California Nursing Home Abuse Lawyers Blog

According to official figures more than 75,000 people died in hospitals in 2010 after having experienced neglect and poor care from hospital staff.

Most if not all were affected by bedsores and infected wounds, others died after becoming dehydrated and malnourished says Nursing Home Abuse and Neglect Lawyer Steven Peck. The death toll from bedsores and wound infections has risen substantially in the last 10 years.

The figures are shocking because bedsores are fully preventable in the majority of cases. When a patient spends longer periods in bed, they need to regularly turn and shift their body position to avoid excessive pressure on tissues. However, when patients are not able to move on their own it is the hospital staff's responsibility to check for tissue damage and to turn patients.

Even though not all fatalities were directly caused by infected wounds and bedsores, the fact that they affected such a huge number of patients suggests very poor level of care says Peck.

Bedsores, Pressure Sores and Decubitus Ulcers are frequently listed on death certificates many other elders also die of blood poisoning, Sepsis, primarily caused by wound infections. Malnutrition and Dehydration are other major signs of nursing home abuse and neglect.

Continue reading "Bed Sores, Malnutrition and Dehydration Are Common Signs of Nursing Home Abuse and Neglect" »

What if the sore gets infected?
Pressure sores, Bed sores and Decubitus Ulcers that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away.

Signs of an infected pressure sore include the following:
•Thick yellow or green pus
•A bad smell from the sore
•Redness or warmth around the sore
•Swelling around the sore
•Tenderness around the sore

Signs that the infection may have spread include the following:
•Fever
•Chills
•Mental confusion or difficulty concentrating
•Rapid heartbeat
•Weakness
How are infected pressure sores treated?
The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenously (through a needle put in a vein) or orally (by mouth).

How can I tell if the sore is getting better?
As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing.
How can pressure sores be prevented?The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously.

It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry. If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur.

If you smoke, you should quit. People who smoke are more likely to develop pressure sores.

Exercise can help improve blood flow, strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you, or refer you to physical therapist that can help.

Continue reading "What Do You Do if a Bed Sores, Pressure Sores, Decubitus Ulcers Become Infected says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

A hospital is an important place that takes care of the sick. It caters people who are in need of proper attention and medical treatment. Since it houses those who are bedridden, paralyzed, and injured as well, it is just very essential for nurses to know how to take care of them properly. Because if not, they will develop some severe conditions that are pretty much difficult to deal with. One of these things that may happen to them is the development of bed sores in hospital. Since these mentioned people are constantly lying or sitting down, the pressure and friction in wheelchairs and mattresses can shed up the skin. Since it does not only affect the epidermis, it can also develop down to the bone. When bed sores occur, it just means that the nurses and the whole management of the hospital do not give the needed requirements of the patient such as constant turning to relieve pressure.

Continue reading "Why Bed Sores, Pressure Sores, and Decubitus Ulcers Occur In Nursing Homes and Hospitals" »

Controversy is usually considered undesirable -- in the same category as conflict, discord, and disagreement. However, when it takes the form of respectful dialogue rather than debate, controversy can transform opinion and even give rise to unexpected progress. One hopes, for the benefit of all concerned, that the current controversy surrounding pressure ulcers might bring about a similarly positive outcome.
In 2010 the Centers for Medicare & Medicaid Services (CMS) halted additional payments to hospitals for selected conditions that were acquired in the hospital (in other words, not present when the patient was admitted). One of these conditions was the pressure ulcer, bed sore and the decubitus ulcer which CMS asserted "could reasonably have been prevented through the application of evidence-based guidelines." This regulation was known as the Inpatient Prospective Payment System Fiscal Year 2009 Final Rule (IPPS FY 2009 Final Rule).[1] In IPPS FY 2009 Final Rule, CMS hedges a bit with language. The rule does not state unequivocally that pressure ulcers are always or entirely preventable -- only that they are reasonably preventable. Still, no recourse exists for hospitals to receive any additional reimbursement for the treatment of hospital-acquired pressure ulcers even if clinicians deem them unavoidable.

A reduction in reimbursement is not the only consequence of the CMS ruling. The assertion by CMS that pressure ulcers, bed sores and decubitus ulcers can be prevented raises the legal stakes for nurses because the ruling essentially implies that if a pressure ulcer, bed sore and decubitus ulcer occurs during hospitalization, it must be the result of inadequate nursing care. Patients, families, attorneys, the courts, juries, and the public will now believe that pressure ulcers, bed sores and decubitus can be always be prevented with adequate vigilance and care, leaving nurses and hospitals open to lawsuits every time a pressure ulcer, bed sore and decubitus ulcer appears to have its onset during hospitalization.

A controversy wouldn't be a controversy without 2 points of view. In contrast to CMS's stance, some believe that pressure ulcers will occur, in certain patients, even if staff members follow the best guidelines or use the latest high-tech skin protection devices.
CMS has already maintained, in writing, that pressure ulcers, bed sores and decubitus ulcers are not all preventable, at least in long-term care settings This is true. In their guidance to state and federal surveyors, CMS states that long-term care facilities must ensure that "a resident who enters the facility without pressure sores, bed sores and decubitus ulcers does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable. Unavoidability means "the resident developed a pressure ulcer, bed sore and decubitus ulcer even though the facility had evaluated the resident's clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice; monitored and evaluated the impact of interventions; and revised the approaches as appropriate.

"Why should the setting matter? We are taking care of the same patients, with the same conditions and comorbidities. It makes no sense to say that a pressure ulcer is avoidable in one venue and unavoidable in a different venue. In hospitals, patients are more acutely ill. At a minimum, I would call it inconsistent public policy."

So, which side of the fence do the experts -- the wound care clinicians -- fall on? Can all pressure ulcers be prevented with the right kind of care? Or is it possible for pressure ulcers to develop despite the best efforts to prevent them?

There is consensus among most wound care clinicians that there is such a thing as an unavoidable pressure ulcer. The debate is about frequency. Some would say they are rare. Others contend that nearly all pressure ulcers are unavoidable because of the underlying comorbidities. These are the 2 extremes, and the truth is probably somewhere in the middle. But if there is such a thing as an unavoidable pressure ulcer, how do we define it? What are the variables that would make a pressure ulcer unavoidable?"

With the most diligent, consistent care, you can reduce the number of facility-acquired pressure ulcers. But no pressure ulcers? "You probably won't get to zero incidence and sustain that, a strong collaborative approach can reduce a facility's incidence of pressure ulcers. At the same time, the continued occurrence of pressure ulcers in certain patients despite appropriate care suggests that there is a floor effect in the prevention of pressure ulcers.

Although opinions may vary on the frequency and circumstances surrounding the unavoidable pressure ulcer, the wound care community does not agree with CMS that all pressure ulcers can be avoided. The WOCN Society are the country's nursing experts in the assessment, prevention, and care of pressure ulcers, and have taken a leadership role in the pressure ulcer controversy. On behalf of nurses who take care of patients at risk for pressure ulcers, the WOCN Society responded to the CMS ruling with the position paper "Avoidable and Unavoidable Pressure Ulcers. This position paper takes the view that pressure ulcers are not entirely avoidable and provides the evidence base to support this stance.

Continue reading "Are Bed Sores, Pressure Sores, and Decubitus Ulcers Unavoidable or Avoidable asks Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Bed Sores, Pressure Sores and Decubitus Ulcers were again the most common medical errors found in the year 2010 closely followed by foreign objects left inside patients after surgeries says Nursing Home Abuse and Neglect Lawyer Steven Peck.
The Department of Health released its 2010 Medical Error Report on It cited numerous stage three or stage four bed sores after hospital admissions--the most common problem in four of the last five years--and secondly foreign objects left behind in residents after surgeries.

Other common mistakes were falls resulting in deaths or disabilities and surgeries on the wrong body parts.

Medication errors resulting in deaths or disabilities have also been a major problem.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Were Again the Most Common Medical Errors Found says Nursing Home Abuse and Neglect Layer Steven Peck" »

There are four stages of bedsores according to the National Pressure Ulcer Advisory Panel (NPUAP), and they vary in severity and depth says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Stage one bedsores are relatively minor because the skin remains intact. Characteristics include:

•Reddish color (in people with light skin color) that doesn't lighten briefly when touched.
•Skin may be bluish or ashen (in people with dark skin color) or there may be no color change at all.
•The site could be painful.
•The site may be warm or cold, soft or hard.
Stage two bedsores are a bit more serious. Skin is broken and the underlying tissue may be damaged or lost. Characteristics include:

•A shallow basin-shaped wound.
•May also appear initially as a blister that is either fluid filled, or has ruptured.
Stage three bedsores are quite serious. A deep wound is present that is deep enough to expose some of the layer of fat that is found under the skin.

•The wound looks like a crater.
•Yellowish colored dead tissue may be visible at the bottom of the wound. This is called slough.
•The damage may begin to spread outward under the surface of the skin.
Stage four bedsores are very serious and can have some dire consequences. The wound is very deep and could expose underlying muscle, tendon or even bone.

•The bottom of the wound likely contains slough and possibly dark, crusty dead tissue called eschar.
•The damage will extend beyond the wound under the healthy surface skin.

Continue reading "There Are Four Stages of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Pressure sores also known as Bed Sores and Decubitus Ulcers have probably existed since the dawn of our infirm species. They have been noted in unearthed Egyptian mummies and addressed in scientific writings since the early 1800s. Presently, treatment of pressure sores in the United States is estimated to cost in excess of $1 billion annually says California Nursing Home Abuse and Neglect Attorney Steven Peck.

Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath. These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads individuals to change body position. These changes shift the pressure prior to any irreversible tissue damage.

Individuals who are unable to avoid long periods of uninterrupted pressure over bony prominences--a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalized--are at increased risk for the development of necrosis and ulceration. These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure.

Two thirds of pressure sores occur in patients older than 70 years. The prevalence rate in nursing homes is estimated to be 17-28%.

Among patients who are neurologically impaired, pressure sores occur with an annual incidence of 5-8%, with lifetime risk estimated to be 25-85%. Moreover, pressure sores are listed as the direct cause of death in 7-8% of all paraplegics.

Patients hospitalized with acute illness have a pressure sore incidence rate of 3-11%. In a study of 658 patients aged 65 years or older who underwent surgery for hip fracture, Baumgarten et al found that 36.1% developed an acquired pressure sore within 32 days after hospital admission.(an acquired pressure sore is one that arose after hospital admission and had reached stage II or higher.) Although the 32-day period included time spent by patients in rehabilitation facilities and nursing homes, the highest incidence rate for pressure sores occurred during the patients' acute hospital stays.

Disturbingly, even with current medical and surgical therapies, patients who achieve a healed wound have recurrence rates of as high as 90%.

Continue reading "The Treatment of Presures Sores, Bed Sores and Decubitus Ulcers Costs Over One Billion Dollars In The United States Annually" »

Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away.

Signs of an infected pressure sore include the following:
•Thick yellow or green pus
•A bad smell from the sore
•Redness or warmth around the sore
•Swelling around the sore
•Tenderness around the sore

Signs that the infection may have spread include the following:
•Fever
•Chills
•Mental confusion or difficulty concentrating
•Rapid heartbeat
•Weakness
How are infected pressure sores treated?
The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenously (through a needle put in a vein) or orally (by mouth).

How can I tell if the sore is getting better?
As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing.

Continue reading "California Nursing Home Abuse and Neglect Lawyer Steven Peck Explains What Transpires When a Pressure Sore, Bed Sore, or Decubitus Ulcer Becomes Infected" »

Pressure sores (bedsores, decubitus ulcers, pressure ulcers) are areas of skin damage resulting from a lack of blood flow due to pressure.

Sores often result from pressure but may also result from pulling on the skin or friction, particularly over bony areas.
The diagnosis is usually based on a physical examination.
Treatment includes cleansing, removal of pressure from the affected area, special dressings, and, sometimes, surgery.

Pressure sores can occur in people of any age who are bedridden, chairbound, or unable to reposition themselves. They are more common among older people. They tend to occur over bony projections where pressure on skin can be concentrated, such as over the hip bones, tailbone, heels, ankles, and elbows. They occur where there is pressure on the skin from a bed, wheelchair, cast, splint, or other hard object .Pressure sores lengthen the time spent in hospitals or nursing homes and increase the cost of care. Pressure sores can be life threatening if they are untreated or if underlying health conditions prevent them from healing.

Continue reading "Nursing Home Abuse and Neglect Is Rampant In Bedridden, Chairbound and People Who Are Unable To Reposition Themselves" »

Decubitus ulcers are also known under the names of pressure sores or bedsores. A person ends up with pressure ulcers after suffering an injury to the skin and the underlying tissue. The injuries usually occur due to pressure on the skin which lasts for a long period of time. In a majority of pressure pressure ulcer cases, these injuries on the skin usually occur in places of the body where the skin covers the bony areas of the body. These places are heels, ankles, hips and especially buttocks.

Every person can end up suffering from decubitus ulcers also known as pressure sores and bed sores but many elderly and / or dependant adults have medical conditions which makes them unable to move a lot and change positions. These individuals dpendant on someone else to care for them are significantly more prone to developing Decubitus ulcers also known as pressure sores and bed sores.

Continue reading "Decubitus Ulcers also known as Pressure Sores and Bed Sores Occur Due to Unnecessary Pressure On the Skin" »

Pressure ulcers, also known as decubitus ulcers, bedsores, or pressure sores, range in
severity from reddening of the skin to severe craters with exposed muscle or bone.
Pressure ulcers significantly threaten the well being of patients with limited mobility.
Approximately 70 percent of ulcers occur in individuals older than 65 years, but younger
patients with neurologic impairment or severe illness are also susceptible
says California Elder Abuse Lawyer Steven Peck.
Prevalence rates range from 4.7 to 32.1 percent in hospital settings and from 8.5 to 22 percent in nursing homes. Pressure ulcers are caused by unrelieved pressure applied with greatforce over a short period of time or less force over a longer period that disrupts bloodsupply to the capillary network, depriving tissues of oxygen and nutrients. The most common sites for pressure ulcers are the sacrum, heels, ischial tuberosities, greatertrochanters, and lateral malleoli.

Tissues are capable of withstanding enormous pressures when brief in duration, but
prolonged exposure to pressures slightly above capillary filling pressure leads to
ischemia and ulceration. According to the National Pressure Ulcer Advisory Panel,pressure sores typically develop in four stages:

• Stage I: Intact skin with non-blanchable redness of a localized area usually over
a bony prominence. Darkly pigmented skin may not have visible blanching; its
color may differ from the surrounding area.
• Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with
a red pink wound bed, without slough. May also present as an intact or
open/ruptured serum-filled blister.
• Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone,
tendon or muscle are not exposed. Slough may be present but does not obscure
the depth of tissue loss. May include undermining and tunneling.
• Stage IV: Full thickness tissue loss with exposed bone, tendon or muscle.
Slough or eschar may be present on some parts of the wound bed. Often include
undermining and tunneling.

Continue reading "Seventy Percent of Pressure Ulcers, also known as Decubitus Ulcers, Pressure Sores or Bed Sores Occur In Elders and Dependant Adults" »

Burdensome health care transitions in the last months of life are common and are associated with poor quality end-of-life care, according to a study published in the Sept. 29, 2011 issue of the New England Journal of Medicine.

Investigations were done concerning health care transitions among 474,829 nursing home residents with advanced cognitive and functional impairment 120 days before death says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Three types of transitions were classified as being burdensome: those occurring in the last three days of life, absence of nursing home continuity following hospitalization during the last 90 days of life, or multiple hospitalizations in the last 90 days of life.

The associations between regional rates of burdensome transitions and the likelihood of feeding-tube insertion, hospitalization in an intensive care unit (ICU) in the last month of life, the presence of a stage IV decubitus ulcer, and hospice enrollment in the last three days of life were assessed.

The investigators found that 19 percent of the patients had at least one burdensome transition, with variation across states (range, 2.1 to 37.5 percent). Blacks, Hispanics, and those without advance directives had an increased risk of burdensome transition. Compared to patients in the lowest category of burdensome transitions, those in the highest area had significantly increased rates of feeding-tube insertion (adjusted risk ratio [aRR], 3.38), ICU time in the last month of life , late hospice enrollment, and a stage IV decubitus ulcer.

Continue reading "Burdensome Health Care Transitions In the Last Months of Life Are Very Common" »

There is no accurate predictive value in pressure ulcer assessment scales. There is, in my opinion, says California Nursing Home Abuse and Neglect Lawyer Steven Peck, only one predictive factor that will determine whether at-risk patients will develop pressure ulcers: Who is caring for these patients. Like most risk assessment scales, the Braden Scale measures only the patient. It does not measure the staff. The incidence of pressure ulcers is related directly to the care, or lack thereof, given by the nursing staff.

Let us assume that there are 200 sets of identical twins with the lowest possible Braden Scale scores. One-half of the at-risk twins are admitted to an understaffed facility with poorly prepared personnel and no pressure-relieving beds. The other half are admitted to the finest facilities with well-prepared nurses, fully staffed shifts, pressure-relieving beds for each patient, and enough staff to turn each patient every 2 hours. It is my contention that the latter group will have dramatically fewer pressure ulcers than the former, despite identical Braden Scale scores.

At some time during the patient's course in the hospital or nursing home, the nursing staff fell down on the job, pure and simple should a pressure sore developed. The sicker and more at risk the patient, the harder hospital and nursing home staff must work to prevent decubitus ulcers.

It is obvious that the Hospitals and Nursing Homes are understaffed, overworked, have too many patients, too little money, and not enough specialty beds. No doubt that these are the problems and concerns. However, we need to acknowledge this and stop blaming patients because they have low Braden Scale scores. A patient develops a pressure ulcer because, at some point, he or she had inadequate pressure relief.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Develop Because of Understaffing and Lack of Care" »

Early this year, the Tennessee Supreme Court in a 12-page decision delivered a virtually complete victory to the family of a 57-year-old woman who died after a four-month stay at a Chattanooga nursing home.

The suit charged that Martha French, who had suffered a debilitating stroke, developed pressure sores or ulcers that, because of poor care, became infected, leading to her death from sepsis.

The decision reversed most of an unfavorable appeals court decision and concluded that French's family could pursue medical malpractice and negligence claims against Stratford House, a 127-bed nursing home. That meant that all of the family's claims would not be placed under the strict requirements of the state medical malpractice law.

In addition, the court ruled that the family could pursue negligence claims based on violations of state and federal regulations and under the state Adult Protection Act.

But even as lawyers assessed the victory, a move was afoot to undo it.

Despite protests from some legislators and advocates for the eldery, the nursing home provisions in the tort reform bill included a key provision that brings all claims against nursing homes under the strict limits of the medical malpractice law, eliminating separate claims for negligence and requiring plaintiffs to provide certification that the care provided did not meet local standards. Punitive damages also are limited to $500,000 or two times the pain and suffering claims. Claims under a protection from abuse also will be blocked.

Lawyers who regularly take nursing home negligence and malpractice cases say the new law completely reverses the French decision.

"I think it is going to effectively weaken protection for vulnerable adults. There will be much less accountability," says the Plaintiffs' bar.

Continue reading "Tennesse Limits Nursing Home Abuse and Neglect Awards" »

A thorough evaluation should done upon admission to any hospital, skilled nursing facility, and long term care organization so that patients are assessed daily for red or open areas which could lead to devastating Pressure Sores also known as Bed Sores and Decubitus Ulcers.

A Braden scale is used to assess each patient. If a patient's score is lower than normal, a facility should implement even more rigorous ways to reposition the patient. Mobility is the first thing they try, but the facilities also should have special mattresses for pressure ulcers.

Educating the public about Bed Sores is important so that they do not lead to needless infections and possible death.

Continue reading "Thorough Evaluations Should Be Done In All Long Term Care Facilities To Halt Any Bed Sore Development" »