Archive for the ‘Legal’ Category

Hyperbaric oxygen therapy case: Liability can result from treatment inaction

Wednesday, March 25th, 2020
hyperbaric oxygen therapy

Many of you have worked with wound care patients needing antibiotics and hyperbaric oxygen therapy.

In the 2016 Texas case of Gonzalez v. Padilla, the issue of whether the antibiotics or hyperbaric oxygen therapy were properly prescribed was a core issue in the case.

The patient was struck while riding his motorcycle and was taken to a university-based medical center with a broken lower right leg and a de-gloved heel.

An open external fixation procedure of his compound, comminuted fracture was successfully performed and a “halo type” fixation device was placed around the leg to hold the bones in place as the fracture healed.

The patient was also placed on IV antibiotics, including Gentamicin and Cefazonlin for a period of five days. In addition, he received daily wound care treatments.

The medical center’s records indicated his right leg showed “obvious evidence of continued blood flow … and no obvious necrosis beneath the heel tissue itself.”

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What does an allegation of ordinary negligence mean?

Thursday, March 5th, 2020
ordinary negligence

When you are named in a lawsuit alleging professional negligence, a requirement calls for a nurse expert.

The nurse expert is called for both parties (plaintiff and defendant) to establish whether the applicable standard of care in the situation was met or was breached.

The requirement of a nurse expert witness to establish whether the standard of care is met is based on the fact that an allegation of professional nursing negligence involves nursing judgment in the care of a particular patient.

The overall standard of care in a professional negligence case against a nurse is what ordinary, reasonable and prudent nurses would have done in the same or similar circumstances.

The establishment of what you as a wound care nurse would have done in a particular case requires, as the court below stated, “highly specialized expert knowledge with respect to which a layman can have no knowledge at all, and the court and jury must be dependent on expert advice.”

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Prior authorization: New rule in effect for pressure reducing support surfaces

Wednesday, February 26th, 2020
prior authorization

Clinicians caring for Medicare beneficiaries who need pressure reducing support surfaces when discharged home are adapting to a new rule.

Those clinicians now need to submit a Prior Authorization Request for Pressure-Reducing Support Surfaces, said Cynthia Broadus, BSHA, RN, CHCRM, LNHA, CLNC, WCC, DWC, OMS, executive director at the National Alliance of Wound Care and Ostomy (NAWCO) in Somonauk, Ill.

The Prior Authorization Request for Pressure Reducing Support Surfaces is a rule established by the Centers for Medicare and Medicaid Services (CMS) that took effect Oct. 21, 2019.

Submitting the preauthorization documentation will identify the need for the pressure reducing support surface and provide the supporting documentation, according to Broadus.

“The authorization must be submitted before the support surface is supplied to the patient and before a claim can be submitted for payment,” she said.

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Pressure injuries often result in serious punitive damages

Wednesday, February 12th, 2020
Punitive damages can be serious in pressure injury rulings.

Pressure injuries should be avoided at all costs. 

The costs of pressure injuries are numerous, but one area of major concern is when their existence results in a lawsuit. These suits typically allege the pressure injury was the result of poor nursing and overall care of the patient and/or resulted in a patient’s death.

Jacqueline Genesio identifies several lawsuits that resulted in significant verdicts in the article “Pressure Ulcers Are Easy Pickings For Lawsuits.”

As she points out, not only can a verdict result in compensatory damages (money paid to compensate the patient for pain and suffering and lost wages, as examples), but also can include punitive damages.

In one 2015 case, Genesio reported an Arizona jury awarded $2.5 million in compensatory damages and $16.7 million in punitive damages to the estate of an 86-year-old woman.

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Colostomy care for inmates is important to maintain wellness

Wednesday, January 8th, 2020
An inmate with a colostomy holds prison bars

We often talk about ostomy care, including the different ostomy types.  

When I was doing research for this blog, it was surprising how many reported cases exist in which colostomy care was the basis of federal lawsuits filed by inmates in various penal settings throughout the United States.

Other recipients of healthcare not in a penal setting have filed such lawsuits as well.

Simply doing an online case law search for “stoma nursing care” or “ostomy nursing care” yields a number of interesting results.

One prisoner’s colostomy care became an issue in a case he filed against the Missouri Department of Corrections (MDOC) in Crew v. Russell.

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Retained surgical bodies can lead to serious wounds

Tuesday, November 19th, 2019
A surgeon checks a wound for retained surgical bodies.

Retained surgical bodies in a patient postop is not an unfamiliar occurrence.

One literature review indicated that with more than 28 million operations in the U.S. nationwide, 1,500 estimated cases per year of retained surgical bodies left in patients take place.

In the 2016 case of Thompson v. Mangham Home Care, Inc., who left gauze in a patient’s surgical wound was at issue.

The patient saw her primary care physician for boils/sores on both of her buttocks in 2008.

The primary doctor prescribed antibiotics without success, and the patient was referred to a general surgeon who treated the condition with antibiotics and warm soaks.

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Wound photos can help determine a clinician’s legal liability

Wednesday, October 16th, 2019
A clinician documents wound photos on a company phone.

In many instances, wound care involves pressure wounds, such as decubiti and poor vascular conditions, such as diabetic foot wounds.

In the following case, the improper administration of chemotherapy agents through an IV line caused a wound that resulted in severe pain and limited the use of two fingers on the patient’s non-dominant hand.

Key evidence in the trial were wound photos of the open wound that occurred because of the negligent administration of chemotherapy by two nurses who were named defendants in the suit — Iacano v. St. Peter’s Medical Center.

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Nurse expert witness impacts pressure injury case

Monday, August 5th, 2019

nurse expert witness

Many of you have provided expert testimony in lawsuits in your own state, or other states, concerning wound care and whether that care was consistent with the applicable standard of care and standards of practice in that situation.

wound care

By Nancy J. Brent, MS, JD, RN

The following Arizona case — Rasor and Donald Miller, Wife and Husband, v. Northwest Hospital LLC — determined if a wound care nurse expert could testify to the cause of a wound sustained by the plaintiff (patient).

The female patient had open-heart surgery at the hospital and received an intra-aortic balloon pump “threatened through her femoral artery.” This required immobilization of her leg.

The patient was in the ICU for several days and the nursing staff discovered a pressure injury on her coccyx that reached stage IV and required 31 debridement procedures.

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Learn how written discharge instructions can protect your practice

Tuesday, July 16th, 2019

discharge instructions

Accurate, complete and defensive documentation is essential in all areas of practice, and wound care nursing is no exception.

wound care

By Nancy J. Brent, MS, JD, RN

One component of documentation that is of utmost importance is written discharge instructions. In the following case, this was one of the central issues the federal court had to evaluate — Shelton v. United States, 804 F. Supp. 1147.

The patient sought treatment at a VA hospital after he was bitten on the tip of the middle finger of his right hand during an altercation with a female after they left a bar.

The wound was painful and bleeding.  He called 911, stating he had been shot. He would not allow the paramedics to examine his finger.

The ED admitting nurse noted on the admission form he had suffered “trauma” to his right middle finger. He was then seen by an ED physician, whom he told he was bitten and that he had been shot.

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Learn why many organizations need a wound expert today

Monday, June 17th, 2019

wound expert

Organizations need for trained wound experts is on the rise.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

The reasons for this increase are multifactorial, said wound expert Nancy Morgan, MBA, BSN, RN, WOC, WCC, DWC, OMS, cofounder and clinical consultant with the Wound Care Education Institute.

We sat down with Morgan to learn why more patients than ever need expert wound care.

Q: What role do chronic diseases play in creating a need for wound care?

People are living longer with chronic diseases such as diabetes and obesity, which predisposes these patients to the development of chronic wounds.

Chronic wounds require treatment with the skills of knowledge of wound experts over the course of several weeks, months and sometimes years.

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