Legal Issues

Cheryl Carver's picture
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off label drug prescription

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.

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WoundSource Editors's picture

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.

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Janis Harrison's picture

By Janis E. Harrison, RN, BSN, CWOCN, CFCN

As I was pushed from the room where my husband was coding, I was met by a tiny little nun, we'll call Sister. She tried to move me to a waiting area nearby but I knew I was not going to step away from the door. They had not listened to or assessed my husband during a very concerning time and he was supposed to be in post-op recovery.

Karen Zulkowski's picture

by Karen Zulkowski DNS, RN, CWS

There are several issues in pressure ulcer definitions. For example, exactly what is the definition for eschar? What is an unavoidable pressure ulcer? How can you decide it really was unavoidable?

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Mary Ellen Posthauer's picture

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.

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Jonathan Rosenfeld's picture

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.

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Jonathan Rosenfeld's picture

By Jonathan Rosenfeld, JD

Even as an injury lawyer who sometimes feels he has seen it all, I am surprised by the tricks that I have seen used by some nursing homes in order to avoid responsibility for their actions. It is unbelievable how poorly kept the patients’ charts generally are in a large number of nursing facilities to begin with, but if a facility feels that there is impending litigation in its future, they may stoop so low as to alter those records in order to cover up its actions. This type of behavior is both unethical and illegal and I am both saddened by the tactic and happy to see punitive damages awarded in cases involving such nursing homes.

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Karen Zulkowski's picture

By Karen Zulkowski DNS, RN, CWS

Last month I talked about the issues that occurred during my husband’s knee surgery. This month I want to bring the focus back to lawsuits and how they arise. What are the implications for the patient and family, and how does palliative wound care fit in?

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Kathi Thimsen's picture
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By Kathi Thimsen RN, MSN, WOCN

The responses that I have been getting from the blogs are terrific! It is wonderful to know that clinicians are interested, questioning, and wanting to know what is in products. So, now in 2012, we continue this blog with the topic of products and practice.

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Karen Zulkowski's picture
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By Karen Zulkowski DNS, RN, CWS

Part 4 in a series discussing the process of litigation in patient care lawsuits

Click here for Part 1
Click here for Part 2
Click here for Part 3

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