An ALN client, a long-term care provider, contacted ALN regarding a matter that had the potential to be a catastrophic case due to altered charting and the type of injuries alleged. Our client had a narrow window of time to respond to the plaintiff’s demand and wanted confidence every possible defense strategy had been explored. ALN pulled together a team of nurse analyst’s and began studying the 8500+ pages of medical records and expert reports. Soon, it became clear, we had an inside out pressure ulcer and an alternate theory of injury…

At the time of the events in question, the plaintiff, Mr. Joe White, was a 59 year old male with a past medical history which included 20+ years of type II diabetes with diabetic neuropathy; hypertension; and hypercholesterolemia. He had smoked 1 pack per day for approximately 15 years before recently quitting. Routine screening in preparation for elective surgery was abnormal, and subsequent cardiac catheterization was positive for multiple vessel coronary artery disease. Mr. White underwent coronary artery bypass grafting of 4 vessels. Mr. White’s surgery was uneventful, however his recovery was complicated by pulmonary effusion, infection, and development of a Stage II wound to his sacral area. After stabilization, Mr. White was transferred to the defendant facility for continued rehabilitation and wound treatment.

On admission to the defendant facility, Mr. White was seen by the wound care team and protocols were implemented. Shortly thereafter, Mr. White’s buttock’s wound demonstrated significant, rapid deterioration. Within two weeks of the plaintiff’s transfer to the rehabilitation center, re-hospitalization was recommended by consulting wound specialists. Mr. White subsequently required multiple wound débridements and plastic surgery reconstruction to his buttocks and peri-area. His treatment course was extensive and he developed multiple complications.

The ALN nurse analysts performed an extensive review of the treatment Mr. White received at both the hospital (pre-facility) and the defendant facility. During the course of the investigation, rigorous analysis was performed surrounding the details of Mr. White’s bypass surgery and recovery. Supportive research was also performed surrounding extensive intraoperative pressure during CABG procedures as well as the use of electrosurgical grounding pads in the coccyx/buttock region.  It was noted time after time, chart descriptions and photographs of Mr. White’s wound found in the medical record were consistent with the National Pressure Ulcer Advisory Panel (NPUAP) definition for Suspected Deep Tissue Injury (SDTI). Mr. White’s wound was NOT consistent with a typical staged pressure wound and it was highly likely the “insult” leading to his “injury” pre-existed the admission to the defendant facility.

Based on the review findings, the ALN team developed multiple strategies for defense consideration. Armed with these tools, the defense team was well prepared to argue the case facts and weaknesses. The case settled…with a significant reduction from the initial plaintiff’s demand.