Lawyer Monthly Magazine - April 2019 Edition

What are common cases you are instructed on as an expert witness? I usually work as a standard of care expert in Skilled Nursing, Rehab, Transitional Care or Assisted Living Facilities relating to falls, bedsores, elopements and aspiration cases, although I’ve had the occasional case involving scabies or other off the beaten path scenarios. What process do you undergo when first instructed on a case? Can you share with Lawyer Monthly your step by step process? I start with a conflict check to confirm there are no conflicts. Secondly, l like to hear an overview of the case to make sure it is within my scope of practice and whether it is a good fit for my expertise. Once the attorney retains me, I like to start by reading the complaint so I can understand what occurred from the Plaintiff’s point of view. Next, I like to review the evidence - usually a medical record -, in order to gain as much insight as possible about the events. I read all depositions to gain an understanding of how the different players in the case see the events that unfolded. Then I create a timeline documenting pertinent events. Throughout my review, I am looking at resident care from a nursing point of view to see if there have been any breaches in the standard of care. After a thorough review Many people place their trust in the hands of others, and when that trust is broken, things can become troublesome. This rings true for those who place their elderly loved ones in the hands of a caregiver or nursing facility. Cyndy Minnery, an expert in long term care, speaks about the legal cases she sees and what changes could be made to spare those who may be victims from a lack of adherence to a quality standard of care. of all of the records, I come up with my opinions and the basis for each opinion. The attorney who retained me usually wants to hear my opinions prior to moving forward. If I’m asked to write an expert report, I start with an overview of the events from the timeline and try to paint a picture with the evidence so there is a clear understanding of the basis for my opinions. The last thing I do in the report is to write my opinions along with the basis for each opinion to support appropriate resident care was provided or identify a breach in the standard of care . I draw from my experience to support an opinion, but I primarily use the evidence from the case, which is usually the medical record or depositions as the basis for my opinions. You were previously worked as a Director of Quality Compliance in Skilled Nursing and Home Health Care; what compliance issues do you commonly see rise? It’s interesting that the compliance issues 30 years ago LONG TERM CARE are very similar to the issues I see today, which have to do with staffing according to resident needs, properly assessing the resident to determine appropriate placement, observation of the resident for change of condition and providing care that is resident focused to meet the needs of that specific resident instead of using a generic treatment plan. One of the biggest issues that does not change over time is appropriate staffing. As the acuity of the resident changes and the needs are more time intensive, the staffing pattern should be appropriate to accommodate the needs. Do you think the resident’s involvement with their treatment plans has changed over the years? Yes, residents are more aware of their rights. The medical community needs to catch up with this new awareness and respect a resident’s right to make choices. Physicians frequently want to order medication or a test because they think it’s in the best interest of their resident, Standard of Care: How Has the Caring Sector and Its Cases Changed? “One of the biggest issues that does not change over time is appropriate staffing. As the acuity of the resident changes and the needs are more time intensive, the staffing pattern should be appropriate to accommodate the needs.” www. lawyer-monthly .com 86 Expert Witness APR 2019