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Plaintiffs' attorneys handling cases against nursing homes often face an uphill battle. Their clients or their clients' families may have little to no knowledge about the case at hand and are typically at the mercy of the nursing home to obtain key information.

In addition, for risk management purposes, nursing homes typically instruct employees to give as little information as possible in the event of a lawsuit.

Thomas A. Sharon, R.N., M.P.H., has assisted litigators in medical lawsuits for and against hospitals and nursing homes for 25 years.

He recently spoke with Lawyers USA about some important strategies to find the whole truth in nursing home litigation cases:

• Determine how the nursing home in question stacks up to other homes.

Sharon suggests attorneys start by perusing the Medicare website (www.medicare.gov) and clicking on the "Compare Nursing Homes in your Area" link.

"There you can find valuable information about all the complaints made against the home in question, and see what you're dealing with," said Sharon.

The site allows the user to compare the quality of each home and check for any health deficiencies, such as bed sores or resident neglect, through its performance on inspection surveys.

• Establish a timeline.

Obviously, attorneys should attempt to obtain a detailed incident report that describes everything from when the injury occurred to when it was discovered. However, the report provided by the nursing home is not always as comprehensive as a lawyer would like.

Nursing home employees, Sharon said, may be told at risk management orientation not to describe anything in detail.

For example, they are told not to tell how an injury occurred. If a patient fell, they are instructed to simply say the patient fell on the floor. And witnesses for the defense are coached to say as little as possible.

"They don't lie," said Sharon. "Most cover-ups have been in what they don't say."

According to Sharon, that is why timelines are incredibly important to a plaintiff's case.

In one hospital trial he oversaw, a woman entered an operating room with a history of prior spinal surgery for a herniated disc. During an operation to reduce pressure on her spinal cord, she fell from her bed and suffered an injury at the base of her neck, resulting in partial paralysis.

Until the plaintiffs put the timeline together, they had to accept the hospital's argument that she was suffering from a neurological deficiency. But forensic evidence showed the fracture was consistent with a fall that occurred during the four-hour span when the woman was in surgery.

"When you know what time something happens, you can prove whether [an injury] was caused by negligence," said Sharon.

• Check for tampering or falsification.

Sharon says the primary concern when it comes to tampering with or falsifying a nursing home record is the overwriting of key data, such as the time an incident occurred.

"What I look for is continuity. There is usually a pattern on these computer entries, the names of nurses on duty, other personnel. You don't have to decipher someone's sloppy handwriting," he said.

Sharon suggests bringing in a handwriting expert to show inconsistencies. If a home uses computerized notes and the attorney suspects a document has been overwritten, a document specialist can determine if the type of ink used is from a printer or a pen.

• Contact other residents.

As with most cases, an eyewitness can provide the best testimony.

If the client was staying in a semi-private room, the attorney should check if there was another patient in there at the time of the accident and if that person is capable of giving testimony.

Sharon also suggests lawyers visit the residence and conduct an onsite investigation, to try to determine if the patient was in any danger and to get a feel for the way the home is run.

"You get a sense of how many residents are in the building versus how many nurses and how much attention is paid to each," said Sharon.

• Procure other documents.

Two types of documents can be pivotal in a case and may get missed in the discovery process.

One is a "fall risk assessment," which is a list of inherent risk factors for individual residents that is supposed to be associated with his or her care plan. This allows the attorney to determine if the correct care plan was put into place and whether it was followed adequately.

Another key document that is often overlooked is a copy of the nursing home's brochure, which Sharon said is a great tool to put the defense on the spot.

"If the brochure says they give [a patient] a certain amount of attention and you have another document saying the average hands-on care is 4 hours out of 24 and the rest of the time the patient is lying unattended, you have a real discrepancy."

For more information on Thomas A. Sharon, visit his website at: http://legalnurseconsultanttom.com/.

Questions or comments can be directed to the writer at: justin.rebello@lawyersusaonline.com