Who Pays for Never Events?

Who Pays for Never Events?

Have you ever missed a doctor’s appointment only to find that you have been billed for not cancelling within a period of time prior to the appointment?  This is a charge that your insurance company will not pay but you are expected to pay.  The theory behind this is that the missed appointment cost the doctor and his staff time that could have gone to another patient.  Time means money.  Makes sense, right?  We can all understand a sound and logical business practice.  However, let’s suppose you kept that appointment, needed surgery, had your surgery and during surgery, or following surgery,  a mistake was made by the hospital, doctor or surgical team which required you to need ANOTHER surgery to correct the mistake.  Should you be billed for the first surgery AND the surgery necessary to “fix” the “never event” surgery?   Still make sense? Of course not!  This situation is considered a “never event”, one that NEVER should have happened in the first place.  So, who pays for never events? 

Understanding Never Events 

Never Events are serious incidents that are wholly preventable with guidance or safety recommendations that should have been implemented by all healthcare providers. Never Events include incidents such as: wrong site surgery (worked on the wrong area of the body), retained instrument surgery (that means something was left inside the body), pressure sores (ulcers), incorrect medications, or mismatched blood transfusions.  These errors are not only costly and time consuming.  In fact, most can be deadly if not caught in time or left untreated.   

Can A Never Event Happen To You? 

Now that you know what types of things are considered never events, are they realistic? Do they really happen? To answer that, let’s look at a real life scenario.  Patient goes in to have surgery.  Surgery appears to go well until 3 days after patient arrives back home and begins to have signs of infection near the surgical site.  A call to the physician’s office asks patient if he has finished his antibiotics and to call back when he has done so, 2 days later.  By this time, patient’s pain has increased, the site of surgery is inflamed and hot to the touch and he has been admitted to the hospital.  Emergency surgery learns that a foreign object was left behind during the first surgery and has now caused infection requiring a much more extensive surgery.   

The good news with this scenario is that the patient’s first surgery was successful.  However, it did require more surgery he was not expecting which led to a new hospital bill.  Hence, the charges that never should have occurred from a surgery that NEVER should have been necessary.   In this scenario, patient recovers, and is surprised to receive an EOB (“explanation of benefits”) from his insurance carrier refusing payment on many of the charges.  In the column, “Patient Responsibility”, he is left with a bill in the amount of several thousand dollars.

 

Yes, it can happen to anyone.  Although it is rare and there are precautions in place to prevent this type of situation.  A more common type that happens are pressure sores, also known as bed sores.  When a person is confined to a bed or chair for a lengthy period of time, such as recovery from surgery or other illness, the pressure on parts of their body weakens the skin and tissue, causing it to break down.  This can cause sores if precautions are not taken to prevent this.  This is considered a never event because medical staff should be following a regimen to prevent this very thing from happening. 

If this happens, what happens with the bill?

If you, or a loved one find yourself in a situation where a medical event has taken place that should NEVER have, and you feel you have suffered injuries and damages from that event due to no fault of your own, contact our office.   If the initial facts warrant further legal investigation, David and his team will gather information about the patient’s history so that he has a complete understanding of how, and when, this occurred.  He will work with you and others to develop a detailed time line to understand what happened to you or your loved one, any warning signs that were ignored by the hospital or doctor and what could have been done to avoid the problem. In essence, David will show you the negligent acts and omissions that may have occurred and help you understand the case prior to filing any lawsuit.

 

Bedsore Pressure Sore Fact Sheet

Bedsore Pressure Sore Fact Sheet

What is a Bed Sore or Pressure Sore?

Bedsores (also known as Pressure Sores) are areas of damage to the skin and underlying tissue which develops due to prolonged pressure or friction on vulnerable areas of the body.  Typical areas include, the tail bone, sacrum, hips, heels and elbows.  These can develop quickly in a person with reduced mobility, such as a person confined to a chair or bed.  Elderly persons are especially at risk which is why this tends to happen more at nursing homes.

Pressure sores, once developed, can be difficult to treat. Bedsores with red irritated skin left untreated will breakdown, leading to tissue death, then the skin will break open and become infected, and ultimately and tragically leading to death in some cases. Bedsores can also trigger other ailments, such as bladder distension, anemia, and sepsis resulting in an untimely wrongful death.

Grades or Stages of Bed Sores

Stage 1

  • The skin is not yet broken.
  • The skin appears red or discolored.
  • The skin doesn’t blanch when touched.
  • The site may be tender, painful, firm, soft, warm or cool compared with the surrounding skin.

At stage II:

  • The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
  • The wound may be shallow and pinkish or red.
  • The wound may look like a fluid-filled blister or a ruptured blister.
  • It will be very painful to the touch and difficult to keep clean.

At stage III, the ulcer is a deep wound:

  • The loss of skin usually exposes some fat.
  • The ulcer looks crater-like.
  • The bottom of the wound may have some yellowish dead tissue.
  • The damage may extend beyond the primary wound below layers of healthy skin.
  • Patient will experience extreme pain to the site and areas around the site.

A stage IV ulcer shows large-scale loss of tissue:

  • The wound may expose muscle, bone or tendons.
  • The bottom of the wound likely contains dead tissue that’s yellowish or dark and crusty.
  • The damage often extends beyond the primary wound below layers of healthy skin.
  • Damage may extend to joint, tendon and bone.

Complications of Pressure Sores

Bedsores with red irritated skin left untreated will breakdown, leading to tissue death, then the skin will break open and become infected, and ultimately and tragically leading to death in some cases. Bedsores can also trigger other ailments, such as:

  • bladder distension (inability to urinate)
  • abscess (collection of pus in the skin and tissue)
  • sepsis (a build up of bacteria entering the bloodstream and can be fatal)
  • anemia  (lack of red blood cells)
  • cellulitis
  • cancer

Risk Factors

Pressure sores and bed sores are caused by constant pressure being applied to a particular area of skin over a sustained period of time.  The skin of older and weaker people tends to be thinner which means they are at an increased risk if confined to a chair or bed for a prolonged stay.

Areas Most at Risk

People confined to a bed or chair are likely to develop sores in the following areas:

  • tail bone
  • sacrum
  • hips
  • heels
  • elbows

Prevention of Pressure Sores

Those in the position or capacity of caring for someone who is confined to a chair or bed for any period of time, should be aware that there is a risk of pressure sores.  Relieving pressure by reducing the amount of time that the pressure is applied to that area is paramount.  There must be a plan that includes the following:

  • position changes
  • supportive devices
  • skin care
  • regular checks for any warning signs
  • proper dietary and hygiene habits

 

Warning Signs of Pressure Sores

When a person is bedridden or confined to a chair, it is necessary to check daily for early warning signs.  Prevention is key.   These signs include:

  • Red/blue/purple or other discoloration in the skin especially in the high risk areas.
  • Torn or swollen skin in those same areas
  • Signs of infection such as skin heat, cracks, wrinkles, swelling, redness, etc.

Treating Pressure Sores

Treatment from the onset of pressure sores is critical.  If treatment can begin during the initial stage, there is a great change that it will not advance further and develop into a potential life threatening situation.

  • position changes
  • special cushions, bedding or mattresses that help reduce pressure
  • dressings and bandages on the affected areas
  • regular and thorough cleaning of damaged areas
  • lotions, medications or creams to help any damage to the skin
  • surgery, if necessary

Where to Get Help

If your loved one is in a place where they are suffering from bed sores or pressure sores, reach out to your own doctor.  If the wound is severe, you may need to get the patient to the hospital for immediate care and treatment.

Legal Options

There are Federal and State laws to protect patients at hospitals, nursing homes and other medical facilities.  A victim or family may initiate a lawsuit.  There are a variety of causes of action to pursue a lawsuit, including post-mortem, based upon negligent acts and omissions, nursing home abuse and neglect, wrongful death and/or medical malpractice.

For More Information on Bed Sores or Pressure Sores, Contact Us Online Here

 

Can You Sue for Bedsores or Pressure Sores?

Can You Sue for Bedsores or Pressure Sores?

Bedsores and pressure sores should never happen while in a hospital, nursing home or other facility.  The bedsore develops due to prolonged pressure or friction on vulnerable areas of the body.  Typical areas include, the tail bone, sacrum, hips, heels and elbows.  Bedsores with red irritated skin left untreated will breakdown, leading to tissue death, then the skin will break open and become infected, and ultimately and tragically leading to death in some cases. (See our Bed Sore Fact Sheet for more Info) Bedsores can also trigger other ailments, such as bladder distension, anemia and sepsis, sometimes resulting in a wrongful death. It is important to understand that bedsores are 100 percent preventable, is a sign of negligence and yes, you can sue for the damage and pain that bedsores or pressure sores cause.

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The Law

There are federal laws in place to protect patients of a nursing home or hospital.  These laws were designed to ensure that the residents or patients get proper care.  In addition to the federal laws, states have enacted their own laws to protect patients.  In Georgia, we utilize the following statutes:  O.C.G.A. §31-8-103 through §31-8-121, collectively known as the “Bill of Rights for Residents of Long-Term Care Facilities”.

It is important to note that bedsores are not the fault of the patient or the resident.  The patient is completely dependent on the staff who has the medical training to care for him or her.  It is the caretaker’s job to make sure the patient is turned regularly if the patient is immobile.  This relieves pressure and prevents the sores. Proper cleaning is also paramount in these situations.  Bedsores are caused by nursing home and hospital negligence.  The patient is the victim.

As such, under certain circumstances, the existence of bedsores on someone who is at a care facility is often enough for a lawsuit.  Consider these questions that will be part of the initial legal investigation:

  • Was your parent or other loved one in need of total care and assistance of all aspects of daily living?
  • Did the staff fail to provide basic hygiene and allow the bedsores to become infected?
  • Did the staff fail to alert a doctor or medical staff for treatment (covering with a bandage for an “out of sight, out of mind approach”)?

How should Someone Proceed Who Believes They Have a Lawsuit?

If you or someone you love is suffering or has been suffering from these types of sores, Contact Us

Attorney David Crawford has the experience and knows exactly where to start.  If the initial facts warrants further legal investigation, David and his team will gather information about the patient’s history so that he has a complete understanding of how, and when, this occurred.  He will work with you and others to develop a detailed time line to understand what happened to your loved one, any warning signs that were ignored by the hospital or nursing home staff and what could have been done to avoid the problem. In essence, David will show you the negligent acts and omissions that may have occurred and help you understand the case prior to filing any lawsuit.

 

Understanding and Recognizing Elder Abuse

Understanding and Recognizing Elder Abuse

In general, elder abuse is a term referring to any knowing, intentional, or negligent acts or omissions by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. Federal and State surveys in the mid-‘80s determined that the standard of living in nursing homes across the country was literally below that of our prisons.  This eventually led to a series of Federal Regulations, which actually set the standard of care for nursing homes in every state.  They are contained in 42 C.F.R Part 483 and the most succinct listing was published in the Federal Register on September 26, 1991. Legislatures in all 50 states have passed some form of elder abuse prevention laws.  These regulations are then supplemented through the state’s administrative codes.  Here in Georgia, we utilize the following statutes:  O.C.G.A. §31-8-103 through §31-8-121, collectively known as the “Bill of Rights for Residents of Long-Term Care Facilities”.

Is it Elder Abuse?

Some forms of abuse are easier than others to verify.  Take for example, physical abuse.  As our parents get older, they tend to bruise for easily.  They may fall, breaking bones as they become more fragile.  This is part of the aging process unfortunately and not always indicative of anyone harming them.  That being said, however, this makes it a bit easier to cover those injuries when abuse is taking place.

Here’s an example of how that can play out.  Ellen’s father was no longer able to live alone.  Ellen worked full time so she found a suitable long term home close to her.  She checked on him and visited him several times a week and brought him home on weekends.  Ellen began to notice that he had bruising along his arms and was very tender when she touched him to help him up.  When she asked him, he refused to talk about it.  The nursing home said he had stopped using his walker and was falling more often.  Ellen spoke to him about it and reminded him to use the walker.  How do you know what is happening in a case like this?  This is a tough one for sure.  To find out, Ellen took him to her physician and had him examined.  The doctor determined that the injuries were from sustained and repeated abuse.  Mostly from someone pulling, tugging on him which ultimately resulted in a broken arm.

Does Neglect Count as Abuse?

Neglect is a form of abuse.  Leaving someone to lay in the bed where they develop wounds or bedsores that are not treated is abuse.  Even medical personnel can be held legally responsible if they are not taking care of the patients as they should.  If it determined to be their duty to care for a patient and they abandon that duty, they can be held liable.

The most common types of nursing home claims are based upon:
(1)    pressure sores (sometimes referred to as bedsores);
(2)    malnutrition;
(3)    dehydration;
(4)    falls;
(5)    physical or mental abuse;
(6)    improper medications;
(7)    failure to diagnose an illness or change in condition;
(8)    chemical or physical restraints;
(9)    unsanitary conditions, and assaults by other residents;
(10)  all of which are usually related to under-staffing at the defendant’s facility.    


Bedsores are caused by nursing home and hospital negligence.  The bedsore develops due to prolonged pressure or friction on vulnerable areas of the body.  Typical areas include, the tail bone, sacrum, hips, heels and elbows.  Bedsores are 100 percent preventable.  Bedsores with red irritated skin left untreated will breakdown, leading to tissue death, then the skin will break open and become infected, and ultimately and tragically leading to death in some cases. Bedsores can also trigger other ailments, such as bladder distension, sepsis, and anemia.  

Initial questions in the legal investigation are:
Did the resident need total custodial care and assistance with all activities of daily living?;
What if the staff failed to turn the patient/resident every two hours and bedsores develop?;
What if the staff fails to provide basic hygiene and the bedsores become infected?;
What if the nurses never call the doctor and simply cover the bedsores with bandages as an “out of sight, out of mind approach”?;
What is the size, measurement of each bedsore? And at what stage is the bedsore? (Stage 1: most superficial, redness, skin irritation; Stage 2: blistering of the skin; Stage 3: involves the whole skin, often with infection; Stage 4: the deepest of skin breakdown, usually extending into the muscle, tendons and often bone is exposed; Stage 5: death);
What if the CNAs are so understaffed and overwhelmed that they cannot take the time to feed the patient/resident and he/she loses 30 lbs. in two months? (Dehydration usually follows malnutrition);
What if the resident can no longer feed themselves and needs to be hand feed every meal?

Family members are usually aware of acute problems such as falls, which result in a clear physical injury requiring hospitalization.   Malnutrition, dehydration, medication errors and illegal restraints are harder to detect but become evident from a review of the records by an expert who is familiar with nursing home standards. 

Can It Be Stopped?

Absolutely.  If the actions are confirmed and the person(s) are determined, this can absolutely be stopped.  There is no need to allow this type of behavior to continue towards your loved ones.  Georgia’s law specifically protects our vulnerable population and there are ways to not only stop this behavior but to punish those who are abusing them.

If you are concerned about someone you know who may be abused or neglected in a nursing home, hospital or even in their own home at the hands of a health care worker, contact us now.  We can help.  David Crawford has the experience, the passion and the legal knowledge to work with you and guide you towards a solution for you and your family.

Frequently Asked Questions During a Civil Deposition

Frequently Asked Questions During a Civil Deposition

Under the GA Civil Practice Act, opposing counsel has the right to take your deposition upon proper notice. As a party to civil litigation you may be required to appear at a specific time and place to give your oral testimony under oath and taken down by a court reporter for transcription.

An attorney may also delve into more specific details and that can be overwhelming, especially when you have been involved in an accident.  This is why it is important that you are represented by an experienced attorney.  If you have been in an accident or are about to undergo a deposition for any type of litigation, having the right attorney can help ease your mind considerably about the process.  Contact us if you need legal representation.  We will work with you to understand your situation and help you get any compensation to which you may be entitled.  

Key Deposition Pointers

Key Deposition Pointers

Key Deposition Pointers

A discovery deposition is the oral testimony of a witness taken down under oath and typed in a booklet format. Depositions are often taken in personal injury cases seeking money damages. Your attitude, truthfulness and appearance at the deposition can either help or hurt you.

Have you received a summons or subpoena to give a deposition?  Contact us.  We can discuss the situation and together determine if you need an attorney to represent you in this matter.