Lawyer Resources for Bed Sores

pressure-sores-in-nursing-homesWhile they take a while to develop, pressure sores (also referred to as pressure ulcers, decubitus ulcers, or bedsores) are a clear sign that long-term care institutions are providing poor care to its residents or patients. Unfortunately, in recent years the number of pressure sores amongst nursing homes, assisted living facilities, and hospital patients has drastically increased. In fact, studies show patients are far more likely to develop pressure sores today than they were a decade ago.

What is the cause behind these pressure sores?

The reason that these pressure sores are associated with inadequate care is because they develop because of unrelieved pressure over an extended period on the bony parts of the body. As the pressure builds up, it restricts the blood flow. As a result, the tissue and skin that does not receive the blood it needs begins to die. This gradually leads to a wound in that area.

Where do these sores develop in nursing home and hospital patients?

Oftentimes these pressure sores will develop in parts of the body that have little tissue or muscle to mitigate the weight of the body. Especially over a longer period, these areas are far more prone to developing issues. Even though these problems may occur anywhere on the body, the most likely areas that these problems may develop include:

  • The back of the head
  • The back
  • The heels
  • The buttocks

Other factors contributing to the development of decubitus ulcers

The lack of movement and positioning are two major factors in the development of pressure sores, but personal hygiene and the patient’s overall health also play an important role. Dehydration and poor nutrition may hinder the body’s ability to heal and may negatively affect skin health. Oftentimes neglect and maltreatment can lead to a patient sitting in his or her own feces and urine or left in wet bedding and/or clothing. Again, this can deteriorate the skin and lead to the development of pressure sores.

Further complications related to open pressure sores

When the pressure is never relieved and combined with conditions such malnourishment and incontinence, chances of a developing pressure sores increase dramatically. Despite the pain that will accompany these pressure sores, it also opens the door to further serious medical complications. These may include:

  • Gangrene
  • Osteomyelitis
  • Sepsis
  • Infection
  • Amputation of affected body part
  • Death

Early detection is important to the treatment of pressure ulcers

In order to be able to deal with these pressure sores as effectively as possible, it is important to identify them at the earliest possible stage. The deeper tissue they affect, the harder it becomes for the skin to heal. Ultimately, the best thing is to never have these sores develop in the first place.

Hold the facility responsible for the negligent care of your loved one

When someone is in the care of a medical facility or nursing home, it is that facility’s responsibility to ensure that these pressure sores do not develop. Basic prevention methods include:

  • Regularly moving patients at consistent intervals
  • Preventing malnutrition and dehydration
  • Making sure the patients remain dry and clean
  • Using specialized cushions or mattresses to relieve pressure for high-risk patients

Be aware of the dangers. Bed sores can be fatal.

The majority of the time, pressure sores develop because the facility is not doing an adequate job of providing patient care. Oftentimes the underlying cause is inadequate training of staff or under-staffing. Remember that it is their responsibility to provide adequate care, but being aware of the conditions may make it possible to avoid the problem from developing altogether.

Lawyers Who Take Bed Sore Cases Seriously

There still is a feeling that amongst some in the medical-legal community that bed sore cases simply don’t have much value and aren’t worth prosecuting. To the contrary, Rosenfeld Injury Lawyers recognizes bed sores as one of the most visible signs of poor care in nursing homes and other medical facilities. Typically, bed sores are a tragic emblem of a system that is broken– where patient needs take a distant position after facilities tend to their profitability. We also are mindful of the devastating impact these wounds have on the individual and their family. Our experience litigating bed sore cases has earned us a reputation as attorneys willing to do what it takes to hold facilities fully responsible for these horrendous injuries that can contribute to complications or even death. We invite you to talk with us as soon as you become aware of the presence of a pressure sore on your loved one.

Kennedy Ulcer In Nursing Home PatientsOver the last twenty plus years, the medical community has termed certain types of pressure sores or ulcers under the name Kennedy Terminal Ulcers (KTU). This severe form of pressure sores has been a source of conflicting opinions and data. Some medical experts claim that these KTU’s are not preventable by nursing home staff and only happen due to skin failure, not due to external factors associated with pressure sores in general. However, there is no evidence to prove this theory.

What Is A KTU (Assuming there is such a thing) ?

Kennedy Terminal Ulcers (KTU) can be described as types of pressure ulcers that develop quickly and often end in a patient’s death. The term was named after the nurse who originally discovered and described these ulcers as unique, Karen Lou Kennedy-Evans. These horrific ulcers have distinct characteristics that differentiate them from other pressure sores. Some of the most common are:

Amputation LawsuitFor a 57-year-old veteran, a short-term admission to a nursing home in California is proving to be more destructive to his body than serving in the Air Force during the Vietnam War. Like many stroke patients, Rahn Hoskins lost the use of his right side and went to the nursing home affiliated with Fairmont Hospital for assistance to help him resume some of his daily activities– including walking.

A recently filed nursing home neglect lawsuit alleges that the skilled nursing facility was negligent for the sheer lack of care that they provided to Mr. Hoskins.  According to a recent article in the Oakland Tribune, the facilities inattentive care ultimately allowed pressure sores to form on Hoskin’s foot which went undiagnosed and treated for several weeks.  It is alleged that the delay in providing medical care resulted in the patient developing a systemic infection that ultimately required the amputation of his foot.

Like many stroke patients, the stroke resulted in nerve damage to the side of the body impacted by the stroke which impeded Hoskins ability to perceive pain or appreciate the significance of the pressure sores.

Understanding Pressure SoresA study by Gosnell and VanEtten finds that pressure ulcers affect approximately 1 million Americans each year. The overwhelming majority of these patients are residents in a care facility, especially elders in a nursing home. Knowing and recognizing the signs of pressure ulcers is your loved ones’ best defense against the neglect that leads to these painful injuries. The Mayo Clinic reports that medical professionals divide pressure sores into four distinct categories of severity:

Stage I Bed Sores appear as a red patch on intact skin. These are the first sign of circulation loss due to a patient remaining in one position for long.

Signs of Stage I Sores include:

More Nursing Home  Staff Trainning NeededA particularly disturbing trend in the nursing home industry remains the wide-spread use of undergarments amongst ‘healthy’ nursing home patients.  In other words, patients who have bladder and bowel control, being forced to use undergarments as opposed to being allowed to use the toilet.

In addition to the incredibly dehumanizing aspect of the practice, encouraging or forcing the practice inherently results in situations where patients are literally left sitting in their own waste for periods of time before they are changed by staff.  The delay in changing patients not only puts patients at risk for complications such as depression or urinary tract infections (UTI’s), but when patient’s are permitted to sit in their own waste over time, the caustic nature of urine and feces encourages skin breakdown which can amplify the development of pressure sores (bed sores / pressure ulcers / decubitus ulcers).

The practice of allowing patients to remain in soiled conditions can be even more troubling– or perhaps life threatening in patients with existing pressure sores as open  wounds can allow bacteria from waste direct access to the body.  The practice may result in complications such as a systemic infection known in the medical community as ‘sepsis’.

Types of feeding tubes

Different types of feeding tubes. Courtesy of www.saddleback.edu

It has been believed for a long time that feeding tubes lowered the risks for developing bedsores in the elderly, but the results of a recent study strongly disagree. According to the study, feeding tubes not only increase the risk, but may in fact contribute to the development of bedsores in elderly patients. What has been revealed is that we need to take a second look at how and when feeding tubes are used and know when to say no when a facility wants to implement the use of one in your loved ones’ care. Pressure sores, commonly referred to as bedsores; occur often in elderly patients with limited mobility that are forced to remain in the same position for a long period of time. The weight on the patients’ joints cuts off the circulation to tissue in the surrounding areas and ultimately results in a painful sore that is open and subject to infection. For a long time, many have believed that feeding tubes help prevent bedsores as well as treat them.

Discomfort Due to Feeding Tubes

Feeding tubes can be extremely agitating to the patient and feed the need for sedation or restraint. If a treatment option requires that your loved one needs to be restrained, you should examine more closely why your loved ones needs such restraint and if there are other options available that do not limit their freedom. Diarrhea and dehydration can also result from the implementation of feeding tubes, which contribute to the development of bedsores and may cause complications to existing bedsores.

Higher Bedsore Rates

After reviewing the results of the study, the difference in the number of patients who developed bedsores while using a feeding tube compared to patients without a feeding tube were staggering. Patients are more than twice as likely to develop a lower stage bedsore with a feeding tube and three times as likely to develop a stage four pressure sore, which can result in infection, septic shock or death. Contrary to the belief that feeding tubes can help with bedsore treatment, the study also found that patients without feeding tubes showed better rates of recovery than those who had them.

New Insight on Care for Patients with Dementia

The results of the study suggest that doctors, caregivers and families of elderly patients with dementia need to consider their options more carefully. While the practice of inserting feeding tubes has been used with the intention of helping the problem, we are finding sadly that they may only be contributing to the problem and causing greater long term complications. Consider all of your options when confronted with the possible use of a feeding tube for your loved one and investigate other treatment options that will not carry the risk of bedsores. Bedsores are not only extremely painful and humiliating to elderly patients, but they can quickly become a serious medical condition. By stage two, a bedsore has become an open wound and as the bedsore progresses to higher stages, the tissue deteriorates down to the bone, in some cases. Infections of the skin, bone, blood and vital organs can occur, possibly even leading to death. If the risk of a treatment option far outweighs the benefit, it is not worth it. We want our loved ones to receive all of the medical care that they need without creating painful or fatal complications in the process. For this reason, we should only allow feeding tubes as a last resort. By limiting their usage, we may be able to successfully reduce the risks for developing bedsores in the elderly and improve their standard of living.

Resources:

http://health.usnews.com/health-news/news/articles/2012/05/14/for-dementia-patients-feeding-tubes-may-increase-bed-sores

Divergent Views Of Juries & Investigators in Nursing Home AbuseWe’d like to think that beauty of our jury system is that it allows reasonable people to hear evidence about a dispute and render a rational decision based upon the evidence presented.  After all, the people on the jury are in the best position to render a fair and impartial decision— right?  Similarly, if a jury comprised of fair and rational people can arrive at one decision, how could anyone think otherwise?

The concept of diverging views of in civil lawsuits is nothing new, but I was again reminded of the extreme disparity between the findings from a jury and those from nursing home surveyors in a recent article written by Michael Booth in The Denver Post, “Jury says man died due to Rocky Ford nursing home’s negligence; state differs”.

The situation Booth contrasts is the recent situation involving a nursing home negligence lawsuit in Colorado where a jury awarded the family of a deceased resident $3.2 million due to the facilities alleged negligence in allowing a resident to develop stage 4 pressure sore.  Meanwhile, the same situation was investigated by authorities from the state’s Health Department and the facility was not cited for any type of “deficient practice because the investigation did not substantiate current deficient practice.”

Bedsores Prevention Through TechnologyWhen it comes to medical complications that realistically pose a serious threat of disabling— or even killing– patients in nursing homes and hospitals across the country, few conditions can compare to pressure sores.

As innocent as the term may sound, when “pressure sores” progress, they should perhaps be more accurately referred to as “large open wounds” when they progress to their more advanced stages.  An advanced pressure sore remains one of the indelible emblems of poor care— when the skin and tissue in the area of the wound gives way to a large opening in the body where the underlying organs and bone may be visible.

What makes pressure sores uniquely disturbing compared with other medical complications is that patients at many medical facilities are no less at risk for developing this complication than they may have been 10, 20… or even 100 years ago!  Unlike other medical complications that have been drastically reduced or eradicated with the implementation of medication and technological advancements, pressure sore prevention relies primarily on the backs of the staff members whom are responsible for caring for immobile patients.

$3.2 Million Awarded In Response To Bed Sore LawsuitBed sores are a progressive complication that can afflict any immobile patient in a nursing home or other type of care facility.  When bed sores (also referred to as: decubitus ulcer, pressure ulcers or pressure sores) develop, the open wounds expose the patient to a risk of complications including infection of the surrounding tissue, bone and even the entire bloodstream— which can prove far more formidable to overcome than the patient’s original condition.

The good news with respect to the overwhelming number of situations involving bed sores in nursing homes is that these cases can be prevented with proper care from staff at the facility.  Paramount to the prevention of bed sores in any facility is the realization by the facility (and staff) that certain patients are predisposed to developing them based upon their physical condition— and prevention methods must be created and implemented.

Similarly, staff need to monitor the skin integrity of each patient they are caring for to identify bed sores in their early stages.  From a treatment perspective, bed sores in their early stages are far more manageable to treat than once they progress to a more advanced level.  In addition to recording the patients skin condition in their medical chart, staff should also advise the attending physician of the situation so a timely intervention can be made.

hospital For many elderly people, a short trip to the hospital can bring about justifiably intense fears. A recent study in the medical journal Neurology found that more than half of elderly patients experience dramatic cognitive decline after short hospital stays. The study took a look at 1,870 people up to 12 years after their treatments.

“Essentially, it’s as if people become 10 years older…than they actually were before a hospitalization,” said Dr. Robert Wilson, a lead author of the study. “We think that a hospital can…accelerate previously unidentified cognitive problems.”

Elderly patients are also more susceptible to pneumonia, medication errors, bed sores and infections during hospital stays. According to a recent article from Harvard Medical School, those who stay in bed for long periods of time rapidly lose muscle strength. Multiple sources say as many as two-thirds of patients age 70 and up emerge from hospital stays in worse shape than they arrived.

woman in hospital bedThe overwhelming number of hospital-acquired pressure sore cares derive from a medical system that is focused on treating a patients acute care needs as opposed to maintaining the patient’s overall well-being.

While the origins of hospital-acquired pressure sore (bed sores) cases and pressure sores that originate during a nursing home admission are quite similar with respect to the underlying factors behind their development, the cases can vary substantially when it comes to a litigation perspective.

Despite the relatively elementary reasons for their development, hospital bed sore cases can become quite complex when the necessary legal maneuvering associated with medical malpractice cases gets involved.

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