Pressure injury and bedsore expert witness

Pressure injury cases are won and lost on one distinction: avoidable or unavoidable. The federal standard at F686 does not require that no resident ever develops a wound. It requires that a resident who enters the facility without pressure ulcers does not develop them unless they were clinically unavoidable, and that a resident who arrives with a wound receives the treatment and services necessary to promote healing and prevent infection and new ulcers.

That makes the record trail decisive. A defensible chart shows risk identified on admission, interventions ordered and delivered, weekly wound measurements that track in one direction, dietitian involvement when intake drops, and physician notification when the wound worsens. A problematic chart shows a Braden score that never changes, repositioning grids with identical entries across three shifts, wound photos that skip two weeks, and a Stage 4 that appears in a hospital record before it appears in the facility record.

The wound itself also has to be staged correctly. Deep tissue injuries, unstageable eschar, moisture-associated skin damage, and Kennedy terminal ulcers are different findings with different implications, and mislabeling is common on both sides of a case.

Records to request

Braden or Norton scale scores from admission forward
Skin assessments on admission and weekly skin checks
Turning and repositioning records, plus the assignment sheets for those shifts
Wound assessments with measurements, staging, and photographs
Treatment administration records (TAR) and wound care orders
Support surface and mattress orders, delivery records, and maintenance
Dietitian assessments, weight records, albumin and prealbumin labs
MDS Section M (skin conditions) and Section K (nutrition)
Physician, NP, and wound consult notes
Hospital admission records describing the wound on arrival
Facility skin and wound policy in effect at the time

Screen this case Request CVs

Federal requirements experts apply

Tags from the CMS State Operations Manual Appendix PP, with the 42 CFR Part 483 citation. Whether a regulation establishes the standard of care is a question for your venue.

Tag	Requirement	Citation
F686	Treatment and services to prevent or heal pressure ulcers	42 CFR 483.25(b)(1)
F684	Quality of care	42 CFR 483.25
F692	Nutrition and hydration status maintenance	42 CFR 483.25(g)
F580	Notify of changes	42 CFR 483.10(g)(14)
F641	Accuracy of assessments	42 CFR 483.20(g)
F726	Competent nursing staff	42 CFR 483.35(a)(3)

Appendix PP is revised periodically. Confirm the version in effect on the date of the incident.

What counsel should investigate

Was the resident scored as at risk on admission, and did the interventions match that score?
Do the repositioning records show real variation, or the same entries repeated?
When the wound advanced a stage, how long until the physician and family were told?
Was a dietitian involved once weight or intake dropped?
Did the ordered support surface actually arrive, and is there a delivery or maintenance record?
Does the facility's unavoidability argument address every element of F686, or only comorbidities?

Which expert fits

Wound care certified nurse or nurse practitionerStaging, healing trajectory, treatment adequacy, and whether the wound was avoidable.
Long-term care RN or Director of NursingAssessment, care planning, delivery of ordered interventions, and documentation standards.
PhysicianCausation, comorbidity contribution, infection and sepsis sequelae, and end-of-life skin changes.
Registered dietitianNutritional risk, protein and calorie adequacy, and the facility's response to weight loss.

Panel members who work these cases

Matched from the publicly profiled ECS panel. Availability and conflicts are confirmed on the call.

Larissa J. Lucas

Physician, Registered nurse

Natalie McGonagle

Registered nurse

Tammy Starion

Registered nurse, Licensed administrator

Caroline Long

Registered nurse

For the paralegal handling this

Wound photographs and the TAR are the two items most often missing from a production. Ask for them by name, and ask for the mattress or support surface invoice. If the hospital staged the wound differently than the facility, flag that on the screening call.

Paralegal resources Records checklist