I have testified or reviewed cases in the following states.
(light green):

I have consulted or testified in cases involving these issues:

• Pressure sore development, including stage IV severity, infection, Osteomylitis, missed treatments, assessment, and supportive documentation
• Sexual misconduct, assault, and rape
• Managing residents with disruptive, combative, violent, and medically non-compliant behavior
• Falls resulting in fractures, lacerations, bruises, and debilitating injury. Evaluating the effectiveness of assessment, documentation, and resident supervision related to falls
• Investigating, correcting, and reporting resident injuries and trauma of unknown origin, including repetitive incidents. Determining whether injuries and trauma of unknown origin were reported to the state agency as required
• Providing and documenting resident ADL’s (activities of daily living)
• Elopement and wandering injuries
• Development of joint contractures, loss of mobility, and functional loss of extremities
• Physical / chemical restraint use, including bed-rail strangulation, psychoactive drug use, adaptive equipment, positioning devices, and use of illegal restraining methods
• Door alarm systems to prevent elopement, and personal alarm devices for preventing falls and mobility injuries
• Involuntary seclusion and corporal punishment
• Significant weight loss, dehydration, and malnutrition
• Post-admission infections including sepsis
• Post-admission invasive procedures; catheterization, feeding tubes, and IV’s
• Burn injuries and death resulting from excessive hot water (scalding), and cigarette smoking.
• Evaluating causative factors including resident supervision
• Providing therapeutic and rehabilitative services
• Medication omissions and errors, including failure to monitor medication and address harmful side effects
• Pain assessment and clinical management
• Hospice care
• Obtaining, transcribing, and carrying out physician orders
• Frostbite and cold injury arising from elopement
• Ordering diagnostic testing, and addressing negative diagnostic results
• Assessing and taking action when "significant resident condition changes" occur
• Timely reporting of "significant resident condition changes" to attending physicians and resident representatives
• Physicians: availability, timeliness of visits, communication with nursing staff, documentation, and treatment
• Medical Director duties, responsibilities, and effectiveness
• Resident supervision associated with a decline in health, injury, or death
• Altercation, destruction, and falsification of resident records
• Nursing assessment and judgment issues associated with resident trauma, injury, and death, especially emergency situations which warrant hospitalization
• Care-giving staffing levels and use of temporary nursing agencies
• Admission practices, representation of facility services, and level of care capability
• Conducting criminal background checks and verifying employment references
• Credentialing medical staff, clinicians, and outside practitioners
• Employee training, orientation, and on-going in-service education
• Providing adequate equipment, supplies, and a safe resident environment
• Providing qualified staff, specialized equipment, and outside resources based on resident issues identified in the MDS (minimum data set) and care plans
• Ownership / Governing Body: hiring competent Administrators, establishing reasonable budget expectations; and, affording Administrators the necessary day to day autonomy to operate the facility
• Competency of Administrators, Nursing Directors, and facility staff
• Federal / state survey violations resulting in actual harm, substandard quality of care, repeat deficiencies, immediate jeopardy, fines, and sanctions
• Patterns of regulatory noncompliance
• Implementing internal policies, procedures, and protocols
• "Quality improvement" programs and initiatives
• "Safety Program" programs and initiatives, including resident incidents and accidents
• "Avoidable" versus "unavoidable" harm determinations based on Federal guidelines
• Resident rights violations including the failure to address resident / family grievances
• Breech of contract based on conveyances made in the facility admissions agreement
• Filing a "false claim" based on facilities which bill for and receive Medicaid / Medicare reimbursement for residents who were abused and neglected