- What Exactly are Pressure Sores?
- How Can I Identify Pressure Sores?
- Who Is at Risk for Pressure Sores?
- How are Pressure Sores Avoided and Treated?
- What are the Responsibilities of Health Care Providers When It Comes to Identifying a Pressure Sore Problem?
- What Do You Do When a Bedsore Problem has Been Identified?
- What Should Someone Do If They Develop Pressure Sores Because of Health Care Negligence?
- If a Claim Is Filed, How Much Money Do Patients Typically Receive in Settlements or Verdicts?
If you learn that your parent or spouse has bedsores, you should be concerned because significant bedsores rarely occur in the absence of negligence. This page helps victims and their families better understand pressure sores and the litigation environment of these claims.What Exactly are Pressure Sores?
Pressure sores, or bedsores, are injuries to the skin and tissue that result from sustained periods of pressure on the skin. Typically, they develop on skin that covers bones; such as the heel, ankle, hips, or tailbone. A pressure sore is technically a tissue injury that develops when a person's movement is restricted for a significant period. This means that pressure sores are a common injury for those who are bedridden. Pressure sores can also pop up from other conditions; such as incontinence, malnutrition, diminishing mental faculties, and other circumstances. Sustained friction and shearing of the skin have also been commonly known to result in pressure sores.How can I Identify Pressure Sores?
Pressure sores vary wildly in severity. Although bed sores typically develop below the waist, they can be found in any area of the body. The affected area may appear red and will likely feel warm to touch. A pressure sore is very sensitive and painful when touched. There are four different stages of pressure sores which help health care providers assess the severity of the sore. However, pressure sores should never really develop past stage II. If pressure sores develop past stage III and IV; the pressure sores are often indicative of negligence.
- Stage I - In the first stage, the skin is not broken around the sore, but may appear red. The site will likely feel tender or painful compared to the surrounding skin.
- Stage II - When a sore progresses to the second stage, the outermost layer of the skin on the sore will be damaged or even lost. A shallow wound may also start to develop, which will look like a blister.
- Stage III - A stage III pressure sore is a relatively deep wound. The affected area will look crater-like and will usually have dead tissue at the bottom of the wound. The damage may even extend beyond the primary wound to layers of healthy skin. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue
- Stage IV - At stage IV, the wound will expose muscle, bone, or tendons. The bottom of the wound will contain dead tissue that will appear darkened.
- Unstageable - Pressure sores that are covered with dead and darkened tissue are considered "unstageable" because it is impossible to judge how deep the wound is.
In terms of potential lawsuits, our law firm considers Stage IV and unstagable bed sore cases. We take Stage III claims under some unique circumstances.Who is at Risk for Pressure Sores?
People who have restricted or limited movement are at the greatest risk of developing pressure sores. For example, those who use a wheelchair or are confined to bed are at greater risk. For those who use wheelchairs, pressure sores can develop on the tailbone, buttocks, shoulders, spine, arms, or legs. Beyond resident immobility, urinary incontinence or chronic voiding dysfunction, and chronic or end stage renal, liver, or heart disease.
There is also test results and objective data points that can indicate risk. Serum albumin below 3.4 g/dl, weight loss of more than 10% during last month and Hgb less than 12 mg per dl are all warning signs. Malnutrition and dehydration are huge risk factors. They include pale skin, dry or swollen tongue, red or swollen lips, swollen and, poor skin turgor, bilateral edema, muscle wasting, calf tenderness, or reduced urinary output.
The overwhelming majority our law firm's bed sore cases are nursing home cases. In nursing homes, around 12.5% of individuals with mobility impairments, malnourishment, or who are in a coma experience pressures sores. Luckily, that number goes down to 2.5% for those who do not suffer from those conditions. But the reality is that no one should be getting a Stage III or beyond pressure sore. When patients and nursing home residents do, it is likely that the cause is negligence by a health care or nursing home care provider.How are Pressure Sores Avoided and Treated?
The best way to treat a pressure sore is to avoid one in the first place. One can do this by taking care of their body. Good nutrition and hydration ensure healthy skin and good blood flow, decreasing the risk of bed sores. Certainly, quitting smoking can be huge here considering that smokers often develop more severe wounds as a result of decreased blood flow.
If a pressure sore does begin to develop, it is important to reposition the body, preventing sustained pressure on vulnerable areas. Placing a pillow between the legs is a simple way to prevent sores around the knees. Also, keeping the skin clean and moisturized also cuts down on risk in general. If a sore progresses past the initial stage, caretakers need to ensure that the wound is kept clean and re-dress the wound often to avoid the spread of infection. If the condition worsens, one might have to undergo a debridement, which is a procedure to remove dead skin.
It is not rocket science. All you need is health care professionals who are diligent and are actively caring for the patient.What are the Responsibilities of Health Care Providers When it Comes to Identifying a Pressure Sore Problem?
Let's start with federal law because it does set the standard of care. Federal regulations set the minimum standard of care with which hospitals and nursing homes when it comes to bedsores. The standard of care for pressure sores requires health care providers to "ensure that (1) a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and, (2) a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing." 42 C.F.R. § 483.25(c).
Pressure sores present a huge problem in the medical community considering how quickly a wound and infection can spread throughout the body. So the clinical guidelines that provide recommendations on how patients should be treated once pressure sores are present must be followed. The biggest factor is assessment, meaning care providers need to determine the size, location, and severity of the sore before developing a plan of action for treatment. The failure to properly assess bedsores is the mother of so many nursing home injury and wrongful death cases.What Do You Do When a Bedsore Problem Has Been Identified?
Once sores have been identified, treatment involves more than just giving attention to the site. If a resident is identified as either at high risk for development of pressure sores or is in fact already developing them, the standard of care requires that aggressive measures must be undertaken to prevent or stop and reverse their formation. What is a nursing home required to do? Turning and proper positioning, application of pressure reduction or relief devices, egg crate or gel mattress pads, propping pillows, providing good skin care (keep the skin clean and prevent excessive moisture), providing clean and dry bed linens. It is also critical that the resident receives adequate nutrition and hydration. This includes assistance with eating, supplements, calorie monitoring, and regular monitoring of weight and hydration levels. It is also vital that all health care providers are kept in the loop. It is not much help if the nursing assistant who has a handle on all of these things is on vacation during the critical period and no one knows what must be done.
Hospitals frequently use a tool known as the Braden Scale, or Braden Skin Assessment, to document the risk that a patient might develop a bed sore. The Braden Scale consists of a number of criteria, each of which has a numerical value. The total score determines the level of risk.What Should Someone Do If They Develop Pressure Sores Because of Health Care Negligence?
If a patient develops a pressure sore as a result of negligence on behalf of someone else, the first thing to do is make sure that the patient is getting the best care possible. Sometimes, negligence occurs long after everyone understands there is a problem.
Victims and their families should also consider talking to an attorney. As discussed above, health care providers have a duty to minimize the risks of bedsores. So when they fail to do so, they need to be held accountable. An attorney will be able to gather the information necessary to bring a claim against a negligent care provider. Failure to prevent or treat pressure sores can be considered a form of medical malpractice. Therefore, it is important to discuss potential courses of action with an attorney before it is too late.If a Claim is Filed, How Much Money Do Patients Typically Receive in Settlements or Verdicts?
The only remedy that the civil justice system provides for in these types of cases is money. So justice in these cases means compensation. The value of a case depends on the particular facts and circumstances behind each victim.
So while the sample verdicts and settlements we provide below (and in Maryland here) are useful and important information, they are also very limited. It is hard to gauge the value of an individual case based solely on looking at similar cases because there are so many different variables involved that have very different weights to them in terms of the settlement or trial value of the claim.
There is one thing you have to keep in mind. The overwhelming majority of these cases settle long before trial, with confidentiality clauses that do not let lawyers like us educate victims and other lawyers about our settlements. So the picking - particularly in Maryland where we practice - are very slim.
Reported settlements in nursing home cases are so rare because nursing homes are smart about covering up their mistakes. They demand confidentiality when cases settle. This has happened in every single nursing home case we have settled. Incredibly, you cannot find a reported nursing home settlement in Maryland in the last few years.
It is tough on nursing home lawyers. We want to get the word out about settlements, but our clients are not focused on that. So we can't hold up a settlement based our desire to get the word out.
With all of that said, here are some recent verdicts and settlements in nursing home cases:
- 2015, New York: $500,000 Verdict - An 86-year-old man undergoes surgery to resolve an aneurysm in his aorta. Although the surgery is successful, the recovery involves several complications, including bed sores developing on the man's buttocks. Even though the man undergoes treatment for the sores, they continue to worsen and spread. After the man is transferred to a new facility nearly a year after surgery, he dies of kidney failure and septic shock. The man's estate sues the hospital where the man was initially treated. Specifically, he alleges that the staff could have prevented the bed sores, which may have led to the man's death. Further, his estate alleges that diligent repositioning could have avoided the problem, to begin with. After a five-day trial, a jury finds for the man's estate, making an award of $500,000 for the patient's pain and suffering.
- 2015, Pennsylvania: $110,000 Settlement - After an elderly man falls in his home, he is admitted to a hospital. He is discharged to a nursing facility, who notes that he has a high risk of skin breakdown. Over the next few months, he develops several pressure sores throughout his body in addition to MRSA and a serious urinary infection. He is transferred to a hospital multiple times but dies from the injuries sustained at the nursing facility. His estate sues the facility, claiming that they were negligent in his care by failing to re-position the man to prevent his injuries. The defendants suggest that all of the injuries were pre-existing. Before trial, the parties settle for $110,000. It is easy to see why the nursing home let this one get published, right? They want you to think that a wrongful death case is worth only $110,000.
- 2014, Pennsylvania: $3,500,000 Verdict - A patient receives surgery for cauda equina syndrome. The surgery proceeds without any complications but during the rehabilitative process nurses begin to note various bed sores on the patient's body. One of the bed sores eventually turns into a deep tissue injury of the tailbone. Over the next few months, the patient requires nearly 18 surgeries, including amputation of his right leg below the knee. He also develops a MRSA infection. He sues the hospital, alleging that they were deficient in treating him. Specifically, he claims that the hospital workers were not adequately trained. He claims that other aspects of the patient's treatment, including malnutrition, contributed to the sores. A jury awards the man $3,500,000.
- 2014, Massachusetts: $14,447,906 Verdict - A 90-year-old woman is admitted to a nursing home. For around one month, staff leaves various infections and bed sores untreated. Because of the infections that resulted from the untreated bed sores, the woman's cognitive abilities begin to deteriorate, causing her to fall out of her wheelchair. Her infections became so severe that doctors consider surgery, but given her age it is considered too risky. The woman eventually passes away from various complications that are traced to her bed sores. Her estate sues the nursing home, who admits various breaches of the applicable standard of care. They dispute that their neglect caused the injuries. In the end, the jury awards for the woman's estate, with over $12,000,000 of the verdict comprised of punitive damages.
- Get example verdicts and settlements in nursing home wrongful death cases
- Get sample nursing home trial outcomes and out-of-court settlements here
The Maryland medical malpractice and nursing home attorneys at Miller & Zois handle many cases involving pressure sores that could have easily been prevented. Medical records can only tell you so much.
Our attorneys dig deep and turn over every stone to figure out the most minute details of each pressure sore case - to find out what happened to you or someone you love (or loved). If you or a family member has developed pressure sores as a result of medical negligence, call us at 800-553-8082 or get a free online consultation.Talking to a Nursing Home Lawyer
Has someone in your family suffered needlessly at the hands of a CommuniCare or other nursing home that made a terrible error? Call our nursing home attorneys at Miller & Zois today at 800-553-8082. Don't want to make a phone call yet? Get a FREE no obligation case review.