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.
Medical standard of care is typically defined as the level and type of care that a reasonably competent and skilled health care professional or facility, with a similar background and in a similar medical community, would have provided in a similar situation and given the same resources. Rising above the standard with expectations of “perfect care” is not a reasonable expectation and does not have to be proved to prevail in litigation. What constitutes the standards of care will change from community to community and often evolves over time.
Standards of care are generally not explicitly written down. They are determined by the analysis, opinions, and testimony of expert witnesses who have the knowledge and similar experience as the practitioners or facilities involved. In the case of pressure injury prevention and treatment, as well as nutrition, they will be practitioners (physicians, nurses, other health care providers) with wound care experience and perhaps certification, in addition to registered dietitians. Standards are usually based on clinical practice guidelines that are research based and peer reviewed, and most experts term them “best practices.” Examples of these are guidelines from The National Pressure Injury Advisory Panel (NPIAP), the Wound, Ostomy and Continence Nurses Society, the World Union Wound Healing Societies, and the Academy of Nutrition and Dietetics, among others.
Here are some questions clinicians can ask themselves to help determine whether their facility is meeting standards of care related to wound care. Many of these questions are based on the NPAIP 2019 pressure injury guidelines,1 among others:
This discussion represents a brief synopsis of the questions you need to consider. The “standard of care” is a legal concept and not necessarily a medical concept. A clinician’s effort to meet standards or lack thereof will largely determine medical malpractice outcomes. It is important to be aware of the standards related to pressure injury prevention and treatment as well as nutrition, hopefully to survive perusal of charts in case of litigation or—better yet—to avoid litigation completely.
In medical malpractice lawsuits, plaintiff attorneys want to show how a health care provider or facility violated the accepted standards of care and was therefore negligent. Clinicians should protect themselves through awareness of the standards and ensure that these standards are incorporated into their individual practices, as well as their facility’s practices.
Heidi H. Cross, MSN, RN, FNP-BC, CWON, is a certified Wound and Ostomy Nurse in Syracuse, NY. She has extensive experience caring for wound and ostomy patients in acute care as well as in long term care facilities. Currently, she is employed by CNY Surgical Physicians consulting for nursing homes in the Syracuse area, and has served as an expert witness for plaintiff and defense attorneys.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.