ALN Litigation Perspective

Fudge & McArthur, P.A.’s Donna Fudge and Benjamin Broadwater announce victory in recent Stage IV Pressure Ulcer/Nursing Home case in Florida.

The complexity of circumstances demonstrated in this case is not atypical of the facts in many of the long-term care cases in litigation today. The importance of cohesion between the medical and legal defense teams cannot be emphasized enough in these cases. From both a clinical and legal standpoint, considerable skills are required to weed through the minutia of what was likely an abundance of medical records and break down the case facts simply into a bad outcome despite the rendering of good care. Of significance in this case was the team’s ability to use the medical record to create the picture of collaborative care provided in the absence of wound documentation. Unfortunately, all too often we see key portions of the medical record are missing, requiring our nurse consultants to hunt for the pieces of the puzzle necessary to reconstruct the plan of care and develop a fail-safe defense strategy.

Defense Jury Verdict: Morgan & Morgan, P.A. represented the Estate of Willie F. Coley, in a lawsuit against TR & SNF, Inc., d/b/a The Nursing Center at University Village, and BVM Management, Inc. in relation to Mr. Coley’s 12+ year residency at University Village’s skilled nursing facility. The Complaint alleged negligence for the development of a Stage IV sacral/coccyx pressure ulcer. Mr. Coley passed away 15 months after leaving University Village and continued to have this pressure ulcer until the time of his death. A graphic photograph of the Stage IV ulcer was shown to the Jury.

This case focused on the final three months of Mr. Coley’s 12+ year residency at University Village. Plaintiff alleged that University Village failed to implement appropriate interventions after re-admission from a hospital stay, and failed to revise any interventions after Mr. Coley developed his sacral/coccyx ulcer, in violation of the Federal Regulation for pressure ulcers, FTag 314. Plaintiff also alleged that the caregivers failed to follow the Facility’s own Policies and Procedures by failing to monitor/track the wound, and by failing to provide adequate pressure relief every 2 hours. As a result, Plaintiff alleged that University Village failed to prevent the development, and worsening, of Mr. Coley’s pressure ulcer. Lastly, Plaintiff alleged that the University Village caregivers failed to properly assess and treat Mr. Coley for Pain allegedly associated with his wound

Defense Themes: The defense focused on Mr. Coley’s 10 most recent Hospitalizations leading up to his coccyx skin wound and his 20 underlying Comorbidities including a history of cerebrovascular accident, stercoral ulcer, dementia, paralysis, C. difficile, and GERD which contributed to Mr. Coley’s development and eventual worsening of his sacral/coccyx ulcer. The Defense proved that proper interventions were put in place when Mr. Coley was re-admitted from the hospital, but despite these interventions, Mr. Coley experienced an unavoidable “Friction Blister” that progressed to a pressure ulcer and eventually became a Stage IV with suspected osteomyelitis. The jury heard expert testimony that the healing of Mr. Coley’s left and right Buttocks skin wounds, adjacent to his Coccyx sore, was evidence that he was being properly offloaded in that area. The Defense argued that it met FTag 314 by: (1) evaluating Mr. Coley’s risk factors for additional pressure sores, (2) implementing interventions for the prevention of pressure sores, (3) monitoring the impact of those interventions by notifying the physicians of changes in the wound and obtaining new treatment orders such as a wound vac and an infectious disease consult, and (4) revising those interventions.

Overcoming Documentation Problems: The nursing home had lost its wound tracking documentation. However, the Defense argued that any lack of documentation did not mean that there was a lack of monitoring. The staff consistently notified Mr. Coley’s physicians of changes in the wound’s condition, and a wound care physician was tracking the wound on a weekly basis from April 23, 2014 through June 4, 2014. The Defense pointed out to the jury that Plaintiff’s allegations were based on records that were “cherry picked” and it was explained that, in order to get a true and accurate understanding of the interventions such as re-positioning, pain management and wound monitoring by the caregivers, the jury had to look at the entirety of Mr. Coley’s Chart, which was filled with evidence that these areas of care were actually provided.

Jury Verdict: Following the 5 day jury trial, the jury returned a defense jury verdict in favor of both Defendants.

Trial Team: Donna Fudge and W. Benjamin Broadwater of Fudge & McArthur, P.A. were lead trial counsel. Caitlin Kramer, Esq., and Paralegals Amy Bozarth and Julie Christ of Fudge & McArthur, P.A. assisted in the trial.

Defense Experts: Dr. Aimee Garcia (Houston, Texas) and Alexa Parker Clark (St. Petersburg, Florida)

It’s the complex cases such as this one which demonstrate the essential need for synergy between the medical and legal defense teams. ALN Consulting’s team of experts are trained to quickly identify key pieces of evidence that are missing or have been falsified. We can piece together a solid picture from numerous records, giving legal teams a clear path to case resolution.

ALN Consulting is a national provider of medical-legal consulting services, founded in 2002. Our expertise includes, yet is not limited to, medical malpractice, long-term care, product liability, class action/mass litigation, and toxic tort. Contact Us to put our legal nurse consulting experts on your case.