Nurses on causation in bed sore cases: Another court opens the possibility

by • July 1, 2009 • UncategorizedComments Off on Nurses on causation in bed sore cases: Another court opens the possibility2756

By Rose Clifford, editor

© 2009 The Medical-Legal News

• The Gist This newspaper has reported on nurse causation testimony in bed sore cases before, most notably in Gaines v. Comanche County from Oklahoma.
On a more clinical level, note that this case follows the golden rule that “if it was not documented, it was not done” with respect to whether the nurses turned the plaintiff every two hours as required.
— RC

Another bed sore case has found some favor in the permitting of nurses to testify to causation for pressure ulcers.
In a Louisiana case, a man developed pressure ulcers in the ICU after a surgery. He sued a hospital and its nursing staff. The plaintiff picked a nurse as a causation expert regarding the ulcers.
The trial court agreed with the defendant hospital that a nurse could not speak to causation on the issue, and granted a summary judgment motion in favor of the hospital.
The plaintiff appealed. The nurse witness was Julia B. Fields, RN.
The appeals court put a different spin on Fields’ causal opinion abilities, or at least enough of a favorable question was raised about Fields to remand the case back to trial and give Fields a proper admissibility hearing.
Fields had said in a deposition that she could not testify to the cause of pressure ulcers, but she also said that, “in her opinion, the most probable causes of [the plaintiff’s] pressure ulcers were his supine position for two days and not being turned by the nurses.” She said that the hospital’s nurses violated their standard of care by not turning the high-risk plaintiff every two hours after surgery and said that nowhere in the nursing notes was it documented that the nurses ever changed the plaintiff’s position.
A physician witness for the hospital stated in his affidavit that, due to the plaintiff’s poor physical condition, which included anemia and heavy blood loss, he would have developed ulcers anyway.
The plaintiff challenged the trial court on appeal, armed with “a copy of the National Pressure Ulcer Prevention Advisory Panel’s summary regarding pressure ulcer prevention points, and the position statement of the American Association of Legal Nurse Consultants regarding expert nursing testimony.”
The court noted that though Fields had debunked herself as a causation witness, Fields “further stated that the issue at hand is a nursing issue… that the nursing staff… failed to timely and accurately assess… skin integrity, that [plaintiff] was not repositioned even once during the first 24 hours following surgery,” and that the hospital did not follow “the statement of the National Pressure Ulcer Prevention Advisory Panel that bed-bound patients be repositioned every two hours and that a written repositioning schedule be used.” Fields also noted that the hospital nurses did not follow the hospital’s own rules for pressure ulcers.
The appeals court then held Fields to Louisiana’s expert witness standards, which follow the federal Daubert standards. Fields’ abilities evidently were impressive enough to the court, based on her methodology, that the court said: “…the decision in Daubert concerned the admissibility of the expert’s opinion based on methodology used and not on his or her qualification as an expert in the area tendered, which… is the same issue raised herein.”
The court, relying on a Cheairs v. State case from Louisiana, also noted that “experience alone is normally sufficient to qualify a witness as an expert.”
The appeals court then remanded the case back to trial for a proper Daubert hearing concerning Fields.
The case was Guardia v. Lakeview Regional Medical Center and Nursing Staff, 2009 WL 1270001 (La.App. 1 Cir.).

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