Nursing Homes Abuse Blog - By Jonathan Rosenfeld

We'd like to think that beauty of our jury system is that it allows reasonable people to hear evidence about a dispute and render a rational decision based upon the evidence presented.  After all, the people on the jury are in the best position to render a fair and impartial decision--- right?  Similarly, if a jury comprised of fair and rational people can arrive at one decision, how could anyone think otherwise?

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?

One of the more difficult social responsibilities that we have is serving on a jury.  In addition to the obvious inconvenience and time away from family and work responsibilities, jurors have the difficult task of determining who to believe in a situation where completely contradictory explanations of an incident are being offered.  

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

At some point during the processing of placing a loved one in a nursing home, families must rely on the representations made by facilities as to the type of care that they are capable of providing. 

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

Upon entering a nursing home, staff must conduct an assessment of various aspects of patient needs in order to assure the best possible care.   Federal law requires that part of the assessment incorporate both a skin assessment to determine if the patient has any existing pressure sores and to develop a plan of care to help ensure that the patient doesn't develop any bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) during their admission.

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?

Contrary to what some medical facilities suggest, the development of pressure sores during an admission to a facility is not an inevitable part of getting older or something that simply coincides with some medical conditions.  Rather, pressure sores are overwhelmingly the result of inattentive care on the part of the facility.

After all, the prevention of pressure sores is not rocket science!  

Basic preventative measures implemented by nursing homes, hospital and other types of long-term care facilities can significantly reduce the incidence of pressure sores.  Well-known preventative measures include:

• Turning patients at regular intervals
• Keeping patients clean and dry
• Ensuring patients are kept well nourished and hydrated
• Utilizing the latest advancements in pressure reduction technologies-- cushions, mattresses ect.

Particularly in patients who may already be disabled or elderly, the development of pressure sores is an especially cruel complication that can cause pain, disability and significantly increase the chances of patients acquiring complex complications such as: sepsis, gangrene or osteomyelitis.

With years of experience representing patients and families in cases involving the development of pressure sores at medical facilities and other types of institutions, Rosenfeld Injury Lawyers understands the troubling issues as they weigh on the individual and family.  

Should the need arise to seek legal recourse in relation to the development of pressure sores, we invite you to review our expanded Pressure Sore Injury section to our firm website with pages devoted to: Pressure Sores in Nursing Homes, Pressure Sores in Hospitals, Pressure Sores in Assisted Living Facilities, Stages Of Pressure Sores and information on frequent complications such as: Sepsis, Osteomyelitis, Gangrene, Necrotizing Fasciitis and Death.

A jury in Georgia has ordered the management company of a nursing home to pay $2 million in compensatory damages to the estate of a woman who died at a facility they operated.  Shortly after entering jury deliberations, the jury ordered Subacute Services, Inc., the operator of Rockmart Nursing and Rehabilitation Center to pay the award in relation to the death of 82-year-old Ruby Mae Taylor.

According to news reports, Ms. Taylor's family initiated the nursing home lawsuit, after her death related to development of decubitus ulcers that she developed during her admission to the facility.

Decubitus ulcers, also known as: pressure sores, pressure ulcers or just bed sores are a horrific problem facing nursing home patients across the country.  Generally deemed to be preventable, the prevention of decubitus ulcers falls squarely on the shoulders of the facility.

Prevention of decubiuts ulcers begins with the development of a detailed care plan for each patient to help determine what factors put the patient at risk and perhaps more importantly: what the facility needs to be doing to care for the patient. 

Despite tremendous strides in patient care with the implementation of technologies, bed sore prevention generally relies on the consistent work of staff.  Known to form when patients are left in one position over extended periods of time, prevention of decubitus ulcers generally involves:

1. Regularly shifting patients in beds or wheelchairs
2. Keeping patients clean and dry
3. Utilizing specialized mattresses to alleviate pressure build up on the bony prominences of the body
4. Ensuring patients have adequate nutrition and hydration
5. Recognizing early signs of decubitus ulcers and alerting the patient's physician

Sadly, when patients' needs go ignored over extended periods, decubitus ulcers are a likely occurrence.  Perhaps that is why the jury in the above matter held the nursing home management company responsible due to the fact that the inadequate care was a result of decisions made by the management company to inadequately staff or train the facility?

Related:

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

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

What is ‘turning’ and why is it important to prevention of bed sores?

Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?

How long do I have to file a bed sore lawsuit?

I never served on a jury before.  So I'll have to imagine how difficult it is to serve as the decision-maker in a pending case.  Particularly when evidence is presented by skilled lawyers, I imagine there must be an element of second-guessing both the sincereity of the witnesses and lawyers involved.

In trials involving the development of bed sores at a nursing home or hospital, the frequent defense arguments center around both inevitability of the wounds and perhaps where the actual wound originated. While these arguments indeed have their place, my experience is that these arguments are brought into play for the purpose of bringing an element of confusion into many pressure sore trails.

By the significance of a recent verdict in a trial against an assisted living facility and home health care agency, I'm guessing there wasn't much second guessing on the juries end! 

After a week long trial, a Georgia jury ordered Country Crossing Assisted Living, its  individual owner and Hutcheson Home Health Care to pay more than $9.5 million to the family of a deceased patient, Charlotte Pauline Dean.

Both Hutcheson Home Health Care and Country Crossing Assisted Living were responsible for caring for Ms. Dean prior to her death in 2006.  According to evidence presented at trial, Ms. Dean's death was related to multiple infected pressure sores while the defendant's claimed that the she only required treatment for one.

By the significance of this verdict, it it apparent that not only did the jury believe the case presented by the plaintiff's (the woman's family), but perhaps more importantly, that the defendants' care was inadequate to say the least.

Related:

"Home Care Nursing" Doesn't Mean "No Care Nursing"

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

Are assisted living facilities responsible for the prevention of bed sores in their patients?

Jury orders health care facilities to pay $9 million in wrongful death suit, by Kristi E. Swartz, The Atlanta Journal-Constitution, March 5, 2011

Nursing Home Injury Laws: Georgia

An important court decision Tennessee Supreme Court decision helps clarify what is necessary for injured parties to prove their care in a nursing home negligence lawsuit.  The case stems from the lawsuit initiated by Kimberly S. French, the daughter of Martha S. French.  Ms. French brought a wrongful death case against the Stratford House nursing home alleging:

Bed Sore FAQs

Nursing Home Injury Laws: Tennessee

Is Sepsis Related to Bed Sores?

From both a medical treatment and legal standpoint, families coping with a situation where a loved one has acquired a bed sore in a nursing home or hospital are quickly faced with difficult questions.

Let's face it, no one expects a loved one to acquire a bed sore.  When notice is received, most families are shocked to learn that they may be faced with making difficult decisions from both a medical and legal standpoint. 

Given the fact that the overwhelming majority of bed sores (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers) are the result of systematic neglect and improper care, medical facilities are frequently hesitant to supply answers to questions like:

What causes the bed sores to develop?

What types of medical treatments are available to treat this condition?

Is the facility responsible for this condition?

What is the legal recourse for a patient with bed sores?

Will my loved one survive?

You are not alone.  With more than 500,000 nursing home and hospital patients coping bed sores, there remains a shortage of complete, concise and updated sources of information.  In an effort to fill this void, we have developed a website devoted to proving the most comprehensive source of information related to bed sores on the internet-- Bed Sore FAQ. 

Bed Sore FAQ is more than a medical-legal website, it is an authoritative resource for families to gather information to assist in the decision making process.  In addition to answers to common questions, Bed Sore FAQ has an expended Bed Sore Resource Center highlighting the following topics:

• Bed Sore Glossary
• Bed Sore Treatment Specialists
• Bed Sore Articles
• Bed Sore Research Studies
• Websites Devoted To Bed Sores

For more than 30 years, attorneys at Rosenfeld Injury Lawyers have fought for injured patients and families who have been harmed due to carelessness or neglect of others.  Put our experience in the fields of nursing home negligence and medical malpractice to work for you!  We invite you to speak to our lawyers for a free case analysis today.

A pending trial against Retama Manor Nursing Center (Texas) will put a families allegations of improper nursing care and poor medical charting—front and center before a jury.

The trial commenced by the family of Emilo Gonzalez, a patient with motile medical complications including: partial paralysis, anemia, seizure disorder, decreased appetite, dementia and Parkinson’s disease, alleges that despite a medical chart that seems to substantiate regular care—including crucial bed sore preventative measures such as turning and re-positioning, the care was never actually provided.

Lawyers for the nursing home, assert that the facility actually performed all of the care that the records demonstrate and the development of Mr. Gonzalez’s bed sore (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers) was simply an unavoidable medical condition that developed due to the fact the Mr. Gonzalez’s body was shutting down.

Inevitability is a common defense asserted by nursing homes and hospitals in litigation involving the development of a bedsore during an admission to the facility.  Despite these arguments, it usually is readily from the testimony of staff at the facility that the care indicated in the patient’s chart was not, nor could have been provided.

As we await to hear how the jury decides this matter, falsified medical charting is a common element of nursing home negligence matters.  As a nursing home lawyer, I have worked on a number of cases where patients’ charts indicated care was provided at a specific date and time--- only when such care would have been physically impossible due to the fact that the patient was dead or had been discharged to another facility.

Certainly, if indeed the medical records in this matter were falsified, it wouldn’t surprise me to see a jury return a substantial verdict in favor of the deceased patients family. 

Related:

Who's To Blame For Bed Sores In The Obese? Or Are They An Inevitable Part Of Being Fat?

Under-Staffing & Under-Funding Alleged In Nursing Home Negligence Lawsuit Where Patient Developed Bed Sores

Why are physically disabled patients at risk for developing bed sores?

How much money does it cost to pursue a claim or lawsuit for bed sores?

A Philadelphia jury awarded $5 million in punitive damages to the widow of a man who died from bed sores he developed during a hospitalization and then worsened during a subsequent nursing home admission.  

The case, believed to be the first of its kind in terms of awarding punitive damages against a nursing home in Philadelphia courts, was allocated: $1.5 million against Jeanes Hospital and $3.5 million against Hillcrest Convalescent Home. 

According to widow's lawyer, Steven R. Maher, Jeans Hospital failed to diagnose the man's urinary tract infection that contributed to the development of bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) and then the man was transferred to Hillcrest Nursing Home where the bed sores worsened.  Despite his wife's best efforts to care for her husband at home, the man succumbed to the bed sores approximately two years after he developed them.

This punitive damage award is in addition to a $1 million compensatory damage award a jury had previously awarded in the case.   Incidentally, Jeanes Hospital is part of the Temple University Health System and Hillcrest is owned by Genesis HealthCare Corp., a large nursing home operator in the Northeast.

While punitive damages are rare due to the high threshold an injured party must prove, in this case 'outrageous and reckless conduct', it doesn't surprise me that these type of damages were awarded in a bed sore case.

Obviously, the plaintiff's lawyers did a great job presenting their case, but when jurors hear and see how devastating a bed sore can be, it most definitely evokes feelings of rage-- when they see how a medical facilities neglect resulted in such devastating injuries such as advanced bed sores.

Related:

Unusual damages set in Phila, bedsores case, Philly.com, March 17, 2010

Over 500,000 Adults Suffer From Bed Sores In Hospitals

New York Jury Punishes Nursing Home Where Man Develops More Than 20 Bed Sores

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?

Bed Sore Pictures, Bed Sore FAQ

Bed Sore Resources

Bed Sore Treatment Specialists

It never fails to amaze me.  Frequently, when I tell people about some of the cases I work on involving bed sores, I only to get a 'so what?' reaction from them.  Are the people who surround me heartless?  Maybe some of them (just joking, honey)?  Nonetheless, the reality is that most people have no idea what a bed sore truly is or the catastrophic consequences that my arise after a person develops them.

When people actually see the gruesome photos of rotting flesh on a person's backside hear about the ongoing medical procedures that are necessary to heal the wound, they begin to understand the real impact of this medical condition.

Along these lines, an obviously compassionate jury in New York awarded the family of a man who succumbed to infection following the development of bed sores almost $19 million.  The New York Post reported that the Brooklyn jury's award was comprised of $3.75 for the man's pain and suffering and a hefty $15 million in punitive damages.

According to the man's daughter's Margaret Whitehurst, the man rapidly declined during his nine month admission to Brooklyn Queens Nursing Home.  "He walked in on two legs and a cane.  He was 237 pounds.  When we got him back, he was 148 pounds and had holes all over his body."

In addition to hearing testimony regarding severe bed sores (also called: decubitus ulcers, pressure ulcers or pressure sores), the jury also heard from an expert witness who testified about how the nursing home altered the man's medical records to make it appear as though he entered the facility with bed sores.

Not having any firsthand knowledge of whether the nursing home made any offer to settle the case prior to trial, I can only assume the offer was insignificant.  I'll bet this facility is now re-thinking its decision to avoid responsibility for the death of this patient.

Read more about this nursing home lawsuit here.

Related:

Lawsuit Claims That Nursing Home's Negligence Resulted In Patient's Decubitus Ulcers

Lawsuit Alleges: One Week In The Nursing Home Results In Significant Deterioration Of Pressure Sores & Sepsis

Nursing Home Negligence Lawsuit Claims New York Facility Allowed Advanced Bed Sore To Develop In Rehab Patient

Big Verdicts Against Nursing Homes

What should I do if my family member develops bed sores during an admission to a nursing home?

Resource:

Nursing Home Injury Laws

A nursing home negligence lawsuit has been filed against Highland Health Care Center and its parent company  Covenant Care Midwest for their negligent care of a patient.  The lawsuit alleges that the patient was admitted to Highland Health Care Center on November 5, 2008 for physical therapy, following a total knee replacement surgery.

During the course of the prescribed physical therapy, the patient developed decubitus ulcers on his back and heel.  The decubitus ulcers became so severe that, surgery was required to help heal the wounds.

The nursing home negligence lawsuit claims Highland Health Care Center made numerous mistakes related to the patient's care and subsequent decubitus uclers, including:

• Failing to notify physicians of the patient's change in medical condition
• Failing to administer treatments prescribed by the physician
• Failing to make observations related to the patient's change in medical condition
• Failing to implement a pressure sore prevention program

The lawsuit is pending in Madison County Circuit Court.  Read more about this nursing home lawsuit here.

In with one problem, out with another...

While I certainly have no way of verifying the facts surrounding this nursing home lawsuit, the facts sound all too familiar.  In cases were nursing homes, hospitals rehabilitation facilities are hyper focused on a specific task, such as physical therapy, other patient needs can often fall to the wayside.  

Nonetheless, skilled nursing facilities have a non-delegable duty to take all feasible measure to prevent development of decubitus ulcers.  In this case, I have a hard time believing that if the facility was indeed performing the specified physical therapy on this patient.  If so, how did the decubitus ulcers develop?

Covenant Care

Covenant Care operates 50 facilities (skilled nursing, assisted living and select therapies) in California, Illinois, Indiana, Iowa, Nevada, Nebraska and Ohio. 

Related:

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?

What steps should I take before meeting with an attorney to discuss a case involving bed sores?

How long does it take for a lawsuit involving development of bed sores at a medical facility to be resolved?

What type of legal recourse does a person with bed sores have?

Resource:

Nursing Home Injury Laws

Bed Sore Resources