Patient falls now represent nearly half of all such events, far outpacing wrong-site surgery, retained foreign objects, or medication errors.

These statistics reflect more than numbers—they reveal systemic breakdowns in hospital safety culture. Falls are not inevitable. Rather, they are frequently avoidable injuries linked to staffing shortages, poor adherence to fall-prevention protocols, and inadequate patient monitoring.

The CDC provides further sobering context:

• 1 million hospitalizations per year among older adults result from falls.
• 3 million emergency room visits annually are fall-related.
• 319,000 hip fractures occur each year, with many leading to permanent loss of independence.
• Falls are the leading cause of traumatic brain injury in older adults.
• A single fall doubles the risk of subsequent falls.

These data emphasize that preventable falls are not isolated lapses—they are a systemic public health issue that the law can and should address.

The Preventability Problem

The Joint Commission’s own research through its Center for Transforming Healthcare demonstrates how effective prevention can be. In one initiative, targeted interventions—screening patients for fall risk, educating staff and patients, assisting with toileting, and performing hourly rounding—reduced fall-related injuries by 62%.

Despite this, healthcare facilities often fail to implement these “common-sense” measures. The reasons vary: understaffing, financial constraints, or a culture that deprioritizes patient safety in favor of efficiency. From a legal perspective, however, the failure to adopt proven preventive measures translates directly into breach of the standard of care.

Legal Theories of Liability in Fall Cases

Medical malpractice practitioners should be attuned to several legal theories that frequently arise in patient fall cases:

1. Negligence in Assessment:
   Facilities often fail to properly screen patients for fall risk on admission or at intervals during hospitalization. Plaintiffs can argue that the failure to assess risk is a breach of the duty to provide safe care.
2. Failure to Supervise:
   Many falls occur during unsupervised bathroom trips or transfers. Evidence that staffing ratios were inadequate, or that aides were unavailable, supports claims of negligent supervision.
3. Failure to Follow Policy:
   Hospitals typically have fall-prevention protocols—such as bed alarms, nonslip footwear, or scheduled rounding. Failure to follow their own policies provides compelling evidence of negligence.
4. Res Ipsa Loquitur Arguments:
   In cases where a high-risk patient falls despite documented risks, courts may allow res ipsa loquitur arguments—the event speaks for itself—since such an injury would not occur absent negligence.
5. Corporate Negligence:
   Beyond individual providers, institutions may be liable under theories of corporate negligence for failing to provide adequate staffing, training, or safety equipment.
6. Wrongful Death and Survival Actions:
   Given the high morbidity and mortality associated with hip fractures and traumatic brain injuries from falls, wrongful death claims are increasingly tied to these cases.

Practical Guidance for Plaintiff’s Counsel

For attorneys representing injured patients or their families, fall cases require both medical knowledge and strategic discovery:

• Request Fall-Risk Assessments: Were standardized tools (e.g., Morse Fall Scale, Hendrich II) completed and updated? Missing or incomplete assessments can be powerful evidence.
• Review Staffing Records: Nurse-to-patient ratios, overtime logs, and shift reports often reveal understaffing contributing to unsupervised falls.
• Obtain Surveillance Footage: Many facilities have hallway or room cameras. Video can demonstrate lack of rounding or delayed response times.
• Examine Policy vs. Practice: Secure the facility’s written fall-prevention policies, then compare them to charting notes and incident reports. Discrepancies strengthen the negligence argument.
• Focus on Prior Incidents: Pattern evidence—multiple falls involving the same facility or staff—can support claims of systemic negligence.

Defense Considerations

From the defense perspective, facilities often argue that not all falls are preventable and that even with reasonable precautions, some patients—especially those with dementia, delirium, or sudden weakness—may fall despite appropriate care. Defense counsel frequently emphasize contributory factors such as patient non-compliance, refusal of assistance, or unforeseeable medical complications.

Practitioners should expect dueling experts. Plaintiff experts typically highlight the feasibility of prevention measures, while defense experts argue that the fall was an unfortunate but non-negligent outcome.

Litigation Trends and Settlement Value

Because falls are common, and often devastating, they make up a significant portion of nursing home and hospital malpractice litigation. Verdicts and settlements vary widely, but cases involving hip fractures, traumatic brain injuries, or wrongful death frequently yield substantial awards, especially where negligence is clear and damages are catastrophic.

Notably, the rising volume of fall cases may pressure insurers and healthcare systems to settle more quickly, rather than risk adverse publicity and large jury verdicts.

The Role of Regulatory Data

The Joint Commission’s sentinel event reports, while not admissible in all jurisdictions, provide useful context for demonstrating the foreseeability and preventability of falls. Likewise, CMS (Centers for Medicare & Medicaid Services) publishes data on nursing home deficiencies, many tied to inadequate fall prevention. These can be powerful tools in litigation to show the widespread recognition of the risk.

Conclusion

The sharp rise in preventable patient falls—now accounting for nearly half of all sentinel events—represents both a persistent failure of healthcare systems and a growing area of malpractice exposure. As the Joint Commission and CDC emphasize, many of these injuries are entirely avoidable with proper assessment, supervision, and adherence to safety protocols.

For medical malpractice practitioners, fall cases present a practical and high-impact opportunity to advocate for patient safety. Whether through litigation, settlement, or systemic reform, the legal community plays a critical role in holding healthcare providers accountable—and in ensuring that patients are not subjected to avoidable harm that undermines both their dignity and their lives.