A Fort Scott, Kansas man who suffered severe injuries from a fall while being treated at Mercy Joplin in December 2024 is suing the hospital and his doctor.
According to the petition, which was filed Tuesday in Newton County Circuit Court, Clarence R. Nalley suffered a fractured hip, had to undergo multiple surgeries and was forced to delay a critical cardiac operation.
Nalley claims Mercy and Dr. Saurav Raj Bahal did not have him under the proper anti-fall precautions.
From the petition:
On or about December 29, 2024, Plaintiff Clarence R. Nalley left work at Walmart in Pittsburg, Kansas after experiencing diffuse abdominal pain, nausea, chills, and sweats. He returned home and recalled going into the bedroom to lay down and then being awakened on the floor. His wife, Plaintiff Kathleen M. Nalley, found him face down on the floor.Plaintiff Clarence R. Nalley was taken to the Emergency Department at Via Christi Hospital in Pittsburg, Kansas where it was documented that Plaintiff had a history of coronary artery disease, aortic aneurysm, hypertension, and diabetes complicated by polyneuropathy.
Further evaluation led to findings consistent with a non-ST elevation myocardial infarction.
As of December 30, Mr. Nalley was on the high risk fall protocol at Via Christi Hospital in Pittsburg, Kansas, in which safety interventions were put into place, including but not limited to, a gait belt, yellow on-slip socks, door signs, fall bracelet, signage for fall prevention measures, bed in low position, appropriate bed rails up, bed/chair exit alarms activated where available, patient supervision when in restroom or on bedside commode, patient and family education, patient door to remain open, bed/movable equipment locked at all times, and personal items, including call light, within reach.
Via Christi Hospital also identified Mr. Nalley as being at high risk of injury, high risk of activity intolerance, and having a knowledge deficit.
Mr. Nalley underwent a cardiac catheterization on December 30.
On December 30, 2024, Transfer was initiated to Mercy Hospital Joplin for consideration of coronary artery bypass graft surgery (CABG).
Upon admission, a nurse applied the Hester Davis Fall Risk Assessment and found that Mr. Nalley was at high risk for fall in the hospital.
On the morning of December 31, Cardiothoracic Surgery, Physical Therapy, and Occupational Therapy had consults with the Plaintiff.
Under applicable hospital standards and internal policies, Defendant Mercy Hospital was mandated to utilize a systematic, clinical process to evaluate, periodically reassess, and execute an individualized fall-prevention plan for at-risk patients.
All three nationally recognized fall-risk assessment tools (Morse, JHFRAT, and H2FRA) would have objectively stratified Mr. Nalley as being at an increased risk of falling based on his underlying clinical presentation.
Defendant Mercy Hospital’s own mandatory fall-risk assessment tool of choice, the Hester Davis Scale, explicitly scored and documented Mr. Nalley as being at high risk of falling.
At the time of these events, Mr. Nalley was receiving a continuous intravenous infusion of Heparin, a high-alert anticoagulant medication that drastically increased the potential physiological consequences and severity of an in-hospital fall injury.
On the morning of December 31, Michele Carey, DNP, APRN-C, explicitly documented that following the patient's fall two days prior, he presented with severe neurological and behavioral red flags, specifically an unwitnessed loss of consciousness, bowel/bladder incontinence, and acute, uncharacteristic altered mental status, thereby establishing the provider's direct knowledge of these critical symptoms.
Case management further documented a recent history of falling in their clinical note on the morning of December 31.
An Occupational Therapy (OT) evaluation on the morning of December 31 states that Mr. Nalley was admitted with nausea, vomiting, and altered mental status, documenting that he exhibited visible physical difficulty completing sit-to-stand transfers without using both arms to push himself up.
Physical therapy (PT) also evaluated Mr. Nalley that day and documented an extensive list of concurrent diagnoses, including daytime sleepiness, chronic fatigue, neuropathy, urinary incontinence, lumbar stenosis, and rheumatoid arthritis, each of which independently and collectively increased Mr. Nalley’s risk of falling.
During their assessment, PT found Mr. Nalley to be functioning independently, exhibiting good safety awareness, and not to be in need of skilled PT services.
Despite his high-risk Hester Davis score, multiple comorbid diagnoses, documented neurological red flags, and continuous Heparin infusion, Mr. Nalley’s protective safety protocols were stripped, and his activity status was abruptly changed to an unmonitored “up ad lib” activity level following that single physical therapy assessment.
The only documented safety interventions implemented by Defendant Mercy Hospital at the time were baseline, universal measures, specifically a call light within reach and yellow non-slip socks, which were entirely insufficient to mitigate the patient's severe, compounded physical and biochemical risks.
On December 31 at 4:18 p.m., Defendant Saurav Baral charted that Mr. Nalley was doing well and free of chest pain.
At the time of the assessment, the patient presented with tachycardia and borderline hypotension, along with a documented history of diabetes managed with the medication Mempagliflozin.
Labs performed that morning and included in the Hospitalist progress note revealed a critically low bicarbonate level of 12 and an elevated anion gap of 23, consistent with an elevated anion gap metabolic acidosis.
This degree of metabolic acidosis with elevated anion gap was a severe, objectively abnormal finding that should have prompted an immediate clinical consideration of potentially life-threatening underlying conditions, including lactic acidosis, potentially related to hypoperfusion, dehydration, and/or infection/sepsis, as well as empagliflozin-associated euglycemic diabetic ketoacidosis.
Regardless of the definitive underlying cause, this degree of metabolic acidosis with high anion gap warranted immediate recognition, diagnostic evaluation, and medical treatment to secure the patient's acute safety and stability.
Defendant Dr. Baral failed to recognize, mention, or document this critical diagnosis of metabolic acidosis with high anion gap in his progress note, and failed to appropriately evaluate its underlying causes or implement any medical plan to address it.
As the attending Hospitalist on December 31, Defendant Baral's documented duties required him to perform medically appropriate examinations, independently interpret diagnostic results, coordinate clinical care, and ensure patient safety.
At approximately 6:45 PM on December 31, a nurse and two hospital technicians heard a loud bang and found the Plaintiff lying unmonitored on the floor in front of his bed.
Following his unmonitored fall, the Plaintiff complained of acute right hip pain, and x-rays confirmed a right-sided, displaced, closed, femoral neck fracture requiring surgical intervention.
Soon after Mr. Nalley fell, the Plaintiff’s respiratory status severely deteriorated, prompting an emergency transfer to the Intensive Care Unit (ICU) where he was diagnosed with RSV pneumonia.
Once Mr. Nalley experienced improvement in his oxygen needs, he was cleared for surgery and underwent a right total hip arthroplasty on January 3, 2025.
Following his January 7 discharge for rehabilitation, Mr. Nalley spent approximately six days in a swing bed facility before returning home.
Following subsequent staple removal on January 31, Mr. Nalley developed a severe right hip prosthetic joint infection. Operative cultures from a February 4 THA revision surgery confirmed infections of Candida albicans and Staphylococcus intermedius, necessitating an aggressive, multi-month regimen of oral antibiotics and IV anti-fungals guided by Infectious Disease specialists.
Consequently, these severe medical complications forced the postponement of Mr. Nalley’s necessary cardiac bypass surgery until August 6, 2025.
As a direct and proximate result of the defendant’s negligence, the Plaintiff suffered personal injuries including but not limited to a fractured right hip, a secondary joint infection, and RSV, requiring multiple surgeries and delaying a critical cardiac operation. As a further result, the Plaintiff has experienced severe depression from social isolation, substantial lost wages, and a permanent, painful right hip limp.
Nalley, who is represented by Ashley E. Billam and Christian Spigarell of the Kansas City firm of Dickerson Oxton, LLC, is suing Mercy and Bahal for negligence and for lack of consortium and is asking for "fair and reasonable damages."
