Successful Strategies for Winning Pressure Injury Litigation against Health Care Providers
- Talk about why they should be able to “Get to Zero!”
- Use the facility’s “Pressure Ulcer Prevention Protocols” against them.
- Use the NPUAP Staging System – the Plaintiff’s best friend
Remember, “Bedsores are a form of elder abuse” – and elder abuse is the way to avoid the caps on punitive damages!!!
EVERYONE is on the plaintiff’s side!
Pressure Ulcer “Prevention Protocols” Pave the Way to Litigation – use them!
- Often inappropriately cast as rules or regulations
- Often inappropriately absolute in their wording
- Look for inflexible deadlines
- Unnecessary mandates
- Often inappropriately labeled as the “standard of care”
- Best of all, they are called PREVENTION PROTOCOLS which implies that all pressure ulcers should be preventable!
The NPUAP Staging System – the Plaintiff’s Best Friend!
- They are now called INJURIES!
- Inevitable & linear wound progression implied by
- Term “staging” itself
- Numeric nature of the staging system
- Allows for erroneous & dangerous misperceptions
- All pressure ulcers/injuries can be stopped at an early stage
The NPUAP Staging System is the Key to Winning Cases for the Plaintiff – Use it to your advantage!
- A woman suffered a cervical fracture falling from her bed and lay paralyzed on the floor at home for unknown period of time (days).
- In addition to new onset paralysis, she had acute respiratory failure.
- She was malnourished at time of admission.
- Patient successfully sued hospital for negligence, alleging that the pressure ulcers progressed as a result of failure to implement the “pressure ulcer prevention protocol”.
- Not documented as being turned q 2 hrs, specialty mattress not provided immediately, other imperfections in care.
- Bolstered by the progression of the ulcer from Stage 1 to Stage 4
Do NOT discuss the critical weaknesses of the NPUAP Staging System
- Do not let on that there are at least 2 distinct mechanisms for pressure ulcer/injury formation – one of which is “inside out” and the other of which is “outside in.”
- Do not allow discussion about why many don’t happen over a bony prominence and have an inexplicable tendency to follow the distribution of a named artery which may be mean arterial pressure matters.
- Do not admit that incontinence associated skin breakdown is not supposed to be staged – allow the usual confusion to persist about the moisture-related issues that are common.
Most Important of All- Do not Discuss Real Evolution of a Stage 4
- They start with a Deep Tissue Injury
which evolves into . . .
- An unstageable lesion as the tissue necrosis works its way from the in side to the outside
and ultimately . .
- A Stage 4 “pressure injury”
SPECIAL THANKS TO CMS!
This can win the case for you
It gets better! Pressure Ulcers are also a CRIME!
“With the introduction of criminal prosecution for gross neglect, a new weapon against poor nursing care has appeared.“ American Journal of Forensic Medicine.
Go ahead, try to convince the jury . . .
- The term stage does not mean “stage” in the way a normal person thinks it does.
- Even though a person usually counts to 4 by starting at 1 – that’s not actually how you get to a Stage 4 pressure injury.
- Pressure ulcers are NOT all the result of poor care – some are medically unpreventable.
- About the term, “injury,” it doesn’t actually mean the clinicians INJURED anyone!