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Transportation Safety

Transportation Safety

Transportation Safety

Author – Cyndi Siders, RN, MSN, CPHRM, DFASHRM, CPPS, Executive Consultant

“Contracted Transportation”

Mr. George Adams has lived in his senior living community for the past two years. George has multiple sclerosis and spends a good portion of each day in his wheelchair.

George is an enthusiastic participant in social events and facility sponsored activities. One of his favorite activities is attending worship services on Sunday mornings. George has attended the same church for the past 40 years.

The senior living facility has contracted with a third-party transportation service to provide resident transportation to local events and activities. On Sunday, January 10th, 2016, a new driver is providing the transportation services and has trouble properly securing George’s chair. After several attempts, he assures George that his chair is properly secured.

The road is slippery with freshly fallen snow. The driver is not able to maintain control while attempting to stop and slides through an intersection. In an effort to avoid a collision the driver makes a sharp turn and aggressively applies the brakes. George’s chair tips over and he sustains significant injuries to his leg, arm and shoulder.

George’s injuries require several weeks of medical care and his overall health and mobility deteriorates with his injuries. George’s family hires an attorney alleging negligent transportation resulting in significant injury, pain, and suffering.1

The News

A robust transportation safety plan with accompanying policies and procedures is an essential element of an effective risk management program. Below are three recently reported cases with licensure, regulatory, and legal implications.

McKnight’s, December 13, 2016;
Nursing home settles negligence suit after blind resident hit by van

“The suit claimed negligence on the facility’s behalf after a resident, who is legally blind, was hit by a facility van while waiting for a ride in 2014. The resident has experienced pain and numbness in his arm since the incident, according to the suit. . . .The suit also claimed that the facility was understaffed, causing the resident to be alone when he was hit by the van, and also that the van was operated ‘negligently’ by the employee.”2

Nursing Home Abuse Advocate (NHAA), May 28, 2015
Carrollton, TX – Nursing Home Driver Failed to Properly Secure Wheelchair in Van; Resident Sustained Spinal Injury Causing Paralysis

“[F]acility failed to ensure resident received assistance devices to prevent accidents, level of harm – Immediate Jeopardy.”3

“Driver B failed to properly secure Resident #1’s wheelchair in the van before transporting the resident to dialysis on 2/19/14. While being transported the straps securing Resident #1’s wheelchair in place came loose and Resident #1 fell backwards in his wheelchair against the rear door of the facility van. Driver B removed Resident #1 from the wheelchair and laid him on the floor of the van, and then transported the resident to the local hospital emergency room. Resident #1 sustained a spinal injury causing paralysis to his legs. . . .The facility failed to properly train facility staff on how to secure residents’ wheelchair in the van before transporting residents.”3

Levin & Perconti, June 22, 2015
Resident in Nursing Home Van Crash Sues

“Last November, a nursing home van carrying a female resident of the Atrium Healthcare and Rehabilitation Center of Cahokia in St. Clair County crashed while enroute from the nursing home to a dialysis treatment center. The resident already suffered from diabetes, kidney failure, and had her right leg amputated. The van was involved in a collision, and the woman, who was riding in a wheelchair, suffered injuries and subsequently had to have her [left] leg amputated.

This past April, she filed a civil lawsuit against the nursing home as well as another health services company, among others, claiming that during the crash she was thrown from her wheelchair and fractured her left leg. According to local reports, the lawsuit states that she had to have the left leg amputated as a result of her injuries from the crash. She has sued the nursing home as the employer of the van’s driver, who is accused of speeding and not operating the van safely, as well as not properly securing the victim. The report also indicates that the fracture was initially wrongly diagnosed and not properly treated, which is what led to the eventual amputation.”4

Risk Management Considerations:

• Develop a comprehensive vehicle and driver safety policy that includes, but is not limited to: vehicle management – selection, inspection and maintenance; driver screening; driver skills validation and training; driver monitoring; use of personal vehicles; passenger training; wheelchair safety; vehicular accident reporting and investigation; and vehicle repairs.

Sample Policies:

o Vehicle and Driver Safety Management
HCIS Resources for Risk site – Facility Programs, Transportation,
https://resourcesforrisk.com/hcis.

o Sample Fleet Safety Program for Senior Living Communities
GuideOne Insurance,
http://www.goriskresources.com/NursingFacilities/Resources/transp.htm

Vehicle Checklist:

o Vehicle Self-Inspection
GuideOne Insurance,
http://www.goriskresources.com/NursingFacilities/Resources/transp.htm

• Develop a formal training program and checklist for securing wheelchairs.

Sample Checklist:

o Wheelchair Transportation Safety Checklist
GuideOne Insurance
http://www.goriskresources.com/Docs/Shared/ts_wheelchair_checklist.pdf

• Develop third-party transportation contracts that include specific requirements for vehicle, resident,
and driver safety; legal review by your attorney is recommended. Ensure the third- party contractor maintains adequate insurance coverage for the services provided.

• Develop a formal process for reporting the details of vehicular accidents including, but not limited to: pertinent details about the other vehicles and drivers, police notification (as appropriate), any injuries,action taken for injured parties, a description of the accident, and vehicle damage.

Sample Form:

o Vehicular Accident Report Form
HCIS Resources for Risk site – Facility Programs, Transportation,
https://resourcesforrisk.com/hcis

• Review the program requirements for Medicaid non-emergency medical transportation (NEMT)
compliance. Resources can be found at https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/nemt.html
including a booklet for providers at:
https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/nemt-booklet.pdf

• Develop a policy and acknowledgement form for the use of non-facility provided transportation. The
policy should specify language such as, “The Facility is not responsible for the quality of service, safety, personnel training, and education and background-check process of non-Facility-approved transportation services.”5

Sample Policy

o Non-medical Transportation Services Language for Transportation Services Policy
– Use of Non-Facility Provided Transportation services
HCIS Resources for Risk site – Facility Programs, Transportation
https://resourcesforrisk.com/hcis

Sample Form

o Non-medical Transportation Services Form.
HCIS Resources for Risk site – Facility Programs, Transportation
https://resourcesforrisk.com/hcis

• Review the use of personal vehicles for business operations and resident transportation. “It is
important to recognize that your organization can be held liable for damages by allowing the use
of non-owned personal vehicles for business purposes.”6

Sample Check-List

o Safeguarding the Use of Non-Owned Personal Vehicles
GuideOne Insurance
http://www.goriskresources.com/Docs/Shared/ts_auto_nonowned.pdf

• Establish a formal process for driver screening and selection including, but not limited to:

o Previous Experience and Employment History
o Past Driving Record – “Motor Vehicle Reports (MVR), subject to applicable privacy laws in a given jurisdiction, will be obtained for all drivers. If a driver is hired, MVR’s will be reviewed on an [annual] basis.”7
o Drug and Alcohol Testing “Upon hire, drivers will be required to pass alcohol and substance abuse testing, conducted by a certified laboratory. Drivers are subject to random testing throughout the year.”8

Sample Forms

o Request for Criminal/Motor Vehicle Records Check
o Transportation Worker Application
GuideOne Insurance
http://www.goriskresources.com/NursingFacilities/Resources/transp.htm

References:
1. Adapted from: O,Neill, Joe. Nursing Home Fails to Ensure Resident Safety During Transportation. [October 5, 2015]. https://www.theexpertinstitute.com/case-studies/nursing-home-fails-to-ensure-resident-safety-during-transportation/
2. Mongan, Emily. Nursing home settles negligence suit after blind resident hit by van. [December 13, 2016]. http://www.mcknights.com/news/nursing-home-settles-negligence-suit-after-blind-resident-hit-by-van/article/578694/.
3. Nursing Home Abuse Advocate (NHAA), May 28, 2015. CARROLLTON, TX – Nursing Home Driver Failed to Properly Secure Wheelchair in Van; Resident Sustained Spinal Injury Causing Paralysis.
4. Levin & Perconti. Resident in Nursing Home Van Crash Sues. June 22, 2015. https://blog.levinperconti.com/2015/06/resident_in_nursing_home_van_c.html.
5. Pendulum. Non-medical Transportation Services Language for Transportation Services Policy – Use of Non-Facility Provided Transportation services. https://resourcesforrisk.com/hcis
6. GuideOne Insurance. Safeguarding the Use of Non-Owned Personal Vehicles. http://www.goriskresources.com/Docs/Shared/ts_auto_nonowned.pdf
7. Ibid.
8. Ibid.

This blog, which does not reflect any official policy or opinion for Vaaler Insurance, Inc. or Siders Healthcare Consulting, LLC, is provided for informational purposes only. It is not intended to provide legal or medical advice, nor is it intended to be an exhaustive list of all risks that need to be addressed for a healthcare organization. While every effort is made to provide accurate information, changes may occur and inaccuracies happen despite best efforts. This information is not a substitute for individual consultations with professionals in these areas and should not be relied on as such. Please work with your legal counsel and business advisor(s) for a plan that is specific to your organization. © 2017 Vaaler Insurance, Inc.

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