What happens when a patient cannot move on their own and depends on hospital staff to prevent a bedsore? On this episode of Justice with Dr. V, Dr. Vigna speaks about patient safety, wound care, and the bedside attention that vulnerable patients need. Drawing on her experience in hospital care, Dr. Vigna discusses nutrition, pressure injury prevention, nurse education, and why patients need someone who can speak up for them. He also discusses how staffing and financial pressures can affect the care patients receive, including concerns about private equity in healthcare. The conversation closes with Dr. Vigna path from medicine to law and the role legal accountability can play when standards of care are questioned.
If someone you love is hospitalized and unable to move independently, this episode offers questions to consider about their care and the prevention of pressure injuries.
Learn more about Vigna Law Group: https://vignalawgroup.com/
This video is for educational purposes only.
#JusticeWithDrV #BedsorePrevention #PatientSafety
Greg Vigna, JD, MD | Vigna Law Group 8939 S. Sepulveda Blvd. Suite 102 Los Angeles, CA, 90045 817-809-9023 | vignalawgroup.com
B
en C Martin | Ben Martin Law Group
3500 MAPLE AVE. SUITE 400
DALLAS, TEXAS 75219
(214) 761-6614 | bencmartin.com
There's plenty of money that goes into hospitals when these private equity companies get involved. They are sucking the money out. They're not spending money on nursing retention. You're not paying those who are performing. And it leads to understaffing. It leads to patient burnout. And over time, doctors lose their voice.
Justice with Doctor Vigna. Solo edition. Hello, I'm doctor Vigna.
00;00;31;02 - 00;01;15;04
Speaker 1
I'm a doctor and a lawyer. My experience in hospitals went from the 1990s to the Covid era, and I enjoyed taking care of patients in hospitals. I felt that was my special skill of keeping patients safe when they were in the hospital, receiving the standard of care and being available 24, seven, seven days a week. I rarely took vacations because I understood that patients get sick on Saturdays and Sundays, and there needed to be one doctor who was available, who knew the knew the patient when they came into the hospital and should follow those patients throughout their hospitalization to be able to understand, identify complications as they occur.
00;01;15;06 - 00;01;48;26
Speaker 1
And one complication is bedsores. And as a doctor, you know, I was fortunate the hospitals where I practice, we were very attentive on skin management because we understood that these problems are largely preventable and avoidable. So bedsores or something that I kind of got good at in terms of how to prevent and how to treat. And from a treatment standpoint, I learned how to manage patients with serious grade for bed sores that kind of sore that you can put your fist in.
00;01;48;28 - 00;02;27;27
Speaker 1
And I manage patients before surgery. After surgery, Bari antibiotics selection, keeping them safe to ensure that they were getting the care they needed to avoid complications following a flap and I provided this level of care at a long term acute care hospital and in Ruston, Louisiana. And we provided 2 to 300 flaps over a ten year period. I was fortunate that we had two plastic surgeons who enjoyed saving people's lives, and they provided the technical skills of closure debridement.
00;02;27;27 - 00;03;01;14
Speaker 1
I managed everything else, you know, made sure that people who were malnourished would get the nutrition they need, either by mouth or by feeding tube. We would have them managed on clinic run beds so that they could get rest, be able that you know, tolerate their nutrition, get their wounds ready for surgery, and then after their flap would manage their drains to ensure that any kind of bleeding or hematoma that potentially could form and ruin that flap, that the drain management was appropriate, attentive.
00;03;01;17 - 00;03;32;21
Speaker 1
And we saved a lot of people's lives. And and unfortunately, health care is kind of change. What has happened is that there have been too many bad actors getting into the field of medicine because medicine generates money, and bad actors understand that there is money to be made. Making money in medicine is okay as long as the standard of care is provided and goods and services are provided to patients, so they have the best outcomes.
00;03;32;24 - 00;04;00;19
Speaker 1
And unfortunately, we are seeing a lot of bedsores occurring in hospitals, hospitals that are being bought out by private equity. And it's been real unfortunate because we are seeing a lot of people who have developed these never event bed sores and then simply discharged and discharged to a nursing home. And they're not seeing a plastic surgeon. They're not receiving the standard of care.
00;04;00;22 - 00;04;32;04
Speaker 1
They are basically being told that their care can be managed at a lower level of care, where they then obtain resistant organisms, progressive malnutrition, other bed sores, and then ultimately get referred to hospice and die. So clearly, you know, I don't fit it in in hospitals anymore because I am a voice. I'm a voice of safety. I'm a voice that nurses need to have the education and they want to be educated.
00;04;32;10 - 00;04;59;18
Speaker 1
I mean, I've done see what's it called, continued nursing education hours. Put on talks for nurses so that they can get their educational requirements on on bed sores. The prevention treatment options. And I enjoyed that. I enjoyed being part of a hospital where nurses could feel comfortable to call me 24 over seven, 2:00 in the morning. They knew that I wanted to know.
00;04;59;20 - 00;05;29;17
Speaker 1
I wanted the nurses to understand that if there was a patient of mine who was resisting a turn, that they had the authority to tell the patient that if you don't, if you know a paralyzed person who's at risk of getting a bed sore, that if they were to refuse to turn, they knew they had the authority to tell the patient that, well, I'm going to have to call Doctor Vigna and, you know, he's going to need to come in.
00;05;29;17 - 00;06;09;03
Speaker 1
He's going to come in and talk to you, you know, and it's 2:00 in the morning. The patients would not when Doctor Vigna called because one, I would support the nurses in their job to make people safe and I would support the hospital to keep people safe because the reputation in my hospital, for my hospital in that community and and the referring doctors that I wanted to make sure that the community knew that there was a safe place for people who were sick and injured, and especially those who the health care system has failed.
00;06;09;08 - 00;06;48;05
Speaker 1
So, you know, what we're seeing at these private equity owned hospitals and large hospital systems that doctors are losing their ability to care. And when I say care, I mean that they understand that generally this is a prevention issue. And if a bed sore happens, it's not their fault. And I disagree with that, that bedside care, it's a multidisciplinary approach to bedside care that when you have a patient who who is dependent, the doctor needs to come in.
00;06;48;07 - 00;07;15;12
Speaker 1
If they can't roll every day, you're checking the heels, ensuring that there is not redness. When patients see that you're at bedside checking their skin at the heels, they're understanding that they're at risk for bed sores. And the nurses will understand that if there is a pressure injury on the backside, I was to be notified and that I would be seeing that person as soon as possible.
00;07;15;12 - 00;07;36;24
Speaker 1
If it's in the evening, it would be in the next morning. If it was identified in the afternoon, it would be that evening, and we would try our best to keep people safe. And every day, if there was a patient who was sitting up more than 30 degrees in bed, I would go to their control and move their head back down.
00;07;36;27 - 00;08;05;10
Speaker 1
And when they ask, why are you moving my head down? I'm saying, because you're putting yourself at risk for bed sores and you lack the mobility. And if your head is more than 30 degrees, you're putting almost five times more pressure on your butt. And what happens is that if you're between the surface of the bed and the bones of the pelvis, that muscle gets compressed.
00;08;05;12 - 00;08;34;26
Speaker 1
When the muscle gets compressed, the arterial supply is compromised, and you need to be reliably turns so that muscle then gets decompressed. And then the blood supply can then resupply the muscle. That would ultimately, if you're not reposition, would die and lead to a bed sore. So private equity what they're doing is they're buying hospitals, community hospitals, hospital systems.
00;08;34;29 - 00;09;06;10
Speaker 1
Then sell the real estate to a REIT, which is a real estate investment trust, where the hospital then needs to pay rent to investors to suck up money. The private equity will then have their management team charge a management fee. So they're getting paid to manage. They're getting paid to suck money out to the REIT. And there's only so much money there.
00;09;06;15 - 00;10;02;06
Speaker 1
And there's plenty of money that goes into hospitals. When these private equity companies get involved, they are sucking the money out and they're not spending money on nursing education. They're not spending money on nursing retention. You're not paying those who are performing. And it leads to understaffing. It leads to patient burnout. And over time, doctors lose their voice because ultimately, the doctors now they're not independent doctors rounding at the hospital, seeing their private patients and the clinic in referring people to that hospital when they could refer people to other hospitals based on the level of care that you have, doctors who are owned by the private equity, they lose a voice.
00;10;02;09 - 00;10;35;16
Speaker 1
And we are seeing serious hospital acquired infections, bed sores that are largely preventable. And, you know, as a doctor and a lawyer. Now, what I can do now is simply prosecute these injuries. Against hospitals, nursing homes, understand the financial aspects, the staffing, and point out where the problems are. And, you know, that's my role. I enjoyed practicing medicine, but I'm a lawyer now, and I've been prosecuting these cases for a long time.