Case Study: How a Nursing Expert Witness Reviewed a Preventable Fracture

When improper repositioning causes serious harm in frail patients

A 100-year-old woman with osteoporosis, was admitted to hospital with complex needs following infection, cognitive decline, and a recent fall.

During an attempted repositioning by two healthcare assistants, she sustained a fracture of her right humerus. The staff allegedly used an under-arm lift technique and failed to use a sliding sheet.

An Apex nursing expert witness was instructed to evaluate whether this constituted a breach of duty. The expert concluded that the injury was avoidable and preventable, and that standard handling protocols were not followed.

Where the moving and handling protocols failed

The Trust’s own Root Cause Analysis revealed that:

• HCAs had no documented orientation to the ward

• A sliding sheet was available but not used

• HCAs used an under-arm grip method, contrary to Trust policy

• The patient immediately reported hearing a “crack” in her shoulder at the time of movement

  
  

“This was an elderly, osteoporotic patient. Staff had a clear duty to use safe handling techniques. The failure to use the sliding sheet represents a breach of the nursing standard expected.”— Apex Nursing Expert Witness

Why a Nursing Expert Witness Emphasises Induction and Equipment Access

The report confirmed that the healthcare assistants were agency staff who had not been formally shown where manual handling equipment was stored. This created systemic risk particularly for vulnerable patients requiring high-dependency support.

A qualified nursing expert witness would expect the following minimum standards:

1. Orientation of all new/agency HCAs to the ward and equipment

2. Use of sliding sheets or hoists for any non-weight-bearing patient

3. Documented competency training in patient repositioning

4. Full incident reporting if injury occurs during care

5. Escalation to medical and safeguarding teams post-injury

The failure to meet these standards contributed directly to injury, pain, immobility, and ultimately a deterioration in condition.

Long-term impact and litigation insight

The patient went on to suffer extreme pain requiring opioids, developed spinal and hip pain, and later passed away. Although causation was complex due to her frailty, the fracture sustained during repositioning was cited in her death certificate as a contributory factor.

This case shows why manual handling injuries can escalate from minor breach to major consequence, particularly where:

• Staff are undertrained or poorly supervised

• Handling policies are not enforced

• Post-event escalation is delayed or absent

Such cases are increasingly litigated and expert witness input is often key in determining whether duty was breached.