Case Study: How a Hospital Negligence Expert Witness Evaluates Unwitnessed Falls After Seizures

When a patient with known seizures falls, who’s to blame?

In this case, a 28-year-old man with a long history of unpredictable seizures presented to A&E after an episode at home. He was assessed as stable and placed in a cubicle, unattended. Shortly afterward, he suffered another seizure, fell from the trolley, and sustained a facial injury.

An Apex hospital negligence nurse expert witness was instructed to review whether this fall was preventable, and if standard policies on risk assessment and patient safety were breached.

Why unpredictable fitting complicates falls prevention in acute care

Despite several seizures over the previous decade, the patient had no formal epilepsy diagnosis or medication in place at the time of attendance. He had self-discharged from hospitals in the past, refused neurological follow-up, and had a track record of erratic engagement.

On this occasion:

• He was assessed by a GP trainee

• His GCS was 15/15 and observations were normal

• He was deemed fit to wait unaccompanied in the waiting room

• No fall occurred at that stage

• The fall took place only later, in a cubicle where bed rails were not raised

  
  

“Not all patients with a seizure history are at constant risk. Without warning signs, it’s not standard or practical to use cot sides for every ambulant patient with past seizures.”— Apex Hospital Negligence Expert Witness

The expert noted that while a falls risk was identified, no post-falls protocol or detailed mitigation plan was developed but also acknowledged that nothing at the time suggested an imminent repeat seizure.

What a hospital negligence expert witness looks for in cases like this

In evaluating whether a breach of duty occurred, a hospital negligence expert witness considers:

1. Was a seizure pattern or aura reported by the patient?

2. Did the patient appear fully recovered and alert post-seizure?

3. Was there a documented falls risk assessment?

4. Were Trust policies on trolley use and observation followed?

5. Was the decision to leave the patient unattended clinically justified?

In this case, documentation showed no evidence of drowsiness, confusion, or impaired mobility. He was mobile, alert, and independently walked to the cubicle. While hindsight raises questions, the expert concluded that the care appeared reasonable given what was known at the time.

Why risk assessment doesn't always equal prediction

The report makes an important legal distinction: risk identification does not equal risk foreseeability. Epilepsy patients are not constantly monitored in A&E unless there are clinical signs of deterioration or an active seizure warning. Without these, full observation and bed rail use are not routinely applied.

The expert found that while record-keeping and communication could have been better, the actual care decisions fell within a reasonable standard for an acute, unscheduled setting.