Archive for the ‘Legal’ Category

The Great (Legal) Debate About Turn and Reposition Documentation

Friday, April 7th, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Documentation of turning and repositioning often leads to legal problems as some healthcare providers chart by exception and others chart at the point of care.

The Great (Legal) Debate About Turn and Reposition Documentation

 

“The hospital never turned the patient, and therefore the patient suffered a serious pressure injury,” declared the plaintiff attorney. The defense team shot back, “Whoa. Slow down. Never is long time, and of course we turned the patient.” How can a basic care intervention such as turning and repositioning have two totally opposing views?

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Disappointed by Debridement

Friday, March 3rd, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Plaintiffs often express shock and disbelief after eschar is removed, which often leaves a wound larger than the original size of the eschar.

Disappointed by Debridement

Wound photo: “Stage 4 decubitus displaying the Gluteus medius muscle attached to the crest of the ilium” by Bobjgalindo is licensed under CC BY 2.0

 

“We were in shock and couldn’t believe our eyes. It was like half her foot was gone.”

“My husband and I were horrified when we saw what they did.”

“My sister and I looked at each other, and I just kept asking why?”

“I had to leave the room and go the bathroom to cry when I saw what they did to my mother.”

You might think these quotes are from people who have witnessed a shocking crime or some sort of violence, but they are not. These are quotes from family members, now plaintiffs, who are suing for poor medical care related to a chronic wound. Their shock all had one thing in common—it came after seeing a wound that was surgically debrided.

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When Your Patient Refuses to Be Turned and Repositioned—And Then Sues!

Friday, February 3rd, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

The battle between optimal medical care and patient rights is one to fight with empathy and finesse to keep it out of the courtroom.

When Your Patient Refuses to Be Turned and Repositioned—And Then Sues!

 

I recently reviewed a lawsuit filed by the family of a patient* with a spinal cord injury. The patient was involved in a car accident and sustained multiple traumatic injuries. The medical team worked tirelessly over the course of many weeks to stabilize him. Because of this catastrophic accident, the patient was understandably quite devastated and depressed. He refused all physical therapy and spent most days lying in bed on his back, despite encouragement from his medical team and pleading from his family. He frequently stated that he wished he was dead and that he wanted everyone to leave him alone, often escalating things to the point of screaming.

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The RATS of Malpractice: Don’t Let Them Invade Your Wound Care Practice!

Friday, December 16th, 2016

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

The new year is quickly approaching, and most of us are reflecting and setting goals for 2017. Here’s a simple plan that outlines what you must do to minimize the risks of practice.

The RATS of Malpractice in Wound Care

 

As wound care practitioners, our main goal is to heal wounds as quickly and painlessly as possible. Over the years, this simple mission has gotten tied up in countless legal matters as disappointed patients and their families turn to attorneys when things don’t work out. Follow this outline of what to do to minimize the risks of practice in the new year.

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The Blame Game: Is It All Right to Blame the Patient?

Friday, November 4th, 2016

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Clearly it is a legal liability when health care professionals (HCPs) do not follow doctor’s orders. But when the patient chooses not to follow doctor’s orders, things are not so clear.

The Blame Game: Is It All Right to Blame the Patient?

 

Most of the lawsuits I deal with have more than one named defendant. For example, the plaintiff (typically a deceased patient’s next of kin) might sue a hospital, a nursing home, and the attending physician at each facility. Sometimes they go a bit further and may even include the administrator, the director of nursing, and individual HCPs, such as the wound care nurse or the registered dietitian nutritionist.

When a lawsuit has multiple defendants, one of the main tasks is determining how much responsibility for the outcome to assign to each party. Responsibility is a nice word for blame, because that is really what we are talking about. Each defendant’s attorney will argue that their client is not to blame, which is obviously their job. What is not so obvious is that this means the attorney must deflect the blame to one of the other parties. It is truly every defendant for himself or herself.

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Intake + Output = Big Documentation Problems

Friday, October 7th, 2016

Nancy Collins, PhD, RDN, LDN, FAPWCA, FAND

Inaccurate and incomplete intake and output (I&O) records pose a problem in litigation, as well as a risk to the patient who requires monitoring of fluid balance for medical reasons. 

Intake + Output = Big Documentation Problems

 

“Would you agree that the nurses did not know how to do basic arithmetic?”

Of course nurses know how to add and subtract, yet I was asked this question in a very challenging manner by a plaintiff attorney. He had just showed me 3 weeks of I&O tables excerpted from the medical chart of the deceased plaintiff, and almost every shift was incomplete. The plaintiff attorney was reducing the problem to poor math skills, implying that not a single day was complete because the nurses who cared for this patient lacked the skills to add a column of numbers. He knew I would disagree because I was not going to say these nurses lacked basic math skills. But he also knew his follow-up question was the real reason for this math ploy.

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Your Patient Died: Should You Send the Family a Card?

Friday, September 9th, 2016

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Bereavement care is part of the job, no matter how difficult it is to talk about death and deal with grieving family members.

Your Patient Died: Should You Send the Family a Card?

 

“Callous disregard.” These two little emotionally loaded words are how the plaintiff complaint summed up the following story from a grieving daughter named Sally.* In her deposition, Sally recounted how nice and welcoming everyone was at the nursing home when she toured it 3 years ago prior to moving her mom in. It seemed like a good place where the staff could provide the care her mom needed; care Sally was no longer able to provide for her at home as her mom’s physical and mental condition continued to worsen. Those feel-good sentiments were replaced by anger, sadness, and ultimately litigation after her mom died. When Sally was asked why she was suing, she replied that no one at the nursing home cared about her mother.

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Great Expectations Unmet: The Real Reason Patients Sue

Friday, August 5th, 2016

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Most lawsuits start not because of poor medical care but because families believe promises were made and broken and they are angry.

 

Great Expectations Unmet: The Real Reason Patients Sue

 

If you speak to any health care attorney about the proliferation of lawsuits against hospitals, nursing homes, and health care providers (HCPs) over the last decade or so, you will engage in a conversation peppered with a variety of legal terms. These may include breach of duty, negligence, malpractice, wrongful death, statutory standard of care, or even criminal culpability. It is important to understand that these are formal words with specific legal meanings, and at least a few of them appear on every plaintiff complaint as the reason for the lawsuit.

This is in sharp contrast to every deposition I have ever read from a plaintiff—usually the surviving spouse or child/children of the deceased. These family members never use legal jargon. Instead, they use emotional terms that reveal the true reason they are suing. Unless the family member works in the medical field, they rarely criticize the actual medical care but rather express great sadness with the personal care and the way they were treated. Plaintiffs frequently remark about the lack of caring they felt in health care. It is these words that we must focus on if we are to understand the patient perspective and thereby improve patient satisfaction.

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Say Cheese to the Camera: Wound Photography Shot by Family Members

Friday, July 8th, 2016

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

These days, most people have a camera in their pocket, giving family members the ability to take their own wound photographs.

Say Cheese to the Camera: Wound Photography Shot by Family Members

 

When we talk about wound photography, we usually are referring to health care professionals (HCPs) taking periodic photographs to document the healing process as part of a patient’s permanent medical record. In fact, some new cameras are made specifically for this purpose. Some of these cameras not only capture an image but also can provide wound measurements, and some even offer automated integration into the patient’s electronic health record.

Today, however, HCPs are not the only ones with cameras. Family members or visitors to a wound clinic or health care facility usually have a camera with them, and they love to use it. This has raised new questions in wound care because many of these unofficial photographs become introduced as evidence in lawsuits.

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Using Your Smartphone at Work: A Smart Idea or Not?

Friday, June 3rd, 2016

by Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

In health care, personal smartphone use at work is a complicated issue with legal implications.

Smartphones at Work

 

The plaintiff attorney drummed his fingers on the table while he stared at nurse Stephanie Holland* for what seemed like an eternity. He was waiting for her to respond to a seemingly simple question during her deposition—“Do you ever use your personal phone at work?”

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