Expert selection · 8 min
How to choose between an RN, DON, administrator and physician expert
The most common expert mistake in long-term care is retaining a clinician to answer an operational question, or an administrator to answer a causation question.
Split the case into standard of care and causation
Long-term care cases almost always contain two distinct questions. Did the facility deviate from what it was required to do, and did that deviation cause this harm. Different disciplines answer them, and a single witness who attempts both is easier to attack on qualification.
What each discipline is actually for
| Discipline | Answers | Typical topics |
|---|---|---|
| Licensed nursing home administrator | Operational and regulatory standard of care | Staffing sufficiency, policies, supervision systems, abuse reporting, survey history, corporate direction |
| Director of Nursing | Nursing systems standard of care | Assessment, care planning, skill mix, supervision of nurses and aides, escalation |
| Long-term care registered nurse | Bedside nursing standard of care | Repositioning, monitoring, documentation, notification, medication administration |
| Wound care certified nurse or NP | Wound standard of care and avoidability | Staging, treatment, healing trajectory |
| Physician or geriatrician | Causation and clinical judgment | Whether earlier action changed the outcome, comorbidity, medication effects |
| Registered dietitian | Nutrition standard of care | Weight loss, intake, supplementation |
| Physical or occupational therapist | Function and safety | Transfers, gait, assistive devices |
| Assisted living administrator | State-licensed community standard of care | Admission and retention, service plans, level-of-care pricing |
Worked examples
- Unwitnessed fall with a hip fracture and thin post-fall documentation: administrator or DON on supervision and response, physician on causation if the mechanism is disputed.
- Stage 4 sacral wound in a resident admitted with intact skin: wound care nurse on avoidability, RN or DON on delivery of interventions, physician if sepsis or death followed.
- Elopement from a secured unit: administrator on security systems and policy, dementia care nurse on assessment and placement.
- Resident-on-resident assault: administrator on reporting, investigation, and hiring, DON on behavior care planning.
- Assisted living resident who declined for months without a service plan change: assisted living administrator first, RN second.
Questions worth asking any candidate
- When did you last work in a facility of this type and size, and in what role?
- Have you testified for both plaintiff and defense, and in what proportion?
- How many times have you been deposed, and has your testimony ever been excluded?
- Which state regulations, in addition to the federal requirements, are you comfortable addressing?
- What in this chart would you expect the other side to use against our theory?
Conflicts and backups
In a niche field, the same experts appear repeatedly. Run the conflict check against the facility, the operator, the management company, and any related entities, not just the named defendant. Ask whether a second qualified expert in the same discipline is available if the first drops out, because an expert lost close to disclosure is a scheduling emergency.
This page is educational and is not legal advice. Regulatory citations reflect CMS State Operations Manual Appendix PP and 42 CFR Part 483; confirm the version in effect for your matter.
