• 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

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.

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

Bed Sore FAQs

Nursing Home Injury Laws: Tennessee

Is Sepsis Related to Bed Sores?

• Turning patients 

• Using pressure reducing mattresses and pads (pressure relieving devices) 

• Keeping residents clean and dry 

• Providing adequate nutrition and hydration 

• Performing skin checks 

• Bone/join infections (osteomyelitis, the infection spreads into your bones and can cause damage to tissue and cartilage) 

• Cellulitis (infection of the skin’s connective tissue, spreads quickly and can cause sepsis and meningitis, two life-threatening complications) 

• Sepsis (bacteria enters your bloodstream, life-threatening condition which can cause organ failure and shock) 

• Cancer (of the skin’s squamous cells)
• Death

• 45,500 hospital admissions had pressure ulcers as the primary diagnosis 
•  1 in 25 hospitalizations related to pressure sores resulted in death during the admission 
•  457,000 hospital admissions had pressure ulcers as the secondary diagnosis 
•  1 in 8 of these admissions ended in death 
•  Pressure ulcer related hospitalizations also cost more than the average hospital stay ($16,755-20,430 as opposed to about $10,000) and requires a longer hospital stay (13-14 days as opposed to only 5 days) 

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.

The nursing home negligence lawsuit, filed by my colleague Attorney David Terry, is filed on behalf of a deceased nursing home patient and alleges the nursing home (Parkwood Skilled Nursing and Rehabilitation Center) and its various management companies operated the facility in a manner where money necessary for essential patient-care services was diverted away from the the facility to the benefit of the facility owners.

The subject of the lawsuit, Nellie Wilks, was an elderly woman who was admitted to Parkwood Skilled Nursing and Rehabilitation Center on July 7, 2008.  At the time of her admission, Ms. Wilks suffered from various medical conditions and was very much dependent on the staff at Parkwood for providing care for her daily living needs.  Despite her maladies, Ms. Wilks did not have any type of pressure sore on her body.

Also at the time of her admission, the staff at Parkwood conducted an assessment of Ms. Wilks needs and determined her to be at risk for developing bed sores, due to her limited mobility, incontinence of bowel and bladder and need for staff assistance with all of her daily living needs.

The failure on the part of the staff at Parkwood (as well as the owners' failure to provide staff with the means to do their job) to properly implement Ms. Wilks' plan of care is alleged to be responsible for the development of a stage IV pressure sore on Ms. Wilks' sacrum. The wound's advanced nature, necessitated a medical procedure known as a diverting colostomy and extensive medical care until her death on October 26, 2008.

The lawsuit against Parkwood specifically alleges the facility failed to provide adequate care to prevent the following:

• Pressure sores
• Malnourishment
• Development of a urinary tract infection
• Osteomyelitis
• Severe pain

Sadly, many nursing home patients are currently suffering horrible pain and embarrassment due to bed sores.  The overwhelming majority of bed sore cases are the result of the facilities failure to properly implement plans of care.  In cases where a bed sore developed during an admission, facilities can be held responsible for the resulting pain and loss of dignity and medical expenses.  

Our nursing home attorneys are available to discuss your situation with you and advise you of your legal rights.  All consultations are confidential and no fee is ever charged unless there is a recovery for you. (888) 424-5757

Related:

Nursing Home Resident Dies From Improperly Treated Pressure Sores During Short Rehab Stay

New York jury awards $19m to family of man who developed advanced bed sores during nursing home admission

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

Angela Thompson v. Parkwood Skilled Nursing and Rehabilitation Center (pdf)

Bed Sore FAQ's

In particular, surveyors discovered the following alarming situations at the Southern Illinois facility:

• The facility failed to have written procedures regarding patient care (Section 350.620 Resident Care Policies)
• Edwardsville failed to provide skilled nursing services that are required to maintain each patient's health-- when the facility failed to identify signs of physical and psychological illness that were apparent in one of the patients (Section 350.1210 Health Services)
• Delaying the implementation of medical care that was necessary for patients who need the services of a physician, licensed nurse or professional nurse
• Failed to maintain adequate patient records pursuant to Section 350,1610
• Neglecting a patient in violation of Section 2-107 of Illinois' Nursing Home Care Act

The above violations came to light following an investigation of an extremely sick patient suffering from uncontrolled diabetes and severe mental illness amongst other maladies.

Nursing home surveyors focused on the fact that the patient at issue was admitted to a hospital emergency room after an extended illness Edwardsville Terrace.  The unidentified patient was admitted to the emergency room with the following diagnosis:

1. Septic shock
2. Dehydration
3. Cardiomyopathy
4. E. Coil
5. Sepsis
6. Right nephrolithiasis causing E. Coli sepsis
7. Chronic ear infection
8. Hypertriglycerdemia

The nursing home patients acute illness necessitated extensive medical treatment and extended hospitalization. While reviewing the patient's chart from Edwardsville Terrace, a gross lack of documentation lead the surveyors to believe the facility failed to provide essential medical care.

Certainly, this survey should give patients and their families cause for concern; due to the fact that this facility failed to meet the basic needs of this patient.  Hopefully, the disclosure of poor care (as well as the $20,000 fine imposed against this facility) will cause Edwardsville to improve their documentation and re-commit themselves to providing necessary care for all of their patients.

Nonetheless, I am sure that this incident is not isolated.  If you believe your loved one was mistreated, abused or neglected at Edwardsville Terrace, I would honor the opportunity to speak to you about the situation and your legal options.

Related:

Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients

Dehydration & The Development Of Bed Sores In Nursing Home And Hospital Patients

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

Improper Transfer Leads To Broken Arm

First Quarter 2010 Illinois Nursing Home Violations Released

Finally, after six months without a catheter change, a nursing home employee recognized the obvious problems: cloudy / brownish urine and testicles extremely swollen due to infection.  The situation initially resulted in a hospitalization where the man's testicles were surgically removed.  Unfortunately, the staff's intervention was too little, too late.  Within a week of arriving at the hospital, the man died from a condition known as urosepsis.

Urinary Tract Infections

Urinary Tract Infections (UTIs) seem like a minor problem, especially in nursing homes, considering the range of common diseases, infections, and illnesses. However, UTIs can prove very dangerous, especially when nursing home facilities fail to prevent UTIs in the first place or fail to provide proper and prompt treatment.

Urosepsis

Urosepsis is basically a severe urinary-tract infection. A UTI occurs when bacteria travels up the urethra (the opening in the body through which urine passes) into the bladder. UITs account for over 30% of infections reported by acute care hospitals and are the most common type of healthcare-associated infection. 

The bacteria can stay contained in the bladder (cystitis), travel to the kidneys (pyelonephritis), or even spread into the bloodstream (urosepsis). With urosepsis, you can suffer a dangerous drop in blood pressure, which can deprive your organs of oxygen. It can even prove fatal if you do not receive prompt antibiotic therapy, with an associated problem of increased use of antibiotics and multidrug-resistant bacteria.

Symptoms of UTIs include:

• Strong, persistent urge to urinate
• Burning sensation when urinating
• Passing frequent, small amounts of urine
• Blood in urine
• Cloudy, strong-smelling urine
• Bacteria in urine

More severe UTIs can also cause the following symptoms:

• Flank (upper back and side) pain
• Lower abdomen pain
• Fever
• Shaking and chills
• Nausea
• Vomiting
• Frequent, painful urination

While most urinary infections are mild, they can progress to more serious infections. Risk factors for urosepsis include:

• Older age
• Being female
• Having an indwelling urinary catheter (Foley catheter)
• Suffering from kidney stones
• Having impaired immunity

Urosepsis and catheter usage

UTIs are a common problem for the elderly because they are more likely to suffer from common risk factors. There is a marked increase in the prevalence of UTIs in both women and men after age 65. Females are more likely to suffer from UTIs as they age because of physiology and hormone changes. 

First, women have a shorter urethra, making it easier for bacteria to travel into the bladder. Second, as women age because the tissues of the vagina, urethra, and base of the bladder become thinner and more fragile. In addition, decreased estrogen levels causes pH changes in the vagina, allowing E.coli colonization, which causes about 80% of all UTIs. Men, on the other hand, suffer more UTIs when older because of prostatic disease. 

Risk factors include:

• Atrophic urethritis
• Atrophic vaginal mucosa (atrophic vaginitis)
• Benign prostatic hyperplasia
• Prostate cancer
• Catheter use
• Chronic bacterial prostatitis
• Genitourinary abnormalities
• Genitourinary calculi
• Renal and perinephric abscess formation
• Urinary diversion procedures
• Urethral strictures

Improperly maintained catheters are one frequent cause of UTIs. Usually, the longer a catheter is in place, the more likely an infection will develop. Up to 35% of patients requiring a urinary catheter for seven days or more will develop a CAUTI. About 50,000 long-term care residents have catheters at any given time according to the CDC’s 2009 report on catheter-associated urinary tract infections (CAUTIs). 

It is recommended that catheters are used only in appropriate situations and are left in place only as long as necessary. (See “Never Event #4: Catheter Associated Urinary Tract Infections and Nursing Homes Abuse Blog: Catheter Usage)

There are steps that nursing homes can take in order to reduce the risk of CAUTIs (proper use, proper technique, and proper situations). Proper use of urinary catheters is important, including:

• Not using urinary catheters to manage incontinence
• Using urinary catheters only in patients as necessary
• Remove the catheter as soon as possible
• Not using urinary catheters as a means of obtaining urine for culture or other diagnostic tests when the resident can voluntarily void

Instead, urinary catheters should only be used when necessary. Situations where indwelling urethral catheters are appropriate include: 

• When resident has a bladder obstruction
• Critically ill patient cannot voluntarily void urine for tests or to measure urine output
• Patients undergoing urologic surgery
• To help genital or anal wounds heal
• If resident requires prolonged immobilization
• To improve comfort for end of life care

Proper technique for urinary catheter insertion can also help reduce the risk of CAUTIs including:

• Washing hands before and after inserting or touching the catheter or catheter area
• Ensuring that only properly trained professionals insert/maintain the catheter
• Only touch the catheter when necessary
• Use sterile equipment
• Ensuring that healthcare personnel who take care of catheters receive periodic in-service-training

If used properly (proper situation and proper technique), indwelling urinary catheters can be a helpful tool when caring for nursing home residents. However, when proper technique, use, and care of catheters are not achieved, serious bacterial infections can occur.  

It is frightening how quickly a simple UTI can turn into a dangerous bacteria infection (urosepsis) that could prove fatal. Bloodstream infections in the elderly are associated with a higher mortality rate compared to bloodstream infections in younger age groups. Therefore, prevention of dangerous UTIs and proper treatment is important. 

If you or a family member has an indwelling catheter, it is important to ask questions about why it is necessary, for how long it is necessary, and proper and hygienic care. 

Thanks to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog Entry

Sources:

Nursing Homes Abuse Blog: Never Event #4: Catheter Associated Urinary Tract Infections

Nursing Homes Abuse Blog: Catheter Usage

CDC: Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009

The Merck Manual of Geriatrics: Urinary Tract Infections

Geriontological Nursing: Urinary Tract Infection - Guidelines to assessment, treatment, and prevention in the older adult

The American Journal of Medicine: Bloodstream infections in the elderly

International Journal of Experimental, Clinical, Behavioural, Regenerative and Technological Gerontology: Unique Aspects of Urinary Tract Infection in the Geriatric Population

Journal of the National Medical Association: Problems in diagnosing infections in the elderly

The Journal of Urology: Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection

Emerging Infectious Disease Journal: Engineering out the risk for infection with urinary catheters

Journal of the American Medical Directors Association: Complications of chronic indwelling urinary catheters

Among the claims presented by the family of the deceased was that the facility was so understaffed that they could not provide adequate care for the woman.  This claim was substantiated at the trial against the facility when it was demonstrated that despite orders for 60 doses of MiraLax, a laxative, the facility administered just 16 doses in the months leading up to the woman's death.

After a two week trial, the jury awarded substantial damages to the woman's family against: the administrator of the facility, director of nursing, Americare Systems, Inc., Shelbyville Residential LLC and Celebration Way.

Read more about this wrongful death lawsuit against an assisted living facility here.

Understaffed Nursing Homes

As lawyers who tend to see the results of things gone bad, I can attest to the problems under-staffing results in.  In some situations, staff are responsible for caring for more than 30 patients per day.  When the stresses put on nurses reach this level it is essentially impossible for them to adequately perform their job. 

Corners begin to get cut.  Not necessarily out of maliciousness or laziness-- but because there simply is not enough time in the day to perform the tasks they are responsible for.  The end result is that patients to not get the care they require and consequently get neglected or hurt.

In most situations, I point blame at the management who make a conscious decision everyday to strip staffing levels to the bare-bones in order to maximize the profitability of their facilities.  Hopefully, when courageous juries, like the one above, start sending messages in the form of large verdicts, operators will begin to change the way they do business.

Related:

Early Detection Is The Key Element To Successful Sepsis Treatment

Failure To Monitor Bowel Movements In Nursing Home Patients Can Lead To Impacted Bowels

High Staff Turnover Rates Plague Most Nursing Homes

To those unfamiliar with sepsis, it is a severe infection that effects the complete body.

The wide-reaching effects of sepsis surprised even me.  According to statistical analysis of septic hospital patients:

• Sepsis is the 10th leading cause of death in the U.S.
• 1/3 of people who develop sepsis will die
• Sepsis results in more than $17 billion in medical expenses every year

The fight against sepsis has now begun!

The Banner Desert Medical Center (Arizona), is now the first medical center in the country to implement a sepsis detection program to help improve the survival rate of patients.  The hospital uses a scientific formula to detect warning signs that are indicative of sepsis including:

• changes in body temperature
• increases in heart rate
• changes in respiratory rate
• white blood cell count

Once the early signs of sepsis are identified, the hospital is able to administer treatment quickly-- and greatly improve the patients survival rate.  At Banner Medical Center, the hospital credits the new program with the early detection of sepsis in 60 patients within the first two-month period that traditional detection techniques were unable to spot.  Read more about this important development in sepsis detection here.

My hope is that the sepsis detection instruments used at this hospital become common practice-- not just amongst hospital patients-- but nursing home patients as well who frequently receive delayed medical treatment because nursing home staff do not have the tools to make a diagnosis of sepsis.

Related:

Is sepsis related to bed sores? BedsoreFAQ.com

Despite Their Avoidability, Bed Sores Continue To Plague Nursing Home & Hospital Patients In All Demographics

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

Bed Sore Resources

Bed Sore Treatment Specialists

In times of need, locating necessary information regarding the legal rights and resources for nursing home patients can be difficult and imposing.  In this respect, we are proud to introduce a new resource for patients, families and practitioners looking for a concise compilation of information regarding nursing home laws.  Nursing Home Injury Laws, provides every states':

• Nursing Home Laws
• Medical Malpractice Laws
• State Resources
• Applicable State Code
• Common Nursing Home Injuries
• Glossary
• Recognized Books & Journals
• Nursing Home FAQ

Additionally, we will be posting regular updates regarding important developments relevant to nursing home care within each state.  Here is a link to Nursing Home Injury Laws.

Here are some of the medical conditions we have discussed over the past year:

Clostridium Difficile / C. Diff

Clostridium difficile (also called C. difficile or C. diff) associated disease (“CDAD”) is a bacterial infection that can cause diarrhea and serious intestinal conditions (such as colitis - inflammation of the colon). CDAD is responsible for about three million cases of diarrhea and colitis annually in the United States.

Stevens Johnson Syndrome

Stevens-Johnson Syndrome (“SJS”) is a systemic disorder that affects the skin and mucous membranes, usually caused by a severe drug reaction. SJS often begins with flu-like symptoms (fever, sore throat, cough, burning eyes), then progresses to red or purple rashes and blisters (photos), especially around the mouth, nose, eyes. These symptoms eventually lead to skin sloughing (the shedding of the top layer of skin) because of cell death. Some patients with extreme cases of SJS appear as though they were severely burned due to the extensive skin loss.

Legionnaires Disease

Legionnaires disease is an infectious disease caused by the Legionella bacteria. There are two types of Legionnaires disease: Legion fever (where people generally develop pneumonia) and Pontiac Fever (symptoms similar to the flu).

Legionnaires disease got its name when a group from the American Legion conference all developed pneumonia. When scientists analyzed the group, they noticed that they all had the same bacterium called Legionella.

Subdural Hematoma

A subdural hematoma is a type of intracranial bleeding (hemorrhage), caused by head injury. Subdural hematomas occur when blood vessels burst in the space between the brain and the outermost membrane that covers the brain (dura mater). The collection of blood forms a hematoma, which puts pressure on the brain tissue.

There are three types of subdural hematomas: acute, sub-acute, and chronic. Acute subdural hematomas are the most dangerous and are usually caused by a severe head injury. With sub-acute hematomas, the signs and symptoms take longer to appear (days or weeks). Chronic hematomas can be caused by less severe head injuries, and symptoms can take weeks to appear because of slower bleeding.

Hypotension

Hypotension (low blood pressure) is a problem for many nursing home residents, causing dizziness and fainting. Blood pressure readings measure the pressure in arteries - systolic pressure (the top number in a reading) measures the pressure the heart generates when pumping blood out to the rest of the body and diastolic pressure (the bottom number in a reading) measures the amount of pressure between heartbeats. A systolic blood pressure of 90 millimeters of mercury or less or a diastolic blood pressure of 60 millimeters of mercury or less is considered low.

Sepsis

'Sepsis' is a bacterial infection in the bloodstream or body tissues, frequently found in patients with severe bed sores. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Frequently, people use the term sepsis to describe 'severe sepsis' and 'septic shock.' Severe sepsis is used to describe people who have organ dysfunction following a diagnosis of sepsis. People diagnosed with septic shock have sepsis with hypo-tension (abnormally low blood pressure).

Amyloidosis

Elderly nursing home residents, especially those suffering from other diseases such as bed sores, have a higher risk of developing amyloidosis, a disease which can damage various tissues and organs. This can cause dangerous complications in residents who are already weak from advanced age or underlying disease.

Amyloidosis is a group of diseases caused by abnormal deposits of amyloid protein (usually produced by cells in bone marrow) in the body’s tissues and organs. The disease frequently affects the heart, kidneys, liver, spleen, nervous system, and gastrointestinal tract. The amyloid protein can deposit in a localized area (localized amyloidosis) or affect tissues throughout the body (systemic amyloidosis). Amyloidosis is diagnosed for testing for the amyloid protein in a biopsy of involved tissue.

Impacted Bowel

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence.

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis or death.

Should a bed sore develop, staff must be diligent in identifying the wound as quickly as possible an implement the use of medical equipment such as pressure relieving mattresses  and other pressure relief devices such as heel protectors to prevent the wounds from advancing.

When bed sore are not timely treated, the wounds may progress and become an advanced stage bed sore. A stage 3 or 4 bed sore typically requires more aggressive interventional medical treatment may be required such as surgical debridement, flap reconstruction or a diverting colostomy may be necessary.

By the time significant medical treatment his utilized, many patients are already suffering from complications such as: osteomyelitis, amyloidosis, gangrene or sepsis. 

In addition to the pain that accompanies bed sores, the medical complications may claim the life of the person.  In my practice, we commonly represent families in wrongful death lawsuits for people who have developed bed sore during an admission to a hospital or nursing home.

Many of these commonly encountered situations are discussed at BedSoreFAQ.com, where we receive thousands of visits every month from concerned family members and care givers. If you have a question, not discussed, feel free to contact me for a no-obligation consultation. (888) 424-5757. Toll-free. Anywhere

The lawsuit claims that on December 12, 2008 Ms. Steiner was admitted to the facility with stage II pressure sores on her buttocks and early stage pressure sores on her heels.  Five days later, when Ms. Steiner was discharged, the pressure sores (also known as pressure ulcer, decubitus ulcer or bed sore) had advanced to stage IV and Ms. Steiner had become known as septic.  As a result of the sepsis (also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia), Ms. Steiner died.

The lawsuit further alleges that Caseyville Nursing and Rehabilitation was negligent in the following ways:

• Failing to screen Ms. Steiner on admission to the facility
• Failed to have adequate staff to treat Ms. Steiner's wounds
• Never developed a care plan for Ms. Steiner
• Never notifying Ms. Steiner's physician as to her condition

My take:

With the obvious disclaimer (I don't know anything about the case other from what is in the newspaper), it would appear as though the Ms. Steiner's family may have a difficult time winning their case. 

As the plaintiff in this matter, Ms. Steiner's family has the burden to prove their case.   Given the fact that Ms. Steiner enter the nursing homes with clearly form pressure sores and the wounds worsened in such a brief period of time, perhaps the damages was done by the time she had entered the facility?

Sepsis and Pressure Sores

With open wounds from pressure sores, bacteria can easily enter the bloodstream and cause and infection in the body.  When the infection progresses, it may cause sepsis.

In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Symptoms of sepsis include:

• Fever
• Low body temperature (hypothermia)
• Loss of ability to appreciate surroundings
• Cool hands and feet
• Anxiety
• Shaking
• Organ dysfunction

In order to provide patients with the best chance of recovery, facilities should identify and treat patients as quickly as feasible. If not treated properly, many patients with sepsis die shortly after the condition develops.

Resources:

Is sepsis related to bed sores? Bed Sore FAQ

Nursing home blamed for resident's sepsis St. Clair Record, December 7, 2009

Sepsis Nursing Homes Abuse Blog August 7, 2008

Nursing Home Injury Laws

Bed Sore Resources

One of the nursing home negligence cases my office is currently investigating involves the death of a man related to complications related to amyloidosis.  Turns out, the man was suffering from an advanced bed sore on his coccyx (also called pressure ulcers, pressure sores or decubitus ulcers) that had progressed so far that the bone in the area had become infected (osteomyelitis).

Elderly nursing home residents, especially those suffering from other diseases such as bed sores, have a higher risk of developing amyloidosis, a disease which can damage various tissues and organs.  This can cause dangerous complications in residents who are already weak from advanced age or underlying disease.

Amyloidosis is a group of diseases caused by abnormal deposits of amyloid protein (usually produced by cells in bone marrow) in the body’s tissues and organs.  The disease frequently affects the heart, kidneys, liver, spleen, nervous system, and gastrointestinal tract.  The amyloid protein can deposit in a localized area (localized amyloidosis) or affect tissues throughout the body (systemic amyloidosis).  Amyloidosis is diagnosed for testing for the amyloid protein in a biopsy of involved tissue. 

Systemic amyloidosis is classified into three major types:

• Primary (AL) amyloidosis
• Secondary (AA) amyloidosis
• Hereditary or Familial (ATTR) amyloidosis

Primary amyloidosis, the most common form of amyloidosis, occurs when a plasma cell in the bone marrow spontaneously overproduces a particular protein portion of an antibody.  AL can affect many areas (heart, kidneys, liver, spleen, nerves, intestines, skin, tongue, blood vessels) and can occur with bone marrow cancer (bone marrow cancer), but is a disease entity of its own.

Secondary amyloidosis occurs as a result of another illness (multiple myeloma, chronic infections including tuberculosis and osteomyelitis, or chronic inflammatory diseases including rheumatoid arthritis and ankylosing spondylitis).  It usually affects the kidneys, spleen, liver, and lymph nodes.  Treatment for AA is usually treating the underlying illness.

Familial amyloidosis is a rare form of inherited amyloidosis that is an inherited autosomal dominant disease (meaning that the offspring of a person with the condition has a 50% chance of inheriting it).  ATTR usually affects the liver, nerves, heart, and kidneys. 

The signs and symptoms of amyloidosis depend on the tissues or organs affected.  The symptoms result from abnormal functioning of the organs and tissues involved.  They may include:

• Swelling of ankles and legs
• Numbness or tingling in hands or feet
• Severe fatigue
• Weakness
• Significant weight loss
• Loss of appetite
• Shortness of breath
• Irregular heartbeat
• Diarrhea or constipation
• Protein in urine
• Feeling full quickly
• Enlarged tongue
• Difficulty swallowing
• Swelling
• Skin changes (thickening or easy bruising)
• Purplish patches around the eyes

 Risk factors for amyloidosis including:

• Age – older than 65
• Other diseases – having chronic infections or inflammatory disease or osteomyelitis
• Family history – history of amyloidosis
• Kidney dialysis – large, abnormal proteins can build up in the blood

The severity of the disease depends on which organs and tissues are affected.  The disease can result in dangerous complications including kidney damage, heart damage, and nervous system damage.  Kidney damage can result when amyloidosis affects the kidneys.  Kidney problems frequently translate to damage with the bodied blood filtering system, allowing protein to leak from the blood into the urine.  This may result in kidney failure. 

Heart damage can also occur when amyloidosis affects the heart.  This reduces the heart’s ability to fill with blood between heartbeats, meaning less blood is pumped with each beat.  Nervous system damage can also occur when amyloid protein deposits affect the nerves.  This can result in numbness, tingling, or difficulty controlling blood pressure. 

There is no cure for amyloidosis, but treatment may help manage the signs and symptoms of the disease, limit further production of amyloid protein, and treat any underlying disease.  Several treatments of primary amyloidosis are being studied including medicine and peripheral blood stem cell transplantation. 

Nursing home residents suffering from painful pressure sores are at an increased risk for amyloidosis.  Should a pressure sore patient develop amyloidosis, they run the risk of organ tissue damage and increased risk of amyloid protein deposits.  Also, paraplegic patients suffering from sepsis as a result of pressure sores also face complications stemming from amyloidosis. 

Sources:

Mayo Clinic: Amyloidosis

Boston University: Amyloid Treatment and Research Program

Amyloidosis Foundation

Pressure sores: aetiology, treatment and prevention (Colin Torrance)

Related:

Bed Sore FAQ

Bedsores: Are You At Risk?

In For Rehab. Out With Bedsores.

"The Nursing Home Says My Dad's Bedsores Were Unpreventable..."

Bed Sore Resources

In addition to monitoring food and liquid intake of nursing home patients, staff need to pay attention to the elimination of the wastes.   When urine and feces are not produced on a regular basis, nursing home staff must bring these problems to the attention of physicians.

One of the more obvious cases of nursing home neglect my office is working on involves a patient who went at least 10 days without a bowel movement.  Shift after shift of nursing home staff tended to our client-- yet no one cared enough to look at his medical chart to see when the last bowel movement occurred.  It was not until the man was taken to a local hospital, was it determined that the man's bowel had become impacted with feces.  Within 24-hours of his admission to the hospital, the man died from complications related to sepsis.

What is an impacted bowel?

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence. 

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis (also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia) or death. 

The most common cause of impacted bowel symptoms is Crohn’s disease.  In a nursing home setting, causes of impacted bowel include: not drinking enough water; not eating a diet with adequate fiber; lack of activity; certain prescription medications and generally unhealthy diet with high fat and processed foods.

When timely identified, impacted bowels can be treated with a higher fiber diet, increased hydration, exercise, laxatives, enemas, suppositories, or manually removing the hardened feces.

Unfortunately, many nursing home patients are highly susceptible to impacted bowels due to a combination of inattentive staff and an unhealthy lifestyle.  In order to minimize the chances of impacted bowels among patients, nursing homes should:  

• Provide the residents with proper nutrition (sufficient fiber, water, and healthy foods), the residents can suffer from painful constipation. 
• Provide as much physical activity as feasible for patients.
• Monitor each patients bowel movements (time, quantity, consistency)  
• Pay special attention to patients complaining of stomach pain or cramping

Resources:

Article Click - Fecal Impaction vs. Constipation

The association of fecal impaction and urinary retention in elderly nursing home patients

Annals of Internal Medicine – Incontinence in the Nursing Home