Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Recognizing that the development of a bed sore during an admission to a hospital as something that simply should not occur, many facilities have begun to categorize their development for what they truly are--- a serious medical error.

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?

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.

Sometimes I get sick of hearing about the 'good ol' days'--  when homes were affordable, people were friendlier, milk tasted like milk (as opposed to some whitish water)--- and how life may have been a little bit better?

Certainly, I'm not one to bicker about they way things were and how tough everything is now, but I certainly have developed a respect for both traditions and learning how to do things fundamentally correctly-- without the addition of all the new gizmo's that alway's promise to improve on the way things were done yesterday.

I began having a hankering for nostalgia after I read an article a colleague emailed me from England, "Why in the 21st century, are NHS patients dying in agony from bedsores?" The article readily references a new book on the British healthcare system, by Michael Mandelstam, "How We Treat The Sick: Neglect And Abuse In Our Health Services."  

Reading though the article and book references within the article, it appears that both authors blame modern developments in our healthcare system for the systematic increases in bedsores and other medical complications that are acquired by patients during their admissions to hospitals and nursing homes.  

In particular, the writers cite the lack of continuity of care from all types of hospital staff, nurses, orderlies, and doctors as one of the main reasons we are seeing the modern day bedsore epidemic at many medical facilities.

In the good ol days, nurses and doctors were assigned particular patients whom they typically cared for during their entire admission or stay.  While caring for the same patients day-in and day-out must have help ease patient nerves, it also encouraged the staff to care for patients with a sense of pride! After all, would anyone want their professionalism questioned when a patient developed a bedsore-- due to their inattentive care?

As Dr. Matin Scurr sums up the current situation:

I've written before about the lack of continuity of care as a result of destroying the 'firm'-- a paitent used to be assisnged to one firm (or team) of medics.  The firm comprised one or two house offices (recently graduated doctors), the senior house officers, registrars and, at the top of the hierarchy, the consultant.

This firm ensured continuty of patient care.  But the firm is no more.  No patient care has become like a high-risk version of pass-the-parcel -- patients are simply handled from doctor to doctor with notes in a folder and no one following them through.

I couldn't agree more with Dr. Scurr's assessment!  Particularly as evidenced by the development of bedsores during hospitalization or nursing home stay, it is important to remember their development is really a sign of systematic neglect--- as opposed to the inadequate care of a few caregivers. 

While we may indeed see the development of other types hospital-acquired complications (medication errors, dropped patients, ect.) derive from a situation involving an individuals poor judgment, bedsores are really emblematic of systematic neglect.  Even in the most fragile patients, bedsores-- particularly advanced wounds (stage 4 bedsores) develop over periods of days and weeks.

When evaluated as a progressive condition, it usually becomes apparent that not only was the staff not doing their job in terms of bedsore prevention--- but perhaps equally importantly-- staff may not have been implementing the necessary medical treatments as the wound progressed.

I can only imagine that forcing a personal accountability issue medical staff would lead to situations where patient care would inherently improve-- both out of the staff's personal pride and perhaps-- fear over personal responsibility over their visibly inadequate care.  Indeed, perhaps its time we take a page from the past and acknowledge seemingly improved efficiencies doesn't translate to better patient care.

Related:

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

Families Must Educate Themselves When It Comes To Bed Sores Acquired In A Nursing Home Or Hospital

How many hospital patients suffer from bed sores?

Reducing Decubitus Ulcers In Hospitals. How One Facility Managed To Reduce Hospital-Acquired Wounds By 63%

Have you seen a bed sore?  If you haven't, advanced bed sores are truly horrific conditions that are perhaps the most gruesome example of institutional neglect. 

However, particularly when there are photographs of a gaping wound on a patient's buttocks or heels, many of these cases seem to miraculously get get resolved prior to when they get presented to a jury.  Perhaps some of the risk managers and lawyers defending these nursing homes and hospitals are providing useful advice to their clients to: settle, settle, settle?

Maybe the 'settle, settle, settle' message got confused in a recent case involving the development of bed sores during a hospital admission following a hip surgery.  The family of Alfred Gonzales, filed a medical medical malpractice lawsuit against Christus St. Vincent Regional Medical Center (New Mexico) due to the bed sores that developed on his heels during his hospitalization. 

The jury awarded Mr. Gonzalez's family $10.3 million.

Ignoring their own protocol, the hospital failed to provide Mr. Gonzalez with the appropriate care and devices to prevent the development of the bed sores (interchangeably referred to as: pressure sores, pressure ulcers or decubitus ulcers).  Tom Rhodes, the lawyer representing Mr. Gonzalez's family said it best;

Shift after shift, they didn't do what they were supposed to d.  After they know they had a problem, they charted saying that there was no problem.  It was haphazard and reckless, like they were really doing the stuff; they were just writing it down.  A lot of it had to do with the fact that he (Mr. Gonzalez) couldn't communicate well.

Obviously, the poor charting and blatant disregard for patient well being was conveyed to the jury in this matter.  The award is comprised on $595,000 in compensatory damages and a hefty $9.75 million in punitive damages.

There is no doubt that the significance of this verdict will travel to hospital administrators across the country.  Though many folks in hospital management positions may brush this case off as a freak situation, my hope is that a majority of the decision-makers take note of this case for the fact that jurors will no longer accept the fact that the development of bed sores during a hospital admission is an inevitable part of being hospitalized.

Related:

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

Medical Facilities Are Not Doing Enough To Prevent Pressure Ulcers On Patients' Heels

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

What are some common defenses used by nursing homes and hospitals in lawsuits involving pressure sores?

Christus St. Vincent Medical Center slapped with $10.3M penalty in bed sore lawsuit by Phaedra Hayword, the New Mexican, February 18, 2011

Nursing Home Injury Laws: New Mexico

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 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

An increasing number of number of pressure sore cases my office is working on involve pressure sores that have developed during a hospitalization.  What was once considered a sad symbol of poor nursing home care, is now increasingly associated with poor hospital care.  Many of our clients who enter a hospital for acute care, wind up extending their hospitalization due to the development of a pressure sore during their stay. 

Federal and State regulations require nursing homes to conduct a thorough assessment of all new admissions.  The assessment evaluates the individuals skin integrity and attempts to determine who is susceptible to develop of pressure sores.  This initial assessment is designed to help nursing home staff implement preventative pressure sore care.

Hospitals on the other hand, are not governed by the same regulations and consequently are not as attuned to pressure sore prevention.  Many hospitals fail to train their staff to identify pressure sore risk and implement policies for pressure sore prevention.

According to the Agency for Healthcare Research and Quality (AHRQ), the number of hospital patients who develop pressure sores (also known as pressure ulcers, bed sores or decubitus ulcers) has increased by 63% since 1996. 

Pressure sores are caused by unrelieved pressure to the skin which cuts off blood circulation to the area.  Hospitalized seniors are particularly vulnerable to development of pressure sores because many have limited mobility and may be bedridden. 

Further increasing the risk of pressure sores amongst the elderly is the fact that many seniors have lost a considerable amount of muscle and fat that would normally help relieve the pressure in younger people.  Most pressure sores develop in areas where there is a 'bony' prominence.  Common areas where pressure sores develop are: the sacrum, coccyx, heels, elbows and ankles. 

Pressure sores are graded by their severity (1, 2, 3 and 4).  A stage 1 pressure sore may be a reddened area with some blistering.  By the time a pressure sore advances to stage 4, a deep wound has developed and may also involve organs and bones.  The AHRQ determined the average duration of a hospital stay for treatment of pressure sores to be 13 days, with an average cost of $37,500.

Pressure sores are preventable.  Hospital staff need to focus on patients factors and take necessary steps to assure patients remain free from pressure sores during their stay.  Among the steps hospitals need to take to prevent development of pressure sores are:

• Changes resident's positioning every two hours
• Use pressure relieving air mattresses
• Make sure patients are receiving proper nutrition
• Keep the resident clean and dry

We can help you

Don't let hospitals get away with providing substandard care. If you or a loved one has developed a pressure sore during a hospitalization, put our experience litigating pressure sore cases to work for you.  We have successfully recovered money for our clients from hospitals throughout the country. Contact the pressure sore lawyers at Rosenfeld Injury Lawyers for a personalized case consultation. All consultations are confidential.   We will come to you. 

Resource: About.com