Articles Posted in Decubitus Ulcer

At Walton Law Firm, we have handled numerous cases involving decubitus ulcers or bed sores, many of them resulting in the death of the patient. But the cases we handle are civil cases; a prosecution of the nursing home or other caregiver to seek money damages. We have never seen any caregiver prosecuted criminally for such neglect.

090903_jean_rudolph.jpgIn Washington State, however, the owner of an assisted living facility and an employee were charged with crimes for the neglect of Jean Rudolph, who died under their care. When Rudolph died in 2008 at the age of 87, she weighed only 68 pounds. The cause of death was related to infections that were caused by bed sores so severe that they exposed her bones, including a hip sore so severe that her hip bone jutted out of her body.

Her son, who visited her twice a week, never knew of the sores. His mother suffered from end-stage dementia and couldn’t speak or express her needs, and each time the son visited she was always under covers.

In the 10 years since I took my first case against a nursing home for elder abuse, I have seen a growing number of homes going without liability insurance. While the uninsured problem used to be confined to the small mom-and-pop assisted living facilities with 6 to 12 beds, now I am seeing in large, institutional-type skilled nursing facilities. On Friday, the Oakland Tribune did an excellent article on this problem.

The article profiles the story of 39-year-old Grover Brown, a multiple sclerosis and Parkinson’s patient with paraplegia. Brown was a resident of High Street Care Center in East Oakland. High Street is owned by Trinity Health Systems, whose president, Randal Kleis, has operated about a dozen facilities all over California under several corporate names.

While in the care of High Street, Brown developed a pressure ulcer on his coccyx, which, due to neglect, worsened to the point that doctors were required to remove his tailbone to curtail the deep infection. Brown and his family hired an elder abuse attorney, who sued High Street for abuse and neglect under California’s elder abuse laws, which also protect “dependent adults” like Brown.

When Georgia Fitsos was diagnosed with Alzheimer’s disease and dementia in 2006, her family came to the sad realization that Georgia could no longer live alone. Too healthy for skilled nursing care, the family chose to place their mother in Broadstone Residential Facility after reading a fancy brochure that promised Georgia “can enjoy a lifestyle of elegance.”

Less than a year after her admission, Georgia’s son found his mother with a big black eye. She told him that someone hit her, but when confronted, the facility said she accidentally hit her face on the table after falling asleep in her wheelchair (Walton Law Firm currently has a very similar case). Only a month later, Georgia’s son found his mother suffering from a shortness of breath. He called 911 because the on-site Broadstone caregiver didn’t speak enough English to make the call.

When Georgia arrived at the Emergency Room doctors were stunned by what they found. A huge, Stage 4 bed sore the size of a “turkey platter” was found on her backside. It had eaten deeply into her flesh, and became infected. The infection quickly turned into sepsis, and Georgia died less than a month later.

The New York Times has a story today about the dramatic increase in hospital patients with bedsores over the last 14 years. A report from the Agency for Healthcare Research and Quality finds that over 500,000 patients admitted to U.S. hospitals in 2006 suffered from a bedsore that was developed either before or during their hospital stay. That represents a whopping 78.9 percent increase over a previous study performed in 1993.

The failure to prevent or treat bedsores has been the basis of several cases here at Walton Law Firm LLP. Most legal claims arising from bedsores (frequently called “pressure ulcers” or “decubitus ulcers”) occur in the nursing home or hospital setting, and involve a bed sore that became a Stage III or Stage IV before appropriate treatment was obtained. Sores that severe can often lead to secondary problems such as infection, and usually require painful treatment.

“Bedsores are preventable, but it’s not easy,” said William Spector, an agency researcher. “It’s not like you just get a prescription and one physician can take care of it. It’s a major team effort that requires a multidisciplinary team of dietary aides, nurses aides, physical therapists and physicians all playing a role.”

A Laguna Hills nursing home faces its second lawsuit for elder abuse in three years for the neglect of one of its residents. In both cases the resident died.

Theresa Sperry died in July 2007 after a short stay a Villa Valencia skilled nursing facility. The lawsuit alleges that with two weeks of admission, Sperry developed pressure ulcers on both of her heels that were left untreated, and worsened to the point of spreading to her muscles and exposing bone. The complaint also alleges that Villa Valencia was not adequately staffed to care for its residents.

Pressure ulcers (also called decubitus ulcers or bed sores) are a big problem in nursing homes. The Orange County nursing home neglect lawyers at Walton Law Firm LLP have represented numerous nursing home residents who have developed very serious ulcers while under nursing home care. Most sores are a result of a combination of factors: poor nutrition, immobility, and neglectful treatment.

A jury in Santa Ana awarded the family of Mary Adams $2 million after the 104-year-old was neglected in a Laguna Hills nursing home. The jury awarded $1 million for the Villa Valencia Health Care’s negligence, and another $1 million in punitive damages.

Juror Rory Paster, a 41-year-old engineering analyst who lives in Huntington Beach, said the jury wanted to “send a message that the company should do a better job of treating patients.”

According to reports, Adams admitted herself into the nursing home after suffering a fractured leg. Shortly after admission, Adams developed pressure sores on her heels, which were ignored, and not adequately treated. As a result, she contracted sepsis, and died about two months after her admission.

Studies show that almost 50% of California nursing homes do not meet federal standards in preventing pressure ulcers. The problems are so widespread that the treatment of these ulcers – also called bed sores – will no longer be covered by Medicare if the sore was acquired after admission into a nursing home.

Family members should be aware that a bed sore can develop in only a few hours if an area of the skin is subjected to enough pressure that cuts off blood flow to that area. The skin will initially appear red and will be painful, slowing appearing to have a purple color. This is the best time prevent the sore from advancing to something more serious.

Nursing home and assisted living residents are at high risk for developing pressure ulcers, and those residents that are bedridden, wheelchair bound, or those will limited mobility must be examined frequently for the development of bedsores. A small bedsore can quickly become a large sore if treatment is not promptly provided.

When there is sustained pressure in an area of skin that cuts off circulation to that area, the skin will start to breakdown creating what is common called a bedsore or pressure ulcer. If you’ve never seen one, consider yourself lucky. Not properly cared for, these sores and develop into wounds so deep that muscle and bone can sometimes be exposed.

It has been reported that two million Americans experienced pressure ulcers every year, usually the result of a combination of poor nutrition, dehydration, and immobility. Recent studies, however, suggest that fighting bedsores requires a team approach, enlisting not just the bedside caregivers, but many other nursing home employees.

A study by the Journal of the American Geriatrics Society involving 52 nursing homes around the United States reported a reduction of almost 70% of serious bedsores acquired in the facilities after utilizing a team approach to the prevention and treatment of sores.

The National Pressure Advisory Panel updated its definition of the four “stages” used to diagnose pressure ulcers or decubitus ulcers (often referred to as bed sores). It also added two new stages on deep-tissue injury and ulcers that cannot be staged. The updated stages of pressure ulcers were released at the conclusion of its 2007 annual conference held in San Antonio, Texas.

A pressure ulcer or bed sore is a localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction. In elderly or disabled patients, sores can begin on the skin of the tailbone, back, buttocks, heels, back of the head, or elbows. Poor nutrition or dehydration can weaken the skin and make it more vulnerable.

The new staging definitions are as follows:

The Centers for Medicare and Medicaid Services announced last month that, it will no longer reimburse hospitals for treating eight “reasonably preventable” conditions as of October 2008 the Wall Street Journal reports. Pressure ulcers are among the most prevalent, costly and dangerous on the list. In addition to interfering with recovery, lengthening hospital stays and causing extreme pain and discomfort, pressure ulcers can increase the risk of infection, with nearly 60,000 deaths annually from hospital-acquired pressure ulcers.

Nursing homes and long-term-care facilities have made strides of their own in prevention, motivated in part by the costs of lawsuits for failure to prevent bed sores. Prevention methods can include using ultrasound to identify skin breakdown before a pressure sore forms, special pressure reducing mattresses and ensuring that residents are turned at least every two hours.

Despite the availability of these, and other, prevention techniques, nursing homes have long failed to do much to prevent pressure ulcers as they had no real incentive to do so (other than the fear of lawsuits). Most commonly, nursing homes save money by not having enough staff on hand to ensure that residents receive the treatments required. They are then “rewarded” for this behavior by Medicare paying them extra money per patient to treat the decubitus ulcers. As of October of 2008, nursing homes will instead have to “pay” to treat pressure ulcers which they cause. Hopefully this disincentive will result in better care for all nursing home residents.