Memorable CLNC® Cases

This Home Health Care Case Gave Me the Kick to Market My CLNC Business

by Patrick Stonich, RN, BSN, BS, CLNC

Patrick Stonich - Certified Legal Nurse Consultant

My most Memorable CLNC® case was one of the first cases I reviewed as a Certified Legal Nurse Consultant. I was hired by a plaintiff attorney on a home health agency case. I was both nervous and confident since my background is operating a Medicare Certified home health agency.

This case involved a post cardiac surgical patient who was in her mid-60s. Following coronary bypass surgery and rehabilitation in the hospital she was transferred to home health for post-surgical care. The discharging physician ordered skilled nursing for wound care, medication management and care coordination with therapy services. The patient was prescribed new medications on discharge and required extensive teaching related to signs and symptoms of infection, new medications and new diet. Physical therapy was also ordered for cardiac rehabilitation. The patient had wounds from the graft site on her upper thighs as well as bilateral forearms. Per the operating room report, the surgeon had difficulty grafting. The patient also had one fall in the hospital, contracted C-Diff and was deconditioned on discharge.

This case was memorable because it was not only my first case, but also because I was comfortable with the specialty. I don’t want to say it came easy to me, but it felt great speaking and writing about a specialty I was so confident about.

The accepting home health agency developed a plan of care on admission. Three weeks later the patient fell at home, her husband called 911 and she was transferred to the hospital. On admission it was determined that the patient was septic from infected graft sites. She died 48 hours later in the hospital.

After extensive review of the medical records I determined that the home health nurse only saw the patient two times, never initiated therapy and failed to coordinate care with the discharging physician. Documentation was altered and late entry documentation suggested that the nurse falsified notes. The nurse indicated that the patient and husband refused further visits. It was my opinion that the agency supervisor did not properly train the staff and failed to appropriately adhere to Medicare standards. The documents that were completed by staff didn’t match the clinical picture. Something was not syncing.

I requested hospital notes, physicians’ notes, nurses’ notes and Medicare submission documents. After all requested records and documents were produced I identified numerous deviations from the standards of care. The home health staff failed to properly consent the patient and failed to complete medication reconciliation. Additionally, coordination with the ordering physician was non-existent and orders were not followed. The agency also billed Medicare for visits that did not occur and failed to properly train the staff.

My CLNC training and systematic way of approaching this case laid out the whole picture and the case was settled on behalf of the plaintiff. While the settlement didn’t bring back the husband’s wife, it did give him closure over his concern that he had done something wrong. He used the settlement to continue his wife’s passion for horses and kept the farm going in her honor.

This case was memorable because it was not only my first case, but also because I was comfortable with the specialty. It gave me the confidence to speak up and express my opinions. I don’t want to say it came easy to me, but it felt great speaking and writing about a specialty I was so confident about.

I received a fantastic thank you letter from my attorney-client and referrals to other attorneys in the firm for several more cases. This case also gave me the kick to market more, keep current attorney-clients happy and look for other Certified Legal Nurse Consultants to subcontract with on cases outside of my specialty.

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