Nursing expert witness advises on infection caused by lack of wound care

A nursing expert witness advises on a case involving a patient who required additional surgeries due to infection from lack of wound care. Plaintiff was 67 when she was admitted to a skilled nursing facility for recovery after her spinal surgery. The neurosurgeon who performed the operation left detailed discharge instructions for the nursing staff to care for plaintiff’s wounds. She was never taken to the surgeon for removal of the staples. Instead, one of the nurses removed several staples, despite evidence of infection or any instructions to do so. The wound reopened, became infected and required additional surgeries to drain and repair.

Plaintiff filed a medical negligence case in Pennsylvania Court of Common Pleas against the nursing center. She alleges the failures of the nursing staff resulted in prolonged recovery and extensive damages.

Question(s) For Expert Witness

1. Was adequate nursing care and service provided?

2. Did the nursing staff deviate from applicable standards?

Expert Witness Response

It is my professional opinion, with a reasonable degree of certainty, that the nursing care provided to plaintiff while a resident at defendant nursing home did not meet the standard of care and caused her actual harm. Nursing personnel had a duty to plaintiff, did not meet that duty, and as a result, she was harmed and required additional surgery for her infected surgical wound and placement in a rehabilitation facility rather than returning home after her rehabilitation at the nursing home.

When initially admitted, it was well-documented and known to the staff, including nursing staff, that plaintiff was at the facility for care of her surgical wound on her spine, as well as rehabilitation with occupational and physical therapy. She was to return home with her husband after the course of therapy and healing of her incision.

Instead, due to the negligence of the nursing staff, plaintiff developed an infection of her incisional area that went unrecognized by the nurses. This failure to act, directly resulted or contributed hospitalization to treat the infection, multiple surgeries to clean, or debride, the incisional area, the application of a wound VAC to assist in healing the wound, long term use of antibiotics and a continuance of pain and discomfort. Additionally, the explicit instruction from the neurosurgeon was for the plaintiff to return to the doctor's office approximately 7 days after her admission to the nursing home. This was never done. Instead, a registered nurse at defendant nursing home took an invalid order from a registered nurse and removed some staples, despite evidence of abnormality of the incisional site.

The nursing staff failed in all aspects of care for a surgical wound. They did not monitor the area every shift, particularly when there were signs of possible infection very early. Nor did nursing staff contact ANY physician, either the primary, but most importantly the neurosurgeon. They allowed the clinical signs and symptoms of an infection to linger, unobserved by a physician and untreated. Additionally, it was abundantly clear in the transfer order form from the hospital that the nursing home nurses were to contact the neurosurgeon in 7 days from admission to make an appointment for an assessment of the incisional area and removal of the staples. They did not follow these instructions, but instead, a nurse took it upon her own discretion, knowing the incisional area was not normal in appearance, to decide which staples to remove, after which the incision opened.

The failures of the nursing staff regarding all aspects of care, treatment, accurate assessment, monitoring of the incision and notification of the physician at the first sign of anything abnormal was egregious and represents a disregard and deliberate indifference in the care of plaintiff. It is because of these failures that her condition deteriorated and required extensive surgeries under general anesthesia, prolonged hospitalization, a functional decline in her condition and prolonged recovery.

The expert has more than 45 years of nursing experience, most of which was working for the state Department of Health evaluating the quality of nursing care.