What Is a Nurse Expert Witness in Tissue Viability?

Sylvie is an Expert Witness with 400 cases under her belt. Litigation, Coroners Court, NMC Crown Prosecution cases. Hard working nurses can feel threatened and unhappy that they must consider the possibility of court. Is the Expert Witness making life harder for nurses? This can be seen in so many cases where nurses feel it’s unfair when a patient refuses repositioning and develops a pressure ulcer and then sues. But let’s unpick this:

An expert witness in wound care is meant to:

·         Provide impartial, evidence-based opinion to courts or regulatory bodies.

·         Clarify standards of care in complex clinical scenarios.

·         Educate non-clinical audiences (judges, juries, and coroners) on what constitutes reasonable nursing practice.

But when this role is misunderstood or misused, it can feel — or be perceived — as punitive, especially by front-line nurses.

An expert witness in wound care is a qualified healthcare professional and usually a Tissue Viability Nurse, who has specialised training and has demonstrated full experience in wound assessment, treatment, and management. Their primary role is to provide unbiased, evidence-based opinions in legal proceedings. This expert witness in Tissue Viability would be expected to:

• Review medical records and documentation

• Produce a chronology and develop the report according to the results of the chronology

• Assess whether wound care met accepted clinical standards with colour, odour, size of wound, state of surrounding tissue, state of healing progress

• Decide if pressure ulcer risk was assessed and a reaction followed with equipment, repositioning plan and documentation of the times of repositioning

• Provide written and unbiased reports for legal cases

• Testify in court (Only in 3% of cases)

• When writing a report or appearing in court, the clinical concepts must be clearly expounded

• Help to determine whether actions contributed to harm (e.g., pressure ulcer development or wound deterioration)

• To describe what an ordinary nurse exercising an ordinary level of skill would have done in the circumstances that were presented at the time

• To identify if practice was a departure from best practice and if that was the cause or materially contributed to the pressure injury or deterioration of a wound.

The Expert Witness is responsible for addressing the “but for” test of causation—namely, determining whether, but for the failure to reposition the patient every two hours, the pressure injuries would not have developed and the patient would have survived.

While patients have the unquestionable right to refuse care such as repositioning, nurses retain a professional and legal obligation to safeguard both the patient from harm and, of course, themselves from potential litigation. Exercising this responsibility requires active negotiation and careful documentation—not passive acceptance. If a patient refused to be repositioned, nurses should explore alternative approaches. For example, lateral tilt equipment is available that can gently reposition individuals without interrupting their sleep and may have been acceptable to them. Simply accepting the refusal without proposing alternatives is not advocacy—it is a failure of duty. Nurses must uphold their responsibility by offering reasonable, evidence-based options. Should the patient decline these alternatives, their autonomy must be respected; however, the nurse has fulfilled their professional obligation to present best-practice solutions. This effort reflects diligence, compassion, and accountability.

However, if a patient’s refusal is passively accepted and then subsequently develops a pressure ulcer as a result, then it cannot be said that the carer did everything reasonably possible to prevent that injury. In such circumstances, responsibility may rest with the decision to accept the refusal without exploring or offering appropriate alternatives and the Expert Witness would detail that opinion in the report.

Expert Witnesses are typically involved in:

·         Medical negligence claims

·         Pressure ulcer cases

·         Amputation-related litigation

·         Care-home or hospital neglect cases

·         Wrongful death involving wound-related complications

·         Standards-of-care disputes

·         Manslaughter cases

·         Falls

Expert Witnesses Qualifications would be extensive clinical experience with wound care with up-to-date knowledge of current treatment standards and guidelines, and it would be important to demonstrate experience in medico-legal reporting or training which would include Legal Report Writing and how to present a case in court.

Wound-related legal cases often hinge on whether a wound was preventable, whether care met professional standards and whether delays or improper treatment caused deterioration. The recognised method of determining if a pressure ulcer was avoidable is to ask the question: “Did the carer do everything possible in order to prevent”? If yes, then they are not responsible. However, if they did not do everything possible (reposition regularly, use equipment, ensure nutrition) and the patient developed a pressure ulcer, even if it was thought they may have developed an ulcer anyway, then the carers have to hold the responsibility for the outcome of the poor care because it cannot be certain that they would have developed the ulcer if appropriate care was provided..

Conclusion

In summary, an Expert Witness in Tissue Viability plays a critical role in evaluating whether wound prevention and management adhered to recognised standards of care. By reviewing clinical records, assessing risk-management strategies, and determining whether alternative interventions were offered and documented appropriately, the Expert Witness provides an objective opinion on both practice and causation. Their analysis is central to deciding whether a pressure injury was avoidable, or a wound need not have deteriorated by applying the “but for” test to establish whether harm would have been prevented had best-practice measures been implemented.

Ultimately, the Expert Witness supports the legal process by translating complex clinical issues into clear, evidence-based conclusions. In doing so, they help ensure accountability, uphold patient safety, and reinforce the standards expected of healthcare professionals involved in wound care and tissue viability.

There is always the possibility that they nurse undertook the care that the Expert Witness details as missing but, if it was not documented, then the Expert Witness cannot state that it has.

Of course, the Expert Witness would always wish the nurses to have provided best practice but the rule of being unbiased means that they must give honest and unbiased appraisal to ensure that if poor care led to injury or death that lessons can be learned and there is justice for the injured. Also, this can lead to the nurses being supported with education to avoid potential and similar injuries in the future.

Medico-Legal Excellence in Wound Care: Supporting Solicitors, Trusts, and Care Homes

If you are a solicitor handling a wound care related case and require an experienced, unbiased, and highly respected Expert Witness, Wound Care Consultants are here to help. With extensive clinical experience and medico legal expertise, we deliver clear, evidence-based reports that stand up in court. Get in touch today to discuss how we can support your legal case.

If you are a Trust or a Care home concerned about litigation, please contact us and we can help you to avoid the distress that is associated with litigation and Safeguarding.