Neglect of Health Care Fall From Improper Transfer
Neglect of Health Care Fall From Improper Transfer

St John Lutheran Home Albert Lea Complaint Findings for Neglect – Falls

In a report concluded on May 13, 2014, the Minnesota Department of Health cites St John Lutheran Home Albert Lea for neglect of health care – falls.

It is alleged that neglect occurred when a resident had a fall with injuries when the alleged perpetrator (AP) transferred the resident in a manner not in accordance with the care plan.

Substantiated Complaint Against St John Lutheran Home Improper Transfer

A preponderance of evidence revealed that the resident was neglected when the AP transferred the resident without the use of a transfer belt as required in the resident’s care plan.  The resident fell during the transfer and sustained a hip fracture.

Interview and document review revealed the resident was recently admitted to the facility with diagnoses that included a history of falls, and a fractured radius, ulna and pelvis.  The resident was assessed as being alert and oriented, had a history of falls, required physical support to stand, had experienced a recent fracture, and was at high risk for falls.  The resident’s temporary care plan required the extensive assist of 2 staff and the use of a transfer (gait) belt for all transfers.  The resident was being assisted by the AP to transfer to a wheelchair at 6:20 a.m. on 4/12/2014.  The AP was not using a transfer belt as required in the resident’s care plan.  The resident lost his/her balance, stepped on his/her own shoes and fell hard to the ground, falling towards the head of the bed and away from the wheelchair.  The resident was unable to move, crying out in pain and was sent to the emergency room immediately.

Hospital records dated 4/12/2014 were reviewed and revealed R-1 was admitted to the hospital and diagnosed with a left hip fracture.  R-1 underwent surgery at the hospital to repair the fracture.

For more information from the Minnesota Department of Health, Office of Health Facility Complaints concerning nursing homes, assisted living and other elder care providers view resolved complaints at the MDH website.

If you have concerns about fall injuries or any other form of elder abuse or neglect contact Elder Abuse and Neglect Attorney Kenneth LaBore at 612-743-9048 or toll free at 1-888-452-6589 or by email at


St John Lutheran Home Albert Lea Complaint
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