The concept of diverging views of in civil lawsuits is nothing new, but I was again reminded of the extreme disparity between the findings from a jury and those from nursing home surveyors in a recent article written by Michael Booth in The Denver Post, "Jury says man died due to Rocky Ford nursing home's negligence; state differs". 

The situation Booth contrasts is the recent situation involving a nursing home negligence lawsuit in Colorado where a jury awarded the family of a deceased resident $3.2 million due to the facilities alleged negligence in allowing a resident to develop stage 4 pressure sore.  Meanwhile, the same situation was investigated by authorities from the state's Health Department and the facility was not cited for any type of "deficient practice because the investigation did not substantiate current deficient practice."

If that mumbo-jumbo was too much for you to understand--- like myself--- it simply means that the facility was found not to be negligent in relation to the care of this patient. 

No deficient practice?  While I'm sure there are medical experts out there that opine that the development of a stage 4 pressure sore (the most advanced stage), the overwhelming medical literature suggests that a stage 4 pressure sore is a medical complication that simply should not occur.  In fact, Medicare has deemed stage 3 and state 4 pressure sores that develop during a hospitalization to be simply inexcusable that they are part of the list of 'never events'-- medical complications deemed so inexcusable that hospitals will not be reimbursed by medicare when they occur at their facilities.

Perhaps the surveyor(s) involved in the investigation of this matter were simply having an 'off day' at the time they conducted their inspection? While indeed a possibility, I'd suspect that it's more unlikely--particularly in situations such as this-- where there are relatively 'clear cut" situations involving poor nursing home care, my hunch is that there is a more drastic underlying problem that needs to be addressed when it comes to calling out poor nursing home care.

While situations such as this can be discouraging for families who wish to report episodes of poor nursing home care, I continue to suggest to families that they indeed need to report all episodes of poor nursing home care or injuries to the regulatory agencies within their states.  While the ultimate findings of the agency may lack the decisiveness that many families crave, the investigations may still turn up valuable evidence for use in civil matter.

Considering that some of these state investigative reports lack any credible findings, it may be a good thing that they are generally inadmissible in civil trials.  Thankfully, there still are some dedicated jurors who are able to use their common sense to determine right from wrong.

Related Nursing Homes Abuse Blog Entries:

Jury Awards Family Of Deceased Nursing Home Patient $3.2 Million In Response To Bed Sore Lawsuit

Nursing Home's Conduct In Wrongful Death Case Angers Jury---- To The Tune Of $200 Million

Nursing Home Lawsuits: Do they represent isolated events or are they representative of poor care?

Are Protective Agencies Doing Enough To Protect Nursing Home Patients?

As innocent as the term may sound, when "pressure sores" progress, they should perhaps be more accurately referred to as "large open wounds" when they progress to their more advanced stages.  An advanced pressure sore remains one of the indelible emblems of poor care--- when the skin and tissue in the area of the wound gives way to a large opening in the body where the underlying organs and bone may be visible.

What makes pressure sores uniquely disturbing compared with other medical complications is that patients at many medical facilities are no less at risk for developing this complication than they may have been 10, 20... or even 100 years ago!  Unlike other medical complications that have been drastically reduced or eradicated with the implementation of medication and technological advancements, pressure sore prevention relies primarily on the backs of the staff members whom are responsible for caring for immobile patients.

By moving a patient from their bed or wheelchair at regular intervals, the bodies natural circulatory process of bringing is allowed to operate as nature intended.  Life-sustaining blood flow to brings nutrients to tissues in the body which may not have been receiving it due to unrelieved pressure on the person's body.

Unfortunately, the anatomical differences in people combined with the unique positioning of the individual in a bed or wheelchair commonly results in situations where the first indication of the build-up of unrelieved pressure on the body--- is a pressure sore in its primary stages.  While, pressure sores in their early stages may be healed with timely care-- too often early stage pressure sores simply progress to more advanced wounds when staff fail to make necessary interventions or in circumstances where patients are quite ill.

Without a tool to determine who needs to be moved--- and when, medical facilities typcially use a one size fits all approach and (theorretically) move patients at regular intervals .  While the regular "turning" may serve its purpose in terms of preventing pressure sores in a substantial number of patients, the frequency may be insufficient or impracticible for others. 

Perhaps the identification of the early stages of pressure sores is about to gets a much needed gift in the form of new medical technology?

I recently read about a new product to help in the assessment of mobility (and circulation) in bed-ridden patients.  The Mobility Monitor is a patient monitoring system used beneath the mattresses of physically compromosed patients, to alert staff when a patient needs to be moved-- or when they can rest.

Beginning in June, the system will be commercially available to nursing homes and hospitals as a much needed tool in the arsenal of pressure sore prevention.

I look forward to seeing this promising device in nursing homes and hospitals.  While the device promises to improve patient care, I would think that such a device would be welcomed by many facilities as the device appears to take much of the subjectivity associated with nursing care out of the patient-care equation and staff can focus more of their energy on actively listening to what the patient needs as opposed to worrying about adhering to a strict schedule.

Read more about the Mobility Monitor here.

Related Nursing Homes Abuse Blog Entries:

Bed Sore Prevention: Staff Must Turn & Reposition Bed-Ridden Patients At Regular Intervals

What devices or products can be used to prevent or relieve bed sores?

Medical Malpractice Lawsuits & Hospital Acquired Pressure Sores

$5 Million In Punitive Damages Awarded To Widow In Bed Sore Case Against Nursing Home & Hospital

The good news with respect to the overwhelming number of situations involving bed sores in nursing homes is that these cases can be prevented with proper care from staff at the facility.  Paramount to the prevention of bed sores in any facility is the realization by the facility (and staff) that certain patients are predisposed to developing them based upon their physical condition--- and prevention methods must be created and implemented.

Similarly, staff need to monitor the skin integrity of each patient they are caring for to identify bed sores in their early stages.  From a treatment perspective, bed sores in their early stages are far more manageable to treat than once they progress to a more advanced level.  In addition to recording the patients skin condition in their medical chart, staff should also advise the attending physician of the situation so a timely intervention can be made.

Perhaps out of fear, shame--- or downright indifference--- the existence of bed sores in patients at some nursing homes seems to get consistently downplayed / ignored; as if the wounds will magically vanish with time. 

I was again reminded of this troubling scenario of 'bed sore denial' when I read about a recent jury verdict in a wrongful death lawsuit involving a Colorado nursing home where a patient developed advanced bed sores that became infected.  According to news reports of the verdict the the Denver Post, the family of an 88-year-old patient at Pioneer Healthcare Center alleged that the facility was both negligent in its care of their loved one and that the facility intentionally failed to disclose the extent of the wounds to family.

The existence of the bed sore wasn't disclosed to the family until a CNA at the facility advised the man's son that the wound on the man's buttocks and scrotum were infected to the extent that they began to smell. By the time the man was transferred to a hospital-- the damage had been done-- and their was little that could be done from a medical perspective.

Obviously, this fact pattern was disturbing enough to the jury hearing this case as they awarded $3.2 million in damages to the man's family.

Related:

Delay In Providing Care For Patient With Pressure Sore Results In Fines Against Facility

Bed Sore Prevention Is An Ongoing Process For All Nursing Home Patients

Mounting Evidence Suggests That Bed Sore Prevention Is Cost Effective

Are Pressure Sores Really That Hard To Prevent? Study Demonstrates Some Nursing Homes Are Successfully Reducing Rate Of Pressure Sores At Their Facilities.

While the origins of hospital-acquired pressure sore (bed sores) cases and pressure sores that originate during a nursing home admission are quite similar with respect to the underlying factors behind their development, the cases can vary substantially when it comes to a litigation perspective. 

Despite the relatively elementary reasons for their development, hospital bed sore cases can become quite complex when the necessary legal maneuvering associated with medical malpractice cases gets involved.

Unlike nursing home negligence cases which are typically based upon a standard of care set forth in the patient's 'care plan', hospital pressure sore cases lack the relatively 'cut and dry' standard of care and require the use of a treating physician or retained expert to establish how the medical facility veered off course with respect to caring for the particular patient.

Given the hesitancy of many doctors to testify against a peer in the medical community, many hospital pressure sore cases rely upon expert testimony to establish both the applicable standard of care (how hospitals in the community are to care for patients) and causation (how the deviation in the standard of care resulted in the patient developing pressure sores).

Consequently, we for most hospital pressure sore cases, we commonly utilize the services of medical experts including both physicians and nurses to assist in proving our cases--- even during our initial case reviews.  While, the utilization of these experts can prove to be fairly time consuming and expensive, these experts can identify cases that are indeed meritorious and those where there may be problems down the road.

Further, as a lawyer who represents families in hospital acquired pressure sore cases, I find that families genuinely appreciate hearing an assessment of their situation from an expert who has no horse in the race.  Similarly, from a settlement posture, the early retention of experts (with case reports) signals a level of preparedness to hospital administrators that your case is prepared and ready to do.  

While there will never can be a guarantee of a specific outcome in any lawsuit, getting your ducks in a row at an early stage can set the stage for the timely resolution of hospital pressure sore cases.

Related Nursing Homes Abuse Blog entries:

Can a hospital be pursued for medical malpractice when a patient develops bed sores during a hospitalization?

Bed Sores Are Amongst Most Common Hospital Errors

Study Claims Hospitals Frequently Under-report Severe Bed Sores

Medical Facilities Need To Identify Pressure Sores As They Develop

In reality, pressure sores will continue to develop in patients in nursing homes and hospitals for a variety of reasons -- some of which is beyond the control of staff.  However, it is important to remember that pressure sores are a progressive condition and they do not progress to an advanced stage (stage 3 or 4) overnight.  

Though not ideal, a pressure sore identified in its early stages can be treated and healed far more rapidly than when a wound opens and underlying tissue and muscle is affected.  Recognizing the perils in delayed treatment for pressure sore patients, a read an article about how a state agency fined a facility for the days between the time the wound was originally noted and when proper care was given to the patient.

The Texas Department of State Health Services imposed a $1,000 per day fine against Ethicus Hospital Grapevine, a specialty hospital, for a nine day period in 2010 when staff delayed in obtaining treatment for a patient with an open pressure sore.  By the time that medical care was implemented, the patient's pressure sore had progressed so extensively that the wound needed to be treated surgically with a procedure known as a debridement.

While a fine in this circumstance is indeed significant because it represents the severity of the threat to the overall health of the patient involved, I'm sure the fine gives little solace to the patient whom had to undergo a serious medical procedure and likely suffered from diminished quality of life.

Related Entries:

Bed Sores Are Amongst Most Common Hospital Errors

Mounting Evidence Suggests That Bed Sore Prevention Is Cost Effective

Without A Prevention Plan, All Nursing Home & Hospital Patients Remain At Risk For Developing Pressure Ulcers

How should medical professionals document a healing bed sore?

From a preventative standpoint, the most widely suggested preventative technique remains turning patients at regular intervals to encourage the bodies natural circulatory process to bring vital oxygen and nutrients to areas of the body that can be starved off from these necessities when patients remain in one position for extended periods of time.

Pressure sore prevention plans remain a fixture at many medical and care facilities that care for the elderly and immobile patients. While promising in theory, these plans require the constant work from facility staff to effectively carry out.

Given the heavy work loads typically placed upon staff in nursing homes and other care facilities, the sad reality is that pressure sore prevention plans typically are not consistently carried out. Consequently, the development of pressure sores at medical facilities remains among the most significant threats to patient well-being.

In this light, I was really encouraged to read about a new pressure sore reduction technology that holds the promise of significantly improving the lives of millions of people who are at risk for developing pressure sores. The product known as Smart-e-Pants was developed by a team of experts in the fields of medcine, engineering and physical medicine who studied different aspects of pressure sores over five year period.

The end product may be reminiscent of ordinary bicycle shorts, but really is an undergarment with embedded electrical sensors to help simulate mini-muscle movements that healthy people ordinary make when they sit in a chair or lay down in bed.

According to one of the product’s developers Dr. Ming Chan, a rehabilitation medicine specialist for Alberta Health Services at Glenrose; “[o]ur aim is to prevent pressure ulcers by bringing blood flow and oxygen to the muscles. Smart-e-pants provides an electrical current for 10 seconds every 10 minutes stimulating the nerves and muscles to replicate what we do when we ‘fidget’ in our chair.”

While it may be a while before we see smart-e-pants devices broadly used in nursing homes and hospitals, researchers are encouraged from the initials trial and at tests completed with a pilot group of patients.

As we cautiously wait for more extensive trials to run their course, I am grateful to see more attention getting placed upon what truly has become an epidemic at many facilities. Who knows? Smart-e-pants may become standard issue to patients at risk for at nursing homes and hospitals?

Related:

Pressure Sores Must Be Timely Treated In Order To Maximize Chances Of Patient Recovery

Who Said Nursing Care Was Easy? The Prevention Of Bed Sores Requires Staff To Turn & Reposition Patients On A Reqular Basis

Why do bed sores commonly develop on the buttocks?

How quickly can a bed sore develop in a nursing home or hospital patient?

At most medical malpractice and personal injury trials, the party initiating the lawsuit (the plaintiff) is claiming they sustained an injury due to the conduct of the person that they are suing (the defendant)-- who generally denies all accusations of wrongdoing.

For a jury who may be hearing weeks worth of testimony from witnesses from both sides, the task of selecting the relevant information and applying it to the particular circumstance can be incredibly difficult--- particularly when both sides to a trial offer reasonable explanations for their positions.

A jury in Pennsylvania was able to sort through the differing opinions presenting in a trial involving the development of pressure sores during an admission to a nursing home.  The lawsuit was initiated by the family of a deceased woman who allegedly developed pressure sores during her admission to The Commons at Squirrel Hill.  In the face of arguments presented by the nursing home that the woman's pressure sores developed prior to her admission, the jury awarded the decedent's family $300,000 in damages.

Related:

$300,000 award set in Squirrel Hill bed-sores case Pittsburgh Tribune-Review January 31, 2012

Are bed sores acquired during a nursing home admission an indication of poor care?

ManorCare Named In Wrongful Death Lawsuit After Patient Develops Pressure Sores During Nursing Home Admission

Family Sues Illinois Nursing Home Over Relative's Death Related To Bed Sores & Infection

• Failing to provide sanitary toilet care

• Breaking a patient’s ankle during transfer from a wheelchair

• Failure to protect residents from abusive staff members

• Failure to report abuse and neglect to state agencies

The Post-Tribune article highlights how Mary Ann Jackson fought for years to live with horrible bed sore injuries she sustained during an admission Northlake Nursing and Rehabilitation Center in Merrillville, IN (now closed).  What started as an 'ordinary' admission for rehabilitation following a stroke and treatment of a small bedsore, developed into a nightmarish 11-month stay at the facility-- that billed itself as a specialized wound care facility.

According to her sister, Shlli Jackson, "[y]ou could see the muscles and ligaments down to the bone.  Her bedsores were so bad she was stuck in a fetal position with her legs glued together."

Amazingly, Ms. Jackson fought to live for almost two years following her ordeal, eventually recovering from the pressure sores and an infection known as "sepsis" that required multiple surgeries and hospitalizations.  Ms. Jackson's will to live was apparent to the director of social services and admissions at the nursing home where she was eventually transferred to, Rick Lipscomb;

She had one foot in the grave.  I don't know how she didn't die.  I've seen animal carcasses on the side of the road that looked better than when she arrived here...

Episodes such as this are an important reminder to me that every patient--- regardless of their apparent condition--- deserves an opportunity to receive the best possible care following an episode of poor care at a nursing home.  Moreover, as a personal injury lawyer, stories like this demonstrate that more attention needs to be focused on the diminishment in quality of life that many nursing home patients have following an incident involving negligent care during the litigation and trial of nursing home negligence cases.

Related Nursing Homes Abuse Blog entries:

Stiffened Joints Or Contractures Can Exacerbate A Patients Risk For Developing Bed Sores

Contractures In Nursing Home Patients Put Them At Risk For Developing Decubitus Ulcers & Other Injuries

Are Protective Agencies Doing Enough To Protect Nursing Home Patients?

Survival rates for sepsis patients is dependent on how quickly the medical facility identifies the problem and implements treatment

Bed sores now join a list of dreadful occurrences such as: operations on the wrong body part, patient suicides, foreign objects left in during surgery and deadly falls in the hospital as situations that simply shouldn't occur in the presence of proper medical care.

According to reports in the Journal Gazette regarding serious medical errors in Indiana Hospital and surgery centers, the development of serious bedsores during an admission tops the list as the most common danger facing patients.

In addition to the recognition by individual state’s health departments as an unnecessary complication, the federal government has similarly categorized hospital-acquired bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) as an inexcusable medical condition categorized as a ‘never event’.  As part of the government’s list of never events, hospitals are prohibited from submitting claims for reimbursement to Medicare for expenses related to bed sore care.

About Hospital Bed Sores

Like bedsores in other medical and long-term care settings, hospital bed sores result when staff allow patients to remain in one position for long periods.  Over time, the pressure from the individual's body restricts blood flow and causes tissue to die.  As the tissue dies, a wound-- commonly referred to as a bed sore develops.

Understanding the clear risks that bed sores can pose to patients--- particularly immobile ones---hospitals need to be mindful of the inherent risks and implement preventative measures such as: encouraging patients to be mobile and using specialized pressure relieving devices like air mattresses and cushions.

Given the overwhelming evidence that pressure sores can be preventable, their presence in a medical setting is inexcusable.  When they do develop, the patient or his or her family may be entitled to pursue a claim for damages against the hospital or medical facility.

Related:

Simple preventative techniques can drastically reduce the rate of hospital-acquired decubitus ulcers

Proper “Coding” Necessary for Hospitals Receiving Bed Sore Reimbursement

Why is it important to differentiate the type of facility where a bed sore developed?

Is The Lack Of Continuity In Patient Care Responsible For The Endless Bedsore Problem?

Representations made in promotional materials and through staff at the facility are frequently a determining factor in facilities selecting one facility over another.

No doubt that inflated assurances are routinely made by personnel (salesmen) to close a sale of a product or service.  While some of the assurances may ultimately prove to be false--- and perhaps a source of frustration to the individual to which they were made---at the end of the day they really are nothing more than (expensive) annoyances--- but usually the person can simply pick-up and move along. 

Contrastingly, in the nursing home context, such assurances derive far more importance and are can frequently mean the difference between a patient thriving and significant deterioration of the patient due to the fact that the facility was not a proper place for the individual in the first place.

Particularly when it comes to caring for specific medical complications--- such as ventilator care, dialysis, or wound care--- families commonly need to rely on representations made by facilities because most of the common tools used in the selection of a facility fail to address ratings for the specific types of care that the patient requires.

I recently read about a situation where such inflated representations resulted in the rapid deterioration--- and ultimate death of a patient.  A recently filed nursing home lawsuit by a family in California alleges that just one month after their mother entered Petaluma Health and Rehabilitation (a skilled nursing home owned by Evergreen Healthcare) for specialized wound care, the woman’s pressure sores quickly advanced to the point that she required hospital care.

By the time the 90-year-old woman had been transferred to nearby Petaluma Valley Hospital the wounds had become so large and infected that the hospital staff reported the situation to the local ombudsman’s office for further investigation of suspected elder neglect.

According to claims made in the nursing home negligence lawsuit, the family selected Petaluma Health and Rehabilitation substantially based on documents that described the home as having experts in wound care.

While I confess to my lack of specific knowledge regarding the specifics of this particular case, I frequently request all admission paperwork and promotional materials as part of my request for production of documents in nursing home negligence lawsuits.  Particularly, when it comes to specialized care—and wound care in particular—I find such materials extremely important in the prosecution of the underlying case.  Sadly, I commonly find a substantial disconnect between these promotional representations made by the facility and the knowledge of the staff in terms to how to carry out such care.

As a caregiver, who’s family or friend may require a specific type of nursing care, you may wish to request a meeting with the supervisor in the department as for your own reassurance that the facility really is capable of providing such care.

Related:

Petaluma Nursing Facility Sued for Elder Abuse, Neglect, by Karina Loffee, Petaluma Patch October 21, 2011

Bed Sore Treatment Specialists

Medical Facilities Need To Identify Pressure Sores As They Develop

Family Blames Nursing Home For Mother's Infected Pressure Ulcers & Death

Sadly, by the time that the wound has progressed and opened-- and even with the best wound care-- the patient faces a painful and emotionally draining recovery.  Realistically speaking, many patients who develop bed sores will likely never recover from this incredibly visual emblem of neglect.

But, what if facilities could prevent the bed sores from developing in the first place?

It's no secret that bed sores (also called: pressure sores, pressure ulcers or decubitus ulcers) can be prevented with educated and attentive staff to assist in keeping patients in the proper position and clean.  The problem at most facilities is that management continuously elect to reduce staffing levels to as low as possible in order to maximize profits at their facilities.  When staffing is the number one cost of operating a nursing home, many operators feel that by reducing staffing levels they can maximize their profits.

While nothing can take the place of a well-staffed facility, new research suggests that the use of basic medical devices can both reduce the frequency of bed sores and help facilities reduce costs by eliminating much of the cost associated with treatment for bed sore complications.

A study conducted by the Toronto Health Economics and Technology Assessment Collaborative recently determined that long-term care facilities, could improve reduce the incidence of bed sores and--- improve their bottom lines if they were to use pressure reduction foam mattresses and foam cleansers.  Further based on data collected, the authors estimate that the pressure reduction mattresses and foam cleansers would save approximately $280 per resident collectively.

According to the studies lead author, Ba' Pham,

These results provide specific evidence to support practice guidelines, which recommend reducing risk factors and improving skin health to prevent pressure ulcers.  We encourage all providers of long-term care to consider these changes.

I'm not naive enough to believe that nursing home operators will look at the quality of life benefits as the sole criteria for implementing an aggressive bed sore prevention plan.  Hopefully as more studies are conducted on this enduring medical problem, management will come to realize that allowing patients to suffer with bed sores is simply bad business--- and further preventative measures will be implemented.

Related:

Why is it important to differentiate the type of facility where a bed sore developed?

Bed Sore Prevention: Staff Must Turn & Reposition Bed-Ridden Patients At Regular Intervals

Bed Sore Prevention Is An Ongoing Process For All Nursing Home Patients

Pressure Sores Continue To Be A Vicious Sign Of Neglect At Medical Facilities

• Failing to treat the patients decubitus ulcers
• A urinary tract infection
• Sepsis
• Medical complications that went unannounced to physicians

Read more about this recently filed lawsuit against Addus Healthcare pending in St. Clair County Circuit Court here.

The threat of sepsis

Sepsis remains a serious threat to patients in nursing homes, hospitals and other types of long term care facilities.  Sepsis is a systemic infection caused by a bacteria that can enter the body through wounds (bed sores), catheters, intravenous lines, surgical wounds, surgical drains.  Sepsis must be identified and treated quickly in order to provide the patient with the best chance of recovery.  Symptoms of sepsis may include:

• Fever
• Chills
• Confusion
• Hyperventilation
• Low urine output
• Discolored skin

Particularly when medical care is delayed for elderly patients, the sepsis can progress to a more advanced complication known as 'septic shock'.  Patients with septic shock are indeed very ill and face serious drop in blood pressure, organ failure and even death.

Addus Healthcare

Addus Healthcare is large, publicly traded company that provides a broad spectrum of healthcare services to patients acorss the country.  In particular, the company boasts a significant number of home care contracts for home-bound patients.  In addition, Addus Healthcare provides:

• Skilled nursing care
• Veteran services
• Private duty
• Adult day services
• Home & community services

Related:

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Early Detection Is The Key Element To Successful Sepsis Treatment

Study Says Older Hospital Patients Are at High Risk of Developing Sepsis

Short-term nursing home admission results in deterioration of pressure sores and sepsis

Is sepsis related to bed sores?

Suit blames Addus Healthcare for woman's death from sepsis 9/29/2011 By Kelly Holleran

Glenwood Healthcare & Rehab is a large 184-bed facility located just south of Chicago, with an “A” wing and a “B” wing.

According to the government’s Medicare Web site, Glenwood received an overall rating of one out of five stars. While this alone raises several red flags, recent surveys from the Illinois Health Department confirm that Glenwood can indeed be a dangerous place for residents.

What stands out most from the four surveys (completed between August and October of last year) are two appalling incidents of what can only be called extreme negligence.

The first incident, which occurred on July 7, 2010, involved a resident accidentally setting himself on fire with a banned lighter. According to a nurse’s testimony in an August 2010 survey:

“I smelled a prevalent odor of smoke, and immediately called my staff to the nursing station...As I went down the B-wing, the smell of smoke was more evident. [When I got to the resident’s room], I saw burns on his left hand and left upper thigh. The resident said he was trying to refill his lighter.”

This incident was in clear violation of state law, which requires each nursing home to provide adequate supervision of all residents, and to keep its environment as clear from hazards as possible. Needless to say, this incident also put all residents of the home in what the survey calls “immediate jeopardy.”

The second incident, which occurred just a month later, involved a resident’s severely infected pressure sore.  According to a September 2010 survey:

“The nurse removed the resident’s dressing, and observed maggots present in the wound. The nurse said that she attempted to clean the resident’s foot with normal saline solution, but that the maggots wouldn’t come off. The nurse said that there were too many maggots to count.”

These two incidents in and of themselves would be grounds for me to be highly suspicious of this facility. But along with these incidents, the surveys found that Glenwood:

• Had a “pervasive urine odor throughout the facility,” and an overflowing garbage container in the B-wing shower room
• Consistently failed to serve hot meals on time
• Harbored at least three patients with dangerous mental disorders.

If you think a loved one might be in jeopardy due or had already suffered harm due to poor to conditions at Glenwood Healthcare & Rehab, we would be honored to speak with you about your situation. As always, consultations are free and completely confidential.

Related Nursing Homes Abuse Blog Entries:

65 Ililnois Nursing Homes On Second Quarter Violation List

Pressure Sores Continue To Be A Viscious Sign Of Neglect At Medical Facilities

Cigarette Lighter Mishap Results In Severe Burns To Nursing Home Patient

What are the signs of infection for people who have bed sores?

While it may be easy to discount the allegations of poor care at a facility across town, what happens when the allegations are made against THE facility where your family may be living? 

Are the mere allegations enough to yank your loved one out of the facility?  Will facilities take it upon themselves to make improvements after concerning stories have surfaced?

If you have a loved one at Hamlin Place Rehabilitation Center in Boynton Beach, FL, you may have heard about a recently filed wrongful death lawsuit filed on behalf a deceased patient at the facility who was allegedly neglected to the point that she developed multiple bed sores on her head and buttocks. 

According to news reports, it was only after the patient was taken to a nearby hospital, was the family informed of the severity of her wounds.  Shortly after the wounds were detected, the woman died from complications related to the wounds.

While bed sores are indeed a problem facing nursing home patients across the country, my experience as an attorney who regularly litigated bed sore cases is that these episodes indeed tend to flare up at facilities with real underlying problems that may be more pervasive than a mere isolated event.

When--- and if--  allegations of poor care do surface at a nursing home where a loved one may be living, the allegations can either be ignored, discounted or confronted head on.  While nursing home administrators likely will decline to discuss specifics of allegations from a pending lawsuit, my experience is that by bringing concerning allegations to the forefront is indeed important as it makes the facility aware that you are tuned in the issues at the facility.  Perhaps as multiple families come forth with similar concerns, the power of unity will demonstrate to the facility that the substandard care will not be tolerated.

Related:

Family sues Boynton nursing home after finding multiple bed sores on loved one, September 13, 2011 by Rochelle Ritchie

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

A New Low In Nursing Home Care: A Bedsore On The Head

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

Are there any federal regulations that apply to the prevention of bed sores?

Universally accepted, nursing homes typically incorporate the Braden Scale (or officially known as Braden Scale for Predicting Pressure Sore Risk), which uses an objective system to evaluate each patient's risk for developing pressure sores in the following areas:

• Sensory perception
• Moisture
• Activity
• Mobility 
• Nutrition
• Friction and shear

While the initial assessment may prove to be useful in pressure sore prevention, facilities must continually monitor each patient to determine if the patient's needs change.  Facilities must remember that any patient can theoretically develop conditions that put him or her at risk for developing pressure sores. Yes, even relatively healthy and young patients must be monitored by staff to help starve off wounds in an early a stage as possible.

I was reminded of this ongoing duty to monitor the skin integrity needs of all nursing home patients after learning about a recently filed wrongful death lawsuit involving a Pennsylvania nursing home.  

The Altoon Mirror reported that the wife of a deceased nursing home patient filed the lawsuit after her husband developed multiple bed sores during his stay.  The bed sore’s became infected and eventually required surgical treatment at a nearby hospital and an admission to a wound care clinic, before the man eventually succumb to the wounds.

The federal court lawsuit claims that Valley View Home failed to provide sufficient care for the man during his stay-- in part due to the fact that he was allegedly at 'low risk' for developing pressure sores according to his initial skin care assessment on admission and appeared to be physically strong as he was able to get about on his own.

As this lawsuit makes its way though the court system, families need to be tuned in to the fact that bed sores remain a significant threat to the well being of all patients and they are a condition that is far easier to prevent than treat.

Related Nursing Homes Abuse Blog Entries:

Extra Calories Essential For Pressure Sore Patients To Heal Wounds

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

Welcome To The Nursing Home. Let's Begin Our Assessment and Care Planning

How does the use of the Braden Scale help in the prevention of bed sores?

According to an August, 2010 survey from the Illinois Department of Health, 27 residents had complaints about mistreatment. These included:

Whenever I hear about a “remotely-operated” care home, I automatically become a bit suspicious.

Patients in any nursing home deserve ‘round-the-clock care, so I wonder sometimes how these “facilities” can get away with such bare-bones staffing.

I was reminded of this disturbing reality recently as I read through a horrifying story from Hawaii. According to The Maui News, an 86-year-old patient in an unnamed “community care facility” in Oahu became so neglected that he developed 11 fatal stage-four bed sores. His main caretaker, nurse Ross Rasmussen, says he only checked in on his patient once a month.

“If I had known there was a problem, I would have done something about it,” Rasmussen claimed in a court hearing on August 26.

Distract Attorney Dawn Shigezawa disagreed, deeming Rasmussen’s treatment to be “severe neglect.”

“If Rasmussen basically did the minimal check and looked down [his patient’s] hospital gown, he would have noticed [the bedsores],” she said. “It wouldn’t have taken much. It was a horrible way to die.”

Rasmussen claimed not to have seen any bed sores on his last visit to the patient on Sept. 11, 2007. The patient was found unconscious one month later, on October 12, with pressure sores on his “entire back side from his shoulders to his heels, with gangrene found on one heel,” according to The Maui News. Only three days after being admitted to the hospital, the patient - who couldn’t speak due to a previous stroke - died.

I find it almost impossible to believe that Rasmussen didn’t notice any bed sores, since late-stage bed sores take fairly significant time to develop. And, even if the bed sores did develop immediately after his last visit, Rasmussen should have known better, as an experienced nurse. Obviously patients who are physically immobile are at an extremely high risk for developing pressure sores, and should be turned several times a day.

I can only hope that this case exposes the truth about what proved to be an extremely negligent “care home.”

Related:

Are seniors in residential care facilities and other alternative living arrangements at risk for developing bedsores?

What are the signs of infection for people who have bed sores?

Is sepsis related to bed sores?

Bed Sore Verdict Against Assisted Living Facility & Home Health Care Agency