Legal Issues

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Nutrition Management

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."

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By Heidi Cross, MSN, RN, FNP-BC, CWON

In the previous blog, I briefly went through the standards of care when it comes to nutrition and pressure injury (PI) prevention and development and discussed what a large role nutrition plays in PI litigation. Here are several instances: Punitive damages of $92 million, later lowered to $11,855,000, were imposed where malnutrition and dehydration were proven against a nursing home. A dietary manager for a nursing home told state surveyors that her nursing home had "dropped the ball" on a resident's nutrition needs when that resident had lost 17 pounds in 75 days; a $1,385,000 settlement was reached. Malnutrition with a loss of 27% of body weight in 15 months led to a $380,000 settlement just before trial. Shocking, isn't it? It literally "pays" to pay attention to nutrition standards of care.

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By Heidi Cross, MSN, RN, FNP-BC, CWON

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.

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End of life wounds

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).

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Wound Care Lawsuits

By Diane L. Krasner, PhD, RN, FAAN

Originally a poster first conceived in 2009, "Six Sticky Wickets That Commonly Occur in Wound Care Lawsuits" is as relevant today as it was a decade ago. In my review of wound care medical malpractice cases, I see these six difficult situations ("sticky wickets") occurring all too often. Strategies for avoiding the Six Sticky Wickets have been updated and are discussed here.

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End of Life Skin

By Heidi Cross, MSN, RN, FNP-BC, CWON

Ms. EB, a frail 82-year-old woman admitted to a long-term care facility, had a complex medical history that included diabetes, extensive heart disease, ischemic strokes with left-sided weakness and dysphagia, dementia, kidney disease, anemia, chronic Clostridium difficile infection, and obesity. Her condition was guarded at best on admission, and she had a feeding tube for nutrition secondary to dysphagia. Despite these challenges, she survived two years at the facility.

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Pain and Suffering Documentation

Heidi Cross, MSN, RN, FNP-BC, CWON

"Me and Jenny goes together like peas and carrots." – Forrest Gump

Just like Forrest's peas and carrots, a pressure ulcer lawsuit and a pain and suffering allegation inevitably "goes together." For good reason, because pain is an ever-present problem in patients with pressure ulcers, venous and arterial ulcers, and even diabetic ulcers, despite sensory issues. How do you, as a health care provider, best protect and defend yourself against a pain and suffering allegation?

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Unavoidable Pressure Ulcers

By Heidi Cross, MSN, RN, FNP-BC, CWON

"At all times material hereto, defendant failed to develop an adequate care plan and properly monitor and supervise the care and treatment in order to prevent her from suffering the development and deterioration of bed sores."

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By the National Pressure Ulcer Advisory Panel

Washington, DC. – April 18, 2019 – On April 9, 2019, Dr. William Padula, NPUAP Treasurer, and Dr. Janet Luddigan, NPUAP President, provided written testimony to the House Committee on Appropriations; Subcommittee on Labor, Health and Human Services, Education and Related Agencies to explore new payment models that could further increase innovation and incentivize the prevention or pressure injuries.

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Risk Factors for Unavoidable Ulcers

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

According to the Agency for Healthcare Research and Quality, more than 17,000 lawsuits related to pressure ulcers (PUs) are filed annually in the United States, second only to wrongful death lawsuits. One of the greatest gifts to defense attorneys was when the Centers for Medicare & Medicaid Services (CMS) published F-Tag 314, finally acknowledging that some ulcers can occur despite best care. The facility essentially can maintain, “Hey, we did everything we were supposed to, and despite that, the patient developed that pressure ulcer”—that is, the ulcer was unavoidable. To prove unavoidability, proper documentation (proof) of best care needs to be in place, as well as documentation that all proper prevention and treatment measures were implemented.