Wound photography is a subject that divides many wound care professionals. On one hand, photography is a valuable tool to show trends in patient healing, and on the other hand, it can be polarizing in a courtroom. My experience as a clinician is positive with wound photography, especially in a courtroom setting.

My first experience facing the legal aspects of wound photography occurred early in my wound care career as a home health nurse. In that case, our patient had been discharged from the hospital because her 90 days were up with Medicare. She had multiple co-morbidities, including lupus, and suffered from 4 Stage IV pressure ulcers that were acquired during her hospital stay.  

I'll never forget the initial discharge instructions for this patient: “keep the patient alive for 90 days so Medicare will cover the readmission.” I decided right then and there that I would have higher goals for this patient.  Our home health team would do more than keep the patient alive, we would heal the patient and document every step of the way. We started by conducting serial photography and establishing a treatment plan. Under our care, the patient's wounds improved, albeit slowly due to the lupus, however Medicare subsequently denied her claim at the end of the certification period. 

Despite our serial photography and extensive documentation on the slow, but steady progress, Medicare suspected fraud likely due to the high cost of her wound care supplies. Medicare eventually brought her case to court. It was my first legal experience. I'll never forgot the words of the Administrative Law Judge who ruled in our favor, who said, “you would have been hard pressed to win without those wound photos.”

Since then, I've been an advocate of wound photography as part of wound documentation.  I would be interested in what others have found. What are your experiences with wound photography?

For another perspective on this subject, reference the archived webinar, Avoiding Costly Legal Pitfalls in Woundcare, available for download at http://www.woundrounds.com/archived-webinar-avoiding-costly-legal-pitfalls-in-wound-care-recorded/ <http://www.woundrounds.com/archived-webinar-avoiding-costly-legal-pitfalls-in-wound-care-recorded/>

Anne Scheurich, RN, BS, CWOCN is the Director of Clinical Services at Telemedicine Solutions/WoundRounds.