Legal Issues

By Mary Ellen Posthauer RDN, CD, LD, FAND Frequently I am asked to review medical records to determine if an individual’s pressure ulcers failed to heal because of inadequate or inappropriate nutritional care. The majority of the cases involve long-term care facilities and the patients are older adults who had unintended weight loss (UWL) and pressure ulcers. After devoting 35 years as a consultant dietitian to nursing homes, I am well aware of the challenges faced by providers as they strive to provide care for our frail elderly.

By Jonathan Rosenfeld, JD Whether the development of a bedsore, also commonly referred to as a pressure ulcer, is the fault of the nursing home or an existing medical condition, the actions taken by the health care facility after the sore is discovered can have a large impact in a lawsuit if the patient suffers from complications arising from the sore. How a nursing home treats patients with pressure sores is just as important during litigation as whether the home is responsible for the development of the sores to begin with. For this reason, nursing facilities should not implement treatment protocol that gives the impression that they are killing the patient or doing nothing to prevent the patient’s death.

By the WoundSource Editors Litigation over hospital-acquired pressure ulcers represents a significant fraction of a medical malpractice attorney's caseload. The liability issues have shifted since October 1, 2008 when the Centers for Medicare and Medicaid Services and several private payers began denying reimbursement for care related to hospital-acquired stage III and IV pressure ulcer. Prior to October 2008, the experts battled over whether a pressure ulcer was avoidable. Now, they still do, but plaintiff attorneys and their experts can point to the government's stance that pressure ulcers are avoidable, "never events". Defense experts must assert that everything possible was done to avoid the ulcer, or it was not really caused by pressure.

by Janet Wolfson, PT, CLWT, CWS, CLT-LANA As the 116th Congress ruffles its feathers and dusts out the corners, it's another chance for the Lymphedema Treatment Act (LTA) to become law. The Senate bill was given bill number S 518, whereas the House bill is pending. In the previous Congress, the bill had a super majority support in both Senate and House. One can only speculate what else might have consumed their time.

Many nurses have spent their careers in different parts of the health care system. This diverse experience allows them to bring exclusive knowledge to medical malpractice cases. Legal nurse consultants (LNC) review medical documentation, seeking information about the patient’s condition regarding a medical malpractice case. LNCs are better suited to find the cause and effect of ongoing medical care. They are more than testifying experts since, regarding medical malpractice, solidly understanding how the health care system works is essential to understanding the standards of care. Helping the lawyer with expertise and experience has been found to bring a medical malpractice case to the best resolution.

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.

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."