As a Houston, Texas medical malpractice lawyers, I handle a lot of cases where the health care provided by medical specialists is at issue.
Hospitalized patients have an attending physician who is responsible for overseeing their care. Surgeons sometimes fill this role for surgical patients, at least until the operation has been completed. After that, a hospitalist (often an internal medicine doctor who has a hospital-based practice) often takes over. In other hospitals, a hospitalist is assigned as the attending physician to each newly admitted patient, from the get-go.
The attending physician usually sees the patient daily, makes medication and other orders to the nursing staff and therapists, and decides when to discharge the patient from the hospital. In addition, the attending physician plays the important role of ordering consultations with medical specialists.
Medical specialists come in all shapes and sizes, like pulmonologists (respiratory system), cardiologists (heart), neurologists (brain, spinal cord, and nervous system), hematologists (blood), infectious diseases, hepatologists (liver), physical medicine and rehabilitation (rehab) and on and on.
For many patients who are hospitalized after a surgery or for an extended period time, wound care specialists can play an important role.
Wound care specialists
While there are many types of wounds, the most common ones encountered in a hospital setting are surgical wounds (incision sites) and pressure ulcers (wounds that form from too much pressure on a spot, causing skin breakdown and even death).
Once pressure ulcers (also called decubitus ulcers, bedsores, or pressure sores) form, they can take a lot of time and treatment to heal. This is why there is so much emphasis on wound prevention.
Wound prevention is largely a function of a hospital’s nursing staff. Most hospitals have standard policies, procedure, and protocols that allow nurses to undertake preventive measures without a specific order from a physician. These measures often include things like turning the patient from side to side every two hours, using a certain elevation for the head of the bed, using skin barrier ointments to protect the skin from moisture, transfer sheets and maneuvers to minimize shear and friction on the skin, protecting the heels and bony prominences, and using specialty beds or mattresses that relieve pressure (including things like low air pressure alternating pressure mattresses). In addition, the attending physician, in performing a head-to-toe assessment of the patient, will often make additional orders to the nursing staff for wound prevention.
In addition, hospital nurses are expected to evaluate patients constantly, and at least each shift to establish a baseline of skin integrity and spot any deterioration. The standard of care requires using an accepted, standardized tool, like the Braden Scale, for these assessments. When new wounds are identified, they need to be described in terms of dimensions (length, width, and depth), color, and whether discharge and odor are present, among other things.
Then, importantly, the nursing staff needs to inform the attending physician or, if a wound specialist is already involved, the wound expert directly.
Today, I deposed a Houston suburban hospital’s wound care specialist.
In this case, I represent an athletic man in his early 60s who had gone to the hospital for a total knee replacement on one side. He was kept in the hospital for a few days, before being sent to the hospital’s in-house rehabilitation unit. Before getting to the rehab unit, though, he developed a bedsore on his buttocks area.
The hospital nursing staff noted the bedsore, but the records reflect that they did not tell any physician about it. The doctors and nurses in the in-house rehab unit identified the problem and started a poorly-planned and executed treatment plan.
A specialist by any other name
Just because someone claims to be a medical specialists does not necessarily mean they are one.
In the deposition today, I questioned the head of this hospital’s wound care department. He is the only physician in the department, was trained as a pediatrician, never took advanced residency or fellowship training in wound care, and, according to his own testimony, has zero hands-on wound care training in his career.
He was called in as a specialist wound care consultant to see my client on his first day that he was a patient in the in-house rehabilitation unit. Despite the fact that my client was in the hospital for another 12 days, the wound care doctor never bothered to check on him again.
During this time period, the medical records reflect that his pressure wound got worse and worse, and started to discharge foul-smelling pus (purulent material). The nursing staff never told him about these developments or that one of the medications he ordered was unavailable.
The hospital and the wound care specialist “circled the wagons” today in the deposition. The doctor said that no one did anything wrong.
Unfortunately for my client, he was discharged home with an infected sacral bedsore. Not even 24 hours passed before his family had to get an ambulance to take him to a major hospital, where he was quickly diagnosed with an infected Stage 4 pressure ulcer, and taken to surgery for painful debridement to clean it out.
In all, the poor wound care by the physicians, wound care specialists, and nursing staff at the first hospital caused this poor man to be hospitalized for 100 days before the wound finally got under control.
We are here to help
Sadly, this type of story of botched treatments by incompetent medical specialists is all too common. If this type of thing has led to serious injury to your or a loved one, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
__________
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He represents patients and family members in medical malpractice and wrongful death lawsuits against hospitals, doctors, surgeons, and other healthcare providers. In 2017, H Texas magazine named him as one of Houston’s top lawyers.
