A life care plan provides a road map for all necessary and appropriate care currently required and into the future with their associated costs. “
What is a life care plan?
A life care plan is a concise summary of all current and future needs and their associated cost that are appropriate and necessary for a patient with a disabling medical condition due to an injury. It is a case management tool which is devised to provide a road map for the care of a patient to maximize function, reduce or eliminate complications, and improve the individual’s quality of life as they age. It allows for management of a patient going forward rather than mismanagement by chaos. In the case of a vaginal mesh patient it will provide a comprehensive plan based on the recommendations of the patient’s medical providers and it will address the individual needs and desires of the patient. It is essential evidence for the court for damages related to injuries suffered from the vaginal mesh. A life care plan is best devised by a medical professional who is a Certified Life Care Planner and will be based on a clinical interview of the patient and family, review of the medical records, a psychological assessment, communications with the treating physicians and other medical providers. Utilizing this information, the life care planner will follow specific methodologies based on published standards that are subject to peer review to devise a comprehensive plan.
A life care plan for a patient with mesh-related complications will likely include the following: 1) Projected evaluations from medical professions such as physical therapy and a psychologist, 2) Projected therapies such as physical therapy and psychological services, 3) Home furnishings which may include a bidet, 4) Home care maintenance care, 5) All future routine medical care, 6) All future surgical care and hospitalizations, and 7) All future prescription and nonprescription medications. All needs will have a start date, frequency, stop date, and an associated cost. A life care plan will include a vocational assessment by a vocational counselor to discuss education needs, work capacity assessments, and loss of earnings capacity.
Chronic pain in patients who underwent the transvaginal mesh procedure is an identified complication of both the procedure itself and the mesh device. The procedure and the device have been associated with injuries to the terminal branches and the main branch of the pudendal nerve. This leads to pudendal neuralgia which is a catastrophic pain syndrome. In addition the mesh procedure and device have caused myofascial pelvic pain disorder (MPPD), which may be every bit as debilitating as pudendal neuralgia. The life care plan must include all appropriate and necessary care regarding the management of chronic pain. This will include life-long physical therapy assessments and treatment to manage the problematic myofascial pain. Chronic medication management is often required and this may include antidepressants, anticonvulsants, muscle relaxers, nonsteroidal anti-inflammatories, narcotic and nonnarcotic analgesics, and local agents such as baclofen or valium suppositories. Chronic narcotic management will require scheduled drug testing. Routine physician follow up and laboratory testing are required for complications and compliance regarding medication management. Selected patients may require implantable devices for pain relief and these will have routine replacement schedules and related cost. On-going life-long treatments with Botox may be required in selected patients with severe intractable myofascial pain. Costs of medication and the procedure fees will need to be included in the plan. The plan may also need to account for anticipated inpatient chronic pain management in the future as well.
A mesh procedure may be followed by chronic pain which may include physical pain, mental suffering, social loss, and vocational loss. Physical complications may include inability to sit, decreased physical tolerance, which may make home management task impossible. These activities have value and will need to be provided by the plan for future expenses going forward to the life expectancy of the patient. There may be significant sphincter complications that may require intermittent catheterization and these costs will need to be provided by the plan. Psychological services are essential for a chronic pain patient and ongoing services may be necessary to follow for depression. Other services such as family, marital, and sexual counseling may be required and provided by the plan. Occasionally inpatient hospitalization for major depression and suicide can be anticipated in severe cases and this will need to be provided by the plan.
Only by careful review of the medical record, patient interview, and consulting with the treating physicians can a comprehensive life care plan be obtained. This will prevent complications and will optimize physical, mental, vocational, and psychosocial welfare of the patient in the future.
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