Posts Tagged ‘Dr. Nancy Collins’

Malpractice or Obesity: Can a 276-Pound Patient Heal a Pressure Injury?

Friday, September 8th, 2017

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

Obesity presents challenges to wound healing, but with knowledge and appropriate care interventions, we can provide optimal conditions to support the best possible outcome for every patient, no matter what size.

Malpractice or Obesity?

 

The US obesity epidemic reached a new all-time high in 2016, according to newly released Centers for Disease Control and Prevention data.1 Every single state has an obesity rate greater than 20%, and in five states it’s even greater than 35%. Topping the chart is West Virginia, at 37.7%.

Many of these people end up in the healthcare system because of obesity-related diseases and sometimes develop a wound, such as a pressure injury. As we know, wounds that do not heal after 12 weeks are termed chronic, and lawsuits because of chronic wounds and their consequences are rampant

The Obese Plaintiff

The discovery process surely will reveal whether a patient was overweight or obese because nutritional status and body weight are factors in the healing process. The tricky part is deciding how much, if any, of the chronicity of the wound was because of obesity.

In a recent case, the patient was 5′3″ and weighed 276 pounds. Can a person of this size heal? The defendants claimed they did everything according to the standard of care, but despite excellent care, the patient did not heal. They recounted some difficulty repositioning the patient because of her size and problems with moisture management in her skin folds. The plaintiff thought those were excuses and that there was size bias in the care given to the patient. So what are the facts when dealing with a larger patient with a wound?

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Three Common Reasons You Might Get Sued

Friday, August 11th, 2017

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

Patients often sue for reasons that have nothing to do with the quality of the medical care rendered, but rather for the human care that is perceived as lacking.

Three Common Reasons You Might Get Sued

 

The last few weeks were very difficult for my family and friends in the medical sense. I had one family member in an intensive care unit on the West Coast, one friend’s father in a rehab facility on the East Coast, and one friend’s son having problems in the outpatient setting in the Midwest. These patients are male and female, young and old, and have very different medical histories, but they all have one thing in common. They all want to sue about their medical care or lack thereof. These cases illustrate three common reasons you might get sued. Let’s take a closer look at what has gone wrong for each patient.

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Nutrition and Wounds: The View From Both Sides

Friday, July 14th, 2017

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

Nutrition is frequently conjoined to wound care lawsuits because patients often lose weight, so it is important to thoroughly document nutrition interventions and education.

 Nutrition and Wounds

 

Most pressure injury lawsuits begin as just that—a lawsuit initiated because of an acquired pressure injury. Usually the wound in question never healed to closure, became infected, led to an amputation, or otherwise caused the patient suffering. During the legal discovery process, all sorts of other care issues come to light, and the scope of the lawsuit grows. One of the most common additional issues is the patient’s nutritional status. Let’s look at it from both sides.

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Truth or Consequences: Admitting Your Wound Care Program Needs Improvement

Friday, June 9th, 2017

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

Some healthcare providers are working in underperforming facilities, and they need to discuss how to improve outcomes before it becomes a matter of legal record.

Truth or Consequences: Admitting Your Wound Care Program Needs Improvement

 

“I didn’t have any special training in wounds. No one else wanted to do it, so I said okay.”

“The weekends were really bad. We only had a few people working weekends.”

“I know some of the patients didn’t get turned all day.”

“We always were running out of supplies, so I improvised.”

All of these confessions, or truths, are from real life depositions of nurses who were working in facilities that patients were suing because they developed wounds. These nurses were not trying to hurt their facility in any way or stymie the defense team, but were simply telling the truth in their opinion.

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Nine Wound Care Documentation Pitfalls to Avoid

Friday, May 12th, 2017

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

Lawsuits often are settled out of court because the medical record documentation is not defensible. Incomplete, illogical, and inconsistent records are far too common, so it is important to avoid the common pitfalls.

9 Wound Care Documentation Pitfalls to Avoid

 

After reviewing hundreds of medical charts involved in litigation, I noticed many of the same problems occurring in the wound care documentation over and over again. From New York to Florida to California, it is remarkable how the same inconsistencies, errors, and oversights tend to stymie the defense of a case. The goal of every healthcare practitioner is to have complete, accurate, and timely documentation of the medical care given to each and every patient. Here are nine wound care documentation pitfalls to avoid.

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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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Your Favorite WCEI Blogs of 2016

Friday, December 30th, 2016

Did you miss any WCEI blogs?  Never fear, we wrap up the year with the topics that were most read, shared, and commented upon.

Your Favorite WCEI Blogs of 2016

In 2016, we covered a lot of ground, bringing you straight talk on range of wound care topics, including ostomy care, diabetic wounds, legal issues, assessment tips, and more. Which were readers’ top five favorites? Here’s the run-down.

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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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