Particularly in patients who may be recovering from a surgery or illness that leaves them with compromised mobility, hospital staff must take efforts to move the patients on regular intervals and retain the blood circulation.

Extended periods in a hospital bed can put pressure on areas of the body that have little tissue or muscle to disperse the pressure.  Even relatively short periods of extended immobilization can result in unrelieved pressure that impairs blood flow and eventually causes the skin and tissue covering the pressure point to die.  As the tissue dies, the underlying tissues and bone may be exposed resulting in a condition known as a bed sore.

Hospital bed sores: a widespread problem

Far from being an isolated complication, hospital acquired bed sores impact thousands of patients every year leaving them with a complication that may be more complex and painful to heal than their underlying illness that they were originally admitted for.

Even at some of the most prestigious medical facilities across the country, hospital acquired bed sores remain a real threat to the well being of patients.  Recognizing the significant threat to patient health, the federal government (Medicare) has added hospital acquired bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) to its list of ‘Never Events’.  As part of the list of never events, hospitals can no longer seek reimbursement for care they provide to patients who have developed a stage 3 or stage 4 bed sore during their hospitalization.

Hospital bed sores: Medical Malpractice?

When a person does develop a bed sore at a hospital, they may be entitled to pursue a claim or lawsuit against the medical center based upon the applicable medical malpractice laws.  Under the medical malpractice laws in most jurisdictions, a lawsuit based upon the development of a bed sore during a hospitalization may entitle the patient to recover damages for their medical bills, disability and pain.

Because the medical malpractice laws in each jurisdiction may impose procedural requirements prior to filing a lawsuit, such as having a physician review a patient’s medical chart, it is important to consult with a medical malpractice lawyer as soon as feasible when a hospital acquired bed sore has been identified.

Related:

• Bed Sores Are Amongst Most Common Hospital Errors
• Medical Errors, Such As Pressure Ulcers, Costing U.S. $20 Billion Per Year
• New Medicare Report On Medical Errors In Hospitals Reinforces Ongoing Problems
• Hospitals Fined For Preventable Medical Complications Such As Bed Sores
• Jury Punishes Hospital With Verdict In Medical Malpractice Lawsuit Where Patient Developed Bed Sores During Admission

What makes younger people even more susceptible to develop bed sores during an admission to a hospital or nursing home is the fact that many staff at the facility fail to appreciate the risks given their age.  Consequently, many of the well-known preventative measures may never get implemented in younger patients as their may be a wrongful assumption that younger patients are not at risk or may be capable of caring for themselves.

In situations where a younger people has developed an advanced bed sore, they may require many of the same medical procedures used for treating pressure sores in patients of all ages.  Many doctors and medical facilities may employ the following techniques to heal bed sores in younger patients:

• Debridement
• Wound Vacs
• Flap Reconstruction Surgery
• Amputation of limbs
• Colostomy

In certain circumstances, a patients youthful vigor may indeed allow them to survive some of the medical complications and rehabilitation associated with advanced bed sores.  However, many younger patients who survive the recovery process may require future medical care to monitor complications or a lifetime faced with disability.

Legal Rights Of Young Bed Sore Patients

Like all cases involving the negligence of a hospital, doctor or nursing home– the injured party has the burden of establishing that the individual or entity they are pursuing failed to meet the standard of care in the community.  Demonstrating the negligence of a party may be accomplished through a variety of methods such as with the use of expert medical testimony from physicians or nurses with a particular type of knowledge about wound care.

Once the negligence of the facility has been established, the damages associated with the injury can be addressed.  In the case of a bed sore lawsuit, damages may include:

• Past and future medical expenses
• Past and future pain and suffering
• Disability
• Disfigurement
• Lost wages

Damages for younger patients must be carefully addressed as many will face a lifetime of medical care due to a bed sore.  Lawyers representing younger people with bed sores may further use the services of a: life-care planner– a doctor or specially trained professional who can assess what type of medical care and supplies an injured person may require in the future and an economist– to help calculate a present value for the future care or lost wages.  Certainly, in cases where a younger person has developed a bed sore at a medical facility it is imperative to evaluate the case based upon the both the immediate harm and future needs of the individual.

Related:

The Less-Wrinkled Faces May Be Younger In The Nursing Home, But Still Require Care

What Brings You To The Nursing Home? The Answers May Surprise You?

Hospital Acquired Pressure Sores Are Devastating Source Of Patient Injury & Death

Nursing Home Abuse: The Deaths Of 13 Children Linked To Poor Care At Chicago Nursing Home

Most pressure sores are preventable and are caused by faulty care where the nursing home or hospital does provide adequate care to prevent and treat bed sores.  Patients vulnerable to developing pressure sores are the elderly, people who are bedridden, and people with diabetes.

Pressure sores in nursing homes can be prevented by taking simple preventative measures including:

• Turning patients
• Using pressure reducing mattresses and pads (pressure relieving devices)
• Keeping residents clean and dry
• Providing adequate nutrition and hydration
• Performing skin checks

Related:

Can dehydration contribute to the development of bed sores?

Can malnutrition cause bed sores?

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

Are pressure relieving mattresses required to be used in nursing homes?

The sun article concentrates on 60-year-old Tyrone Bush, a maintenance man, who was admitted to Desert Springs Hospital for a quadruple heart bypass surgery in 2008.  It was during Bush’s recovery at the hospital, that he developed multiple bed sores (or pressure sores, pressure ulcers, decubitus ulcers) on his buttocks.

More than two years later, Mr. Bush continues to be plagued from the wounds and requires extensive medical treatment for them including doctors visits and debridement procedures– where the dead skin is removed to allow the new skin to grow over the open wounds.

Not surprisingly, the hospital where the wounds developed blames the wounds on Mr. Bush himself, implying that the wounds were unpreventable given his size.

Related:

What is surgical debridement of bed sores?

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

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

Nursing Home Injury Laws: Nevada

While some facilities suggest that the development of bed sores is an inevitable part of the aging process, the overwhelming majority of circumstances behind the development of bed sores at a medical facility indicate that the facility was simply not doing an adequate job caring for the patient.

The mechanics behind bed sore development

Bed sores (or otherwise referred to as: pressure sores, pressure ulcers or decubitus ulcers) are the result of basic mechanical principals: force and shear.  When patients in nursing homes and hospitals are left in place for extended periods, the weight of their body on relatively hard surfaces such as hospital beds and wheelchairs gradually impairs the bodies circulatory process.

Gradually, blood flow is restricted to the areas of the body that remain with unrelieved pressure.  Without a nutrient rich supply of blood, tissue and skin die— giving way to an open wound.  Like most medical conditions, bed sores do not develop overnight.  Most situations involving the development of bed sores during an admission to a medical facility result from patients being left in place over an extended period of time!

Prevention of bed sores requires a team effort

While the medical community has made tremendous strides in the prevention and eradication of diseases that have long troubled society, relatively little progress has been made when it comes to reducing the incidence of bed sores in patients who are infirm or elderly.  Some studies on patient care have shown that patients today are more likely to develop a bed sore today than they were just ten years ago!

What may be most troubling about bed sores compared with other medical complications, is that the factors that are associated with development of bed sores remains well-understood by the medical and non-medical community. Whether it’s a small family-operated nursing home or large university hospital, bed sore prevention requires quite a bit of hands-on care.  In addition to keeping patients active, other preventative measures include:

• Rotating physically disabled patients out of their beds on regular intervals
• Keeping patients clean and dry- changing incontinent patients quickly
• Encouraging adequate nutrition and hydration
• Utilizing specialized devices such as pressure relieving mattresses and cushions for patients with limited mobility

Medical complications associated with bed sores

Thankfully, when bed sores are identified in their early stages patients chances of a full recovery are quite good.  Unfortunately, when facilities are slow to acknowledge the presence of a bed sore or the wound has advanced, there is a good chance of medical complications such as:

• Osteomyelitis
• Gangrene
• Sepsis
• Limb amputation
• Death

Knowing the prevalence of complications from advanced bed sores (stage 4), it is crucial that staff at medical facilities carefully document each pressure sore and keep the patients physician regularly updated as to their condition.

Legal rights for you and your loved one

Given the well known measures known to prevent the development of bed sores, the development of bed sores during an admission to a nursing home, hospital or assisted living facility is simply inexcusable.  As opposed to other types of nursing home negligence or medical malpractice cases, where an individuals error can result in patient injury, most cases involving bed sores are reflective of the negligent care on the part of an entire facility.

Attorneys at Rosenfeld Injury Lawyers have successfully resolved bed sore cases involving different types of medical and non-medical facilities on behalf of families and individuals in Chicago and on a national basis.  If your family member has developed a bed sore under the care of a facility, we would be honored to talk with you regarding your potential legal rights.  As with all of our cases, our consultations are free and confidential and we only charge a fee when there is a recovery.

Related:

Without A Prevention Plan, All Nursing Home & Hospital Patients Remain At Risk For Developing Pressure Ulcers

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

What are the stages of bed sores?

Is an autopsy necessary when a family suspects bed sores caused the death of a family member?

Special padding on wheelchairs, heel pads and pressure relieving mattresses are the most common types of pressure relieving devices used in nursing homes and hospitals. Like all medical devices however, to achieve maximum benefit from the new technology staff must receive proper training.

Occasionally, we see long delays between the implementation of the pressure relieving devices from the time that they were originally ordered by the doctor.  Sometimes the delay is based on the fact that the facility may be inadequately stocked with the devices.  Yet in other situations, facilities may claim that such devices are too expensive.

Unfortunately, given the alternative– having patients with advanced bed sores, the reality is that these devices are a bargain from both a cost savings standpoint in terms of bed sore treatment expenses as well as the physical and psychological toll bed sores take on patients.

Related:

Bed Sore Prevention May Require Nursing Homes To Obtain Pressure Relieving Devices For Their Patients

Why do some wound clinics and nursing homes suggest the use of Clinitron beds for patients with bed sores?

Hospitals Fined For Preventable Medical Complications Such As Bed Sores

According to the Southeast Texas Record, Ronald Lee Phillips, Sr. was admitted to Memorial Hermann on Oct. 29, 2006, for two consecutive seizures.  The Record reports that his doctors, Dr. Darella Cooper and Dr. Jeffrey Klem, were informed of his symptoms in the evening, yet delayed seeing Mr. Phillips until the next morning.

“At some point after admission, {Dr. Klem} was informed of Mr. Phillips’ condition, which indicated a potential heart attack,” the suit states. “However, Dr. Klem failed to respond in a timely manner, and delayed seeing {Mr. Phillips} for several hours.”

During the evening, Mr. Phillips suffered a heart attack, which resulted in severe physical and mental injuries, the suit states. Mr. Phillips remained a patient at Hermann Baptist until mid-November 2006. Throughout his stay, Mr. Phillips developed a stage 3 decubitus ulcer, as well as a staph infection, according to court records.

Mr. Phillips is suing Hermann Baptist for physical pain, suffering, mental anguish, physical impairment, physical disfigurement and incurred medical expenses. Mr. Phillips’ wife, Fredericka – also a plantiff in the case – is suing Hermann Baptist for mental anguish, loss of consortium,, and loss of services. The Phillips are suing for an undisclosed amount.

Texas law states that plaintiffs may sue for up to $250,000 in medical malpractice cases.

Of the ten costliest medical errors, pressure ulcers ranked No. 2, second only to postoperative infections. Other common errors included infection due to a central venous catheter, infection following a blood infusion, and abdominal hernia. Hospital-acquired pressure ulcers are among the Federal Government’s list of “never events,” or avoidable injuries that should never occur at U.S. hospitals.

The first Health Affairs study, authored by Milliman consultant Jill Van Den Bos, found that the total annual cost of medical errors is about $17 billion. The total “social cost” – the sum of costs to doctors, providers, and all other individuals affected by the error – is much higher, between $348 and $913 billion. Van Den Bos and her colleagues arrived at their conclusions by analyzing an 8-year sample of national medical claims data, from 2000 to 2008.

The second study,  by John Goodman of the Dallas-based National Center for Policy Analysis (NCPA), produced similar findings.

“Your chances of dying from a cause other than the one you were hospitalized for are as high as one in 200,” says NCPA senior fellow and coauthor Pamela Villarreal, adding that all patients have a one in twenty chance of getting a hospital-caused infection.

Villareal advises hospitals to adopt a “no-fault” compensation system, whereby compensation for death would be set at $200,000, and injury at $20,000.

“This type of compensation system would give hospitals and providers economic incentives to reduce error rates,” says Villareal.

Goodman and Villareal estimate that as many as 6.1 million injuries occur in hospitals each year as a result of adverse medical effects.

In a recent interview with The Hospitalist, two “documentation specialists” gave tips for understanding your loved one’s chart:

1. First, understand that universal “codes” are used by hospitals. The codes help the hospital’s internal ”coders” submit an accurate claim to Medicare. Most codes are taken from the “ICD-9-CM,” or International Classification of Diseases.  For example, even though nurses can give a “stage” (1-4) of a pressure ulcer, it must also be accompanied with the proper code in order for a patient to receive reimbursement.

2. If you’re confused about your loved one’s chart, ask to see a “Documentation Specialist.” “Documentation Specialists” are intermediaries between physicians and coders. “We’re just trying to help physicians capture the quality of care that they’re giving,” says Stephanie Jensen, RN, coordinator of the Clinical Documentation Integrity program at Omaha’s Nebraska Medical Center. “We want to make sure that, in the medical record, the documentation supports the severity of illness…and overall clinical picture.”

3. A useful acronym to know is a “DRG,” or “Diagnosis-Related Group.” “DRGs” number about 500, and are used by Medicare to determine the amount it should pay to hospitals. Patients in the same “DRG” tend to use similar amounts of hospital resources.

4. The more specific a physician can be in his or her diagnosis, the more good it will do patients. “If it’s not documented, it didn’t happen,” says Karen Bachman, BSN, director of clinical documentation at Good Samaritan Hospital in Suffern, NY.

Related:

Nursing Homes Abuse Blog: Hospital Bed Sores

Medicare has determined that pressure ulcers are indeed preventable and hospitals may no longer seek reimbursement for patients who develop pressure ulcers during a hospitalization.

While Medicare’s assignment of pressure ulcers to its list of never events remains an important development for patient safety, the fact remains that pressure ulcers are indeed a significant problem for many patients and result in many families seeking answers regarding medical care and legal options.

Here is an assembly of web resources related to pressure ulcers:

Psychology of Medicine

Computers that monitor prisoners in a correctional facility are not a bad idea in nursing facilities to ensure that the patient in the nursing home are being well cared for and not falling and are turned appropriately. The latter is one of the most reliable ways to prevent pressure ulcers.

Jeffrey M. Levine, M.D.

Jeffrey Levine, M.D. has this website and blog to discuss geriatric patient care and wound care. The recent blog posts go into detail about geriatric law and what, legally, is needed to care for the elderly patient in a residential facility.

HELPGUIDE.org

Discussed here is elder abuse and the warning signs, prevention and who is at risk. Many times in residential facilities, pressure ulcers are a tell tale sign of elder abuse.

Lippincott’s NursingCenter.com

This is a nurse to nurse dialogue about typical nursing practices. There are many misconceptions about nursing and what is correct and incorrect modes of care.

Cooperlabs blog

This is a site that focuses on skin care and what to do to take care of skin during all stages of life. It discusses the care of skin during the stages of pressure ulcers.

PR Splash

The discussion her is on Aderma® which helps in the treatment of pressure ulcers. The training to use Aderma ® has revved up during 2010 and has high hopes as 2011 as begins.

Blood Test Guides

Medicare is threatening covering pressure ulcers, therefore more and more hospitals are becoming stricter in their guidelines and precautions to prevent them.

INQRI

A new technique was founded and implemented by nurses in this program and may go to hospitals’ countrywide. They technique details using music over a loudspeaker that stops when it is time for position changes.

advance for NURSES

This nursing program teaches prospective nurses how to recognize and treat symptoms of pressure ulcers. Warning signs are outlined, plus treatment regiments.

suite101.com

Skin is defined in detail with a picture and then the stages of pressure ulcers are outlined to assist people in recognizing them. Treatment guidelines are given to aide in the treatment.

Healthy Weareokok.com

This website demonstrates the wholistic approach to caring for the patient in the home health setting. It ranges from diet and fitness to medically caring for the patient.

ACTION ® making a difference

What happens when you see a reddish patch of skin on a patient? The telltale signs of pressure ulcers are definitely important to be able to look at and diagnose so treatment begins immediately.

Gerry Bolger

The author, Gerry, is an experienced nurse and leader in the health field. He focuses on elder care.

The Wound Care Blog

This is a huge reference collection of information concerning wound care and technology on wound care. Discussions include surgery, debridement, acupuncture, healthy eating and much much more.

wound care – ultraviolet

Using ultraviolet therapy while doing wound care helps eliminate the odor associated with pressure ulcers. This can assist the patient in healing because it helps focus on taking care of the wound and not controlling the smell.