Wound Care: Legal Issues for Providers
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Wound care is a risky business these days. Providers who render wound care services are at risk for:
- Liability for negligent wound care
- Violation of fraud and abuse prohibitions based on substandard wound care
- Liability for abandonment when wound care services are discontinued
- De-certification from participation in the Medicare/Medicaid Programs
- Disciplinary action by state licensure boards with regard to individual practitioners who provide substandard wound care services
- Indictment and prosecution for criminal neglect
- Standards of care are rapidly changing with regard to wound care. Many providers can remember the days when practitioners assumed that patients who were chronically ill would develop wounds. Now there are attorneys for patients and their families who would like to apply a standard of care that states that when patients develop wounds, it is due to providers' negligence. This latter standard is certainly inappropriate if, for no other reason, than because it is not yet known with certainty what causes all wounds, what will work to heal wounds, and why some wounds heal and others do not. Nonetheless, when standards of care change rapidly, providers are always at increased risk.
- Not all providers of wound care services have kept up with recent changes in standards of care. For example, according to the guidelines of the Agency for Health Care Policy and Research (AHCPR) and other national organizations, the routine application of Betadine is no longer an acceptable treatment for pressure ulcers. Yet practitioners still routinely receive orders from physicians to apply Betadine; a treatment that is clearly outside applicable standards of care.
- Providers are at risk for wound care services because there has always been a "folk medicine" component to wound care. Many staff members have encountered orders for wound care that included shortening, liquid antacids, mixtures of sugar and water, and ointment intended for use on cows' udders to prevent chafing when they are milked. A practitioner, for example, once described a wound as a "three-bear wound." When asked about the meaning of this term, she explained that the doctor ordered staff to fill the patient's wound with honey, and that it took three plastic bears worth of honey to do so! Hence, a "three-bear wound." Despite some recent information about the possible benefits of Medihoney, treatment with honey bought in the grocery store is certainly contrary to national standards of care.
- Finally, providers are at increased risk for wound care services because wounds look and smell terrible, especially to those who do not routinely encounter them; including patients, their families, judges, and jurors. From a practical point of view, it is hard for those unfamiliar with wounds to understand how patients could have such awful wounds unless someone has been negligent.
©2020 Elizabeth E. Hogue, Esq. All rights reserved.