Archive for the ‘Litigation Wound Care’ 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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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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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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Should wound care nurse carry out off-label use order?

Monday, June 3rd, 2019

off-label

A reader submitted a question about a physician ordering her to crush two Flagyl tablets and sprinkle them onto a patient wound.

wound care

By Nancy J. Brent, MS, JD, RN

The nurse knew this was not the correct way to administer the medication. However, she is concerned that since the physician ordered this method of administration that she is obligated to follow the order.

Part of this nurse’s conflict is that this method of administration is not generally consistent with current standards or practice.

But in many facilities and home care agencies, the use of Flagyl tablets in this way is a common and customary practice, as we discuss in our blog, “We’ve Always Done It This Way:  Flagyl Crushing & Other Wound Care Bad Habits.”

However customary such a use may be, it can create potential legal liabilities for you.

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Substandard wound care can lead to legal risk for clinicians

Monday, May 20th, 2019

professional negligence

Dedicated wound care professionals pride themselves on providing optimum care for their patients.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

Did you know you also have an ethical and legal obligation to provide the best care possible or you face legal risk?

You could be held liable whether you are an experienced or new wound care clinician, certified or not certified, or work in acute care, long-term care or the ambulatory environment.

Providing substandard wound care not only harms patients, it also can result in a patient or their family taking legal action against you and other clinicians involved in the patient’s care plan, said Nancy Brent, JD, MS, RN, a nurse attorney who represents nurses before the state regulatory agency and has a solo law practice in Wilmette, Ill.

And no one wants to face professional negligence or malpractice allegations.

“The legal fallout from litigation pertaining to patient care can range from being sued for medical malpractice or professional negligence, in addition to the fees related to legal representation and damages owed if you’re held legally responsible,” she said.

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Case illustrates importance of clear wound care delegation

Friday, April 12th, 2019

delegation

In the following case, the issue of delegation of wound care was the focus of the case.

wound care

By Nancy J. Brent, MS, JD, RN

A female patient’s doctor ordered home healthcare services after her hospitalization for renal disorders and congestive heart failure. The patient employed a local home healthcare agency to provide skilled nursing care for the patient’s many health problems.

Six months later, the physician discovered his patient had developed four decubitus ulcers, including one on her right hip, which measured 5-1/2 centimeters in diameter and 7-1/2 centimeters deep.

The physician ordered the nurses to clean the wounds regularly and two months after the orders were being carried out, he delegated to the nurses to begin to pack the right hip wound with Betadine gauze.

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