Midway Neurological Staff Failed to Recognize Critical Brain Injury Signs, Leading to Resident’s Death

The Illinois Department of Health has cited and fined Midway Neurological & Rehabilitation Center when staff failed to recognize critical signs of a traumatic brain injury and delayed emergency medical care for a resident who had fallen twice. The resident died two days later from a massive brain bleed that could have been detected earlier with proper assessment and immediate medical intervention.

The tragedy began when a nursing home resident fell in her room during the night, causing severe bruising around her left eye and behind her left ear. When a licensed practical nurse discovered these injuries the next morning during breakfast, the resident explained that “she fell last night in her room” and “tripped and hit the left side of her face on her dresser.” The resident admitted she “didn’t report to anyone” because she “thought that she was fine.” The nurse noted that “the skin surrounding the resident’s left eye was black” and also observed “discoloration behind the resident’s left ear” – a critical warning sign known as Battle sign that indicates serious head trauma.

Despite these alarming symptoms, the nursing staff failed to recognize the severity of the situation. The nurse conducted a basic assessment, gave the resident an ice pack, initiated routine neurological checks that appeared normal, and contacted the physician who ordered only a “routine facial x-ray.” The resident was placed on observation and told she “cannot leave the nursing unit without a staff member,” but was otherwise treated as having minor injuries.

Later that same day, the resident went to the facility’s smoking patio where a smoke monitor witnessed her second fall. The monitor observed that when the resident “was finished smoking, she got up, walked over and placed cigarette butt in the discard container” but then “walked around garbage can, staggered and fell to the ground hitting head.” An outside program employee who was visiting the facility saw the resident being brought back in a wheelchair, noting she “had a dark red purple discoloration to left eye and was complaining her head hurt.”

The situation rapidly deteriorated that evening when a nurse “immediately assessed the resident” and discovered she “had a gash to the left side of her head” and “was lethargic.” Most critically, “the resident’s vital signs were abnormal, oxygen saturation level was decreasing to 87% on room air.” The nurse administered oxygen, which improved the resident’s oxygen levels to 95%, but the resident soon became unresponsive, prompting staff to call 911 and begin CPR.

When paramedics arrived, they found nursing home staff performing CPR on the unresponsive resident. The EMS crew noted several critical signs that should have been recognized earlier, including a “hematoma to back of the resident’s head” and confirming that the resident “presented with battle sign behind left ear” along with “swelling with black and blue discoloration to left eye.” The paramedics also observed that the resident “presented with dilated pupils” – another serious neurological warning sign.

At the hospital, medical staff immediately recognized the gravity of the situation. The resident “presented unresponsive to the hospital” with “bruising around left eye and around left mastoid” and “a large scalp hematoma.” Doctors noted the resident’s “pupils are fixed and dilated” and that she “does not respond to pain or voice, does not open eyes.” Given these “signs of trauma to the head, Battle sign, bruising over the mastoid, the resident was emergently taken for CT of head.”

The CT scan revealed the devastating extent of the brain injury that had gone unrecognized for hours. The resident was diagnosed with “a large traumatic subdural with shift causing herniation” – specifically “a large right cerebral convexity acute subdural hematoma measuring up to 3 cm with severe 1.7cm leftward midline shift, subfalcine and uncal herniation.” The neurosurgeon who examined her determined that “the resident’s prognosis was very poor without any chance for any significant functional outcome.” The resident died two days later.

The facility’s director of nursing later acknowledged the critical failure in care, admitting that “given the bruising to the resident’s left eye and posterior left ear, the resident should have been transferred to the hospital when staff first noted injury earlier in the day.” Medical literature confirms that Battle sign – the bruising behind the ear that staff observed – “typically requires significant head trauma and may indicate significant internal injury to the brain” and “takes Battle sign 1-2 days for the sign to appear,” meaning the resident’s initial nighttime fall was far more serious than staff realized.

The facility had clear policies requiring immediate action during medical emergencies. Their “change in resident’s condition or status policy” stated that “during medical emergencies 911 will be notified for transport to the hospital.” However, staff failed to recognize that the combination of Battle sign, facial bruising, and the resident’s reported fall constituted a medical emergency requiring immediate hospital evaluation rather than routine monitoring and X-rays.

One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.