The Gait Belt: legal and ethical issues around falls

Marilyn M. Pink Ph.D., PT

While in physical therapy (PT) school, I was taught that patients who did not wear gait belts during gait or balance exercises, a fall resulting in personal injury could be a medical negligence/personal injury claim and is an issue of ethics. And, if the personal injury does result in a lawsuit, the physical therapist loses.

Please note that when using a gait belt there needs to be contact (or very close) supervision. (If not the supervision, then why the gait belt?) The level of supervision needs to be documented in the chart as well as the use of the gait belt. In this BLOG, whenever the term ‘gait belt’ is used, please assume the level of supervision was either contact or close.

Recently I’ve visited various out-patient clinics and rehabilitation facilities. I made it a point to ask the PTs whether they used gait belts when treating patients with balance/gait deficits that could result in falls. I asked if, in these patients, there were ever any personal injury due to balance or falls. And, I noted the type of business of employment.

This led to some very interesting discussions. I decided to include YOU in the discussion. The following is a survey regarding this topic. Please choose the appropriate survey for your profession/place of work. For those of you in the legal profession, the first survey is for you. For those of you who work with patients as a physical therapist, there is a three-question survey following the legal profession survey.For those working in physical therapy academia, the last survey is for you. I am quite interested in hearing from you – both in the survey and in the BLOG. I will let you know the results on the survey in a subsequent BLOG.

< please put this in some kind of survey tool such as Survey Monkey. >

FOR THOSE IN THE LEGAL PROFESSION:

1. Have you ever had a case involving personal injury when your client was not wearing a gait belt?

YES ___ NO____

2. If yes,

a. Was your client wearing a gait belt at that time?

Yes ____ No_____

b. Was there a gait belt on the premises?

Yes ____ NO ____ I don’t know _____

FOR PHYSICAL THERAPY CLINICIANS:

Where you taught to use a gait belt in school? Yes No

Do you use a gait belt when treating patients with balance/gait deficits?

Yes __ Sometimes__ Never __

If Yes or Sometimes, do you use your own gait belt or that of your employer?

My own ___ My Employer’s___

Which type of physical therapy facility is your employer? (please check as many as appropriate for you)

Hospital/SNF/long term care ___

Out-patient clinic ____

Home Health _____

Other ______

FOR PHYSICAL THERAPY ACADEMICS:

Are students at your school taught to use gait belts? Yes__ No __

FOR those in the LEGAL PROFESSION:

1. Have you ever had a case involving personal injury when your client was not wearing a gait belt?

YES ___ NO____

2. If yes,

a. Was your client wearing a gait belt at that time?

Yes ____ No_____

b. Was there a gait belt on the premises?

Yes ____ NO ____ I don’t know _____

In a medical negligence case, it will be important to know whether a gait belt owned by the owner of the business was on the premises at the time of the personal injury. Also, it will be important to know whether the use of gait belts was appropriately in the Policy and Procedure manual at the time of injury. If the rehabilitation business does not have a gait belt on the premises, the facility may be liable for not providing a safe environment.

The bottom line is that every physical therapy place of business should have functional gait belt(s) on the premises and the use of the gait belt needs to be in the Policy/Procedure manual.

The above paragraphs are only about legal ramifications around the gait belt. Let’s now look at the ramification around ethics (which can also be found in a legal claim).

The American Physical Therapy Association has identified eight principles around the core values of ethics: accountability, compassion, professional duty, social responsibility, altruism, compassion/caring, excellence and integrity. It is the professional duty of a PT to do no harm (i.e. no personal injury) to the patient. Also, if the patient falls, the question of ‘excellence of care’ arises.

So, if the PT does not use a gait belt and personal injury ensues, the question of ethics must be asked.

1. Did the PT have a professional duty to the patient?

2. Did the PT act in manner providing excellence of care?

If you have any questions about gait belts, gait, physical therapy clinics, ethics, balance, slips/trips/fall, personal injury or medical negligence, please let me know. marilyn@marilynpinkphd.comI will be delighted to speak with you.