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 plaintiff’s expert has been ON the NPUAP so they MUST be right!
- 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!
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
These statements misrepresent the position of the NPUAP. The NPUAP clearly stated its position shortly after the 2016 Staging System was released:
Position Statement 1: The diagnosis of a “pressure injury” does not mean that the health care provider(s) “caused” the injury.
Position Statement 2: Some pressure injuries are unavoidable despite provision of evidence-based care by the health care team.
Position Statement 3: The numerical staging system does NOT imply linear progression of pressure injuries from Stage 1 through Stage 4, nor does it imply healing from Stage 4 through Stage 1.
Position Statement 4: The NPUAP Staging System classifies pressure injuries based on the type of tissue loss that can be visualized or directly palpated.
Position Statement 5: The pressure injury may be more extensive than initially apparent. The wound base and surrounding tissue should be assessed for variations in sensation, temperature, firmness, color and any expression of drainage from surrounding tissues when palpated.
Position Statement 6: Deep Tissue Pressure Injury (DTPI) may evolve into a full thickness wound despite optimal care.
Position Statement 7: Any pressure injury should be treated in accordance with current evidence-based practices and monitored closely for changes that require re-evaluation of treatment strategies.
https://www.npuap.org/wp-content/uploads/2012/01/NPUAP-Position-Statement-on-Staging-Jan-2017.pdf