Legal Issues

I have been there, done that. Sitting in the fact witness chair in front of a plaintiff attorney who is wildly waving a copy of my facility’s wound care policy and procedure, demanding to know why certain things weren’t included in the policy, and why what was in the policy was not followed to the letter. Plaintiff attorneys have the right to demand copies of a facility’s policy and procedures as part of discovery and will go through them with a fine-tooth comb, compare what is in the policy with the care that was provided, and fault the facility for any deviations. It goes without saying that I promptly returned to my facility with a new understanding for how our policy was written and possible gaps and weaknesses.

As detailed in my last few blogs, nutrition plays a huge role in risk for skin breakdown as well as healing of wounds. Just about ALL wound litigation involves nutrition in one way or another, be it diabetes control (or lack thereof) or weight loss, which occurs often in patients with dementia and toward end of life, or general malnutrition.

By Heidi Cross, MSN, RN, FNP-BC, CWON Since the advent of coronavirus disease 2019 (COVID-19), I haven’t done much flying, but I love travel and I love flying. One of my favorite experiences is a window seat at about 30,000 feet on a clear sunny day. The views can be spectacular – whether flying across the Rockies or the Plains or any of the stunning and varied scenery of this country or the world. A couple of my most memorable flights involved flying into New York City with views of the New York skyline with Lady Liberty in clear sight, or into Washington, DC with clear views of the Mall, the Jefferson Monument, and the Capitol. The Alps and the Rockies are incredibly awe-inspiring, beautiful, and breathtaking. From there, you get a good overall picture of the landscape.

By Heidi Cross, MSN, RN, FNP-BC, CWON "It was the best of times, it was the worst of times." – Charles Dicken When Charles Dickens wrote this introduction to his Victorian-era novel, A Tale of Two Cities, his novel was aimed at the brewing French Revolution, but he could have been writing about the best and worst of modern American health care. His novels depicted how life could be pretty miserable during those times, with no social safety net and no real medical care. Fortunately, times have changed, and we have improved social supports as well as, some would argue, the best health care system in the world (although, sadly, not all people in the United States enjoy access to our great health care system, but I digress).

Pressure injury risk and development are multifactorial, individualized processes. Each patient presents with a unique set of circumstances and needs. In looking at charts for attorneys to determine whether standards of care related to pressure injuries have been met, key elements include turning and positioning measures, support surfaces, mobility, proper and timely assessment of risk factors and wounds, physician communication and notifications, communication with family, proper wound treatments, and nutrition assessment and measures.

By Heidi Cross, MSN, RN, FNP-BC, CWON "Defendants failed to provide adequate nutrition to prevent plaintiff from suffering severe malnutrition and weight loss. This allowed the development of a severe pressure ulcer, numerous infections, and dehydration and malnutrition. Had defendants provided proper care, the pressure ulcer, infections, and malnutrition and dehydration would not have occurred."

The United States is one of the most litigious nations in the world, with the result that numerous medical malpractice lawsuits are initiated against hospitals and other health care facilities, as well as practitioners. Commonly, these lawsuits allege that the facility failed to meet standards of care related to management of wounds including pressure injuries, failed to provide adequate nutrition, and did not properly address issues such as incontinence.

In medical malpractice litigation, a thorough review of the medical chart is done to determine whether the facility or health care provider “met the standards of care” related to the medical issues at hand in the complaint. Attorneys hire specialists in the field to serve as expert witnesses to make this determination. Whether the case is settled or goes to trial, if the facility can show that it met most if not all standards of care, then the defense prevails. If not, the plaintiff has proved neglect with a breach of duty and receives compensation.

A client walks into the law firm and states that a family member has suffered from unfair treatment and, as a result, acquired a pressure injury while in the hospital. The firm gathers the information, and the lawyer tells the family member at a later appointment what is needed to start the process. The lawyer will most likely give the family member some forms to fill out with a list of paperwork that needs to be gathered.

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC Providers may view off label drug use (OLDU) for wounds as the "new wave". However, if there is little or no scientific evidence supporting the practice, it can possibly lead to more problems than good. Keep in mind that not every health care setting embraces off label drug use. For example, state surveyors view OLDU differently in long-term care versus home care. Providers should avoid any risk of being involved in a pressure injury investigation. OLDU may be considered a factor in the event of such an investigation. Hospice patients are considered to be in more of a "dying with dignity" category, therefore OLDU may be considered more acceptable.