By Nancy Brent, MS, JD, RN

Previously, I have discussed the critical role of nurse expert witness testimony in lawsuits involving RNs, APRNs, or LPNs. However, the credibility of such testimony can be challenged for various reasons.

In the following case, the defendants in a lawsuit question whether the plaintiff’s expert witness has the proper nursing background to testify.

Wound care after surgery

A female patient in her 70s was hospitalized for surgical repair of a fractured ankle. Post-surgery, she remained in the hospital for eight days and was immobile for most of that time. She was discharged with three pressure injuries.

Four days later, she was readmitted for wound care, surgical debridement to remove infected and necrotic tissue, and antibiotic treatment.

The patient filed a lawsuit against the hospital, alleging negligence in preventing and treating her pressure injuries. She claimed the hospital’s systemic failure to implement preventative measures caused additional injuries.

A wound care-certified RN from a neighboring state testified on behalf of the patient, asserting:

- Familiarity with the standard of care in the state where the patient was hospitalized

- Familiarity with treating hospital patients with wounds

- A professional background in skilled nursing and rehabilitation facilities

- Certification and direct involvement in wound care

The nurse expert testified that the hospital nurses failed to adequately inspect and detect the patient’s skin condition or properly treat the wounds once they developed.

Although the hospital agreed that the pressure injuries occurred due to its nurses’ failure to reposition the patient, it filed a Summary Judgment Motion. It alleged the nurse expert wasn’t qualified to testify under its state law governing expert testimony because she was unfamiliar with hospital-specific standards of care for post-surgical orthopedic patients.

In addition, the hospital alleged the expert couldn’t testify about standards of care for non-nursing staff, such as dieticians and physicians.

The hospital asked that the only claim against the nursing staff that shouldn’t be dismissed was their failure to reposition the patient.

The trial court granted the hospital’s Summary Judgment Motion and dismissed all the patient’s claims with prejudice.

The patient filed a motion asking the court to reconsider its judgment, alleging that it evaluated issues not raised in the Summary Judgment. She also addressed the court’s concerns about the state locality rule and the reliability of her expert's opinions.

The trial court issued an amended order to the Summary Judgment Motion, stating that disqualifying the expert witness was based on a state statute and state rules of evidence.

The patient appealed this decision.

Appellate court decision

The appellate court sided with the patient, determining that the trial court granted the Summary Judgment Motion on grounds the hospital didn’t raise and that the hospital’s argument that the expert couldn’t testify because she didn’t work in a hospital was erroneous.

The expert witness was licensed in the same profession as the hospital’s nursing staff.

Moreover, the hospital presented no evidence that the standard of wound care in a skilled nursing or rehab facility differs from that of a hospital’s post-operative patients.

The expert witness also had experience in preventing pressure injuries in post-op patients.

The appellate court remanded the case for further proceedings.

Talking points of this case

The expert witness’s testimony could prove pivotal, especially given the hospital’s admission of its staff’s failure to reposition the patient.

It’s unclear where the idea originated that standards for wound care would be remarkably different in different clinical settings. However, nursing standards of care apply to all nurses who provide care, including, in this instance, care for pressure injuries.

Remember that if the nurse expert in this case had a different clinical focus — maternal child health, for example — the appellate court may have ruled differently.

For nurses providing expert testimony about wound care, it’s important to:

- Understand the origin of the wound in the context of care standards.

- Stay current on state-specific nursing practice definitions and requirements.

- Maintain up-to-date wound care credentials and certifications.

- Be truthful and precise about your expertise and experience in your testimony.

This case demonstrates how important nurse expert witness testimony can be and the complexities surrounding its admissibility. While the ultimate verdict could be determined by more than just this nurse’s testimony, the appellate court’s decision highlights a critical point: nursing standards of care can apply across various clinical settings when expertise aligns with the case at hand.