The Cause Of Many Nursing Home Patients’ Injuries May Be Related To An Underlying Medical Issue

iStock_000008035213XSmallMost of the time a family contacts my office, it is due to an incident involving abuse or ongoing neglect. Although perhaps less obvious, after we investigate many of the cases, the underlying problem may be a complex medical condition that may ultimately prove important in successfully prosecuting the matter.

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 (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‘ 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).


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.

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Client Reviews

Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Through every step of the case, Jonathan kept my family informed of the progression of the case. Although our case eventually settled at a mediation, I really was impressed at how well prepared Jonathan was to take the case to trial. Lisa
After I read Jonathan’s Nursing Home Blog, I decided to hire him to look into my wife’s treatment at a local nursing home. Jonathan did a great job explaining the process and the laws that apply to nursing homes. I immediately felt at ease and was glad to have him on my side. Though the lawsuit process was at times frustrating, Jonathan reassured me, particularly at my deposition. I really felt like Jonathan cared about my wife’s best interests, and I think that came across to the lawyers for the nursing home. Eric