California Nursing Home Abuse Lawyers Blog

Among nursing home residents, Blacks and Hispanics were more likely to suffer from pressure ulcers or bed sores. indicates Peck Law Group Nursing Home Abuse and Neglect Lawyer Steven Peck. Nursing homes can help to prevent or heal pressure sores, bed sores and decubitus ulcers by keeping residents clean and dry and by changing their position frequently or helping them move around.

Nursing Home and Long Term Care Facilities also must prevent the bed sores, pressure sores also known as decubitus ulcers from forming due to neglect which failures cause infections and fatal bone diseases such as osteomylitis.

Blacks and Asians were less likely than whites to have a usual primary care provider. The percentage of people with a usual primary care provider also was significantly lower for Hispanics than for non-Hispanic whites. Low-income and middle-income people were significantly less likely than high-income people to have a usual primary care provider.

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A California Skilled Nursing facility has been sued for "willfully neglecting" an elderly dementia patient who was left to die in her own filth and feces by overworked staff.

The facility was severely understaffed by poorly-trained workers leading to dirty conditions and a lack of care. The abused elder had vascular dementia and required one-to-one care.

Within a week of arriving at the facility the elder developed blisters on her feet and bed sores, pressure sores and decubitus ulcers sores on her back.

The family continually raised concerns the elder wasn't being washed and even found her sat in a cold room with no dentures or glasses, and her face and hands covered in feces. The nursing staff at the facility indicated the elder frequently fell out of bed.

The elder was transferred to an acute care hospital 20 days after being admitted to the skilled nursing facility, dehydrated, malnourished and covered in infected bedsores and bruises where she died.

This is a situation where the skilled nursing facility allowed too many residents to be cared for by too few staff who were poorly trained. As a result thereof,the residents of this facility were not getting the proper care that they are entitled to according to the Law says California Nursing Home Abuse and Neglect Attorney Steven Peck.

Continue reading "Elder Dies Because of Willful Elder Abuse and Neglect says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

As elders become more physically frail, they're less able to stand up to bullying and or fight back if attacked. They may not see or hear as well or think as clearly as they used to, leaving openings for unscrupulous people to take advantage of them. Mental or physical ailments may make them more trying companions for the people who live with them..

Tens of thousands of seniors across the United States are being abused:
Harmed in some substantial way often people who are directly responsible for their care
More than half a million reports of abuse against elderly Americans reach authorities every year, and millions more cases go unreported.

Where does elder abuse take place?
Elder abuse tends to take place where the senior lives: most often in the home where abusers are apt to be adult children; other family members such as grandchildren; or spouses/partners of elders. Institutional settings especially long-term care facilities can also be sources of elder abuse.

The different types of elder abuse:
Abuse of elders takes many different forms, some involving intimidation or threats against the elderly, some involving neglect, and others involving financial chicanery. The most common are defined below.

Physical abuse:
Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.

Emotional abuse:
In emotional or psychological senior abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress.

Sexual abuse:
Sexual elder abuse is contact with an elderly person without the elder's consent. Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse.

Neglect or abandonment by caregivers:
Elder neglect, failure to fulfill a caretaking obligation, constitutes more than half of all reported cases of elder abuse. It can be active (intentional) or passive (unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does).

Not providing healthcare, but charging for it :
Overcharging or double-billing for medical care or services
Getting kickbacks for referrals to other providers or for prescribing certain drugs
Overmedicating or undermedicating
Recommending fraudulent remedies for illnesses or other medical conditions
Medicaid fraud

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A superbug victim, for infections, was not given proper medical assessments until seven weeks after going into the hospital indicates Los Angeles Elder Abuse Lawyer Steven Peck.

A particular 86-year-old was admitted anemia and dehydration.

But it was not until 50 days later after being moved to a new ward for the second time since being admitted, that staff carried out a falls risk assessment, a nutrition assessment and an assessment which outlines the patient's chances of developing bed sores. The elder also tested positive for C diff a horrible and painful infection which killed eighteen other residents.

According to Department of Health Services records, the assessments and the medical records were inadequate in care planning for these elderly patients.

The bed-sore assessments, in this matter, rated many of them as at "high risk" of developing pressure sores, but ignored guidelines for review procedures.

Continue reading "Proper Medical Assessments Are Mandatory For the Safety of Elder Patients Says California Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Staphylococcus is a group of bacteria that can cause a number of diseases as a result of infection of various tissues of the body. Staphylococcus is more familiarly known as Staph (pronounced "staff"). Staph-related illness can range from mild and requiring no treatment to severe and potentially fatal.

The name Staphylococcus comes from the Greek staphyle, meaning a bunch of grapes, and kokkos, meaning berry, and that is what Staph bacteria look like under the microscope, like a bunch of grapes or little round berries. (In technical terms, these are gram-positive, facultative anaerobic, usually unencapsulated cocci.)

Over 30 different types of Staphylococci can infect humans, but most infections are caused by Staphylococcus aureus. Staphylococci can be found normally in the nose and on the skin (and less commonly in other locations) of 25%-30% of healthy adults. In the majority of cases, the bacteria do not cause disease. However, damage to the skin or other injury may allow the bacteria to overcome the natural protective mechanisms of the body, leading to infection and death says Van Nuys Nursing Home Abuse and Neglect Lawyer Steven Peck.

When the bacteria enter the bloodstream and spread to other organs, a number of serious infections can occur. Spread of the organisms to the bloodstream is known as bacteremia or sepsis. Staphylococcal pneumonia predominantly affects people with underlying lung disease and can lead to abscess formation within the lungs. Infection of the heart valves (endocarditis) can lead to heart failure. Spread of Staphylococci to the bones can result in severe inflammation of the bones known as osteomyelitis. When Staph bacteria are present in the blood, a condition known as staphylococcal sepsis (widespread infection of the bloodstream) or staphylococcal bacteremia exists. Staphylococcal sepsis is a leading cause of shock and circulatory collapse, leading to death, in people with severe burns over large areas of the body. When untreated, Staph aureus sepsis carries a mortality (death) rate of over 80%. Although not common, Staph aureus has been reported as a cause of chorioamnionitis and neonatal sepsis in pregnancy, but group B streptococci are the most common bacterial cause of this life-threatening condition for the fetus.

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The Consumer Federation of California supports SB 558 (Simititan) because it would allow elder abuse both physical and neglect to be enforced using a preponderance of the evidence standard indicates California Nursing Home Abuse and Neglect Lawyer Steven Peck.

As the bill author noted, "It is estimated that over 132,000 elders in California are abused every year. However, for every abuse reported, research has found that at least 5 others go unreported, making the actual number of abused people much higher than the reported rate. Studies show that neglect and abuse of nursing home residents have reached epidemic proportions. A report by the Centers for Medicare and Medicaid Services found that at least 91% of homes have been cited for health and safety deficiencies. Yet many residents who suffer neglect and abuse find it virtually impossible to seek justice in court."

This bill will strengthen protections for California's most vulnerable consumers: seniors. SB 558 (Simitian) will empower elderly adults and their advocates to pursue necessary legal protection.

Current law provides elder abuse civil cases are litigated with a higher legal standard than what is used in civil financial abuse cases: clear and convincing evidence. This bill would correct this anomaly, and give seniors and senior advocates a more appropriate, effective tool for holding elder abusers accountable.

Continue reading "Elder Abuse Standard Enforcement In California Is Moving Toward A Preponderance of The Evidence According to Los Angeles Nursing Home Abuse and Neglect Lawyer Steven Peck" »

If your loved one has a bed sore and is later diagnosed with sepsis then there is a strong likelihood that the sepsis is due to the bed sore or open wound. Sepsis is an illness caused by infection in the bloodstream by bacteria says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Sepsis must be identified and treated as early on as possible in order to provide the best chances of survival. If left undiagnosed and untreated, sepsis can be fatal. 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.

Symptoms of sepsis include:
•Fever
•Low body temperature (hypothermia)
•Loss of ability to appreciate surroundings
•Cool hands and feet
•Anxiety
•Shaking
•Organ dysfunction

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).

Sepsis is a common medical condition; it accounts for:

•1-2% of all hospitalizations
•25% of all intensive care visits
•100,000 deaths per year
•The most common cause of death in intensive care units
In order for treatment to be most effective, it must be implemented as soon as the diagnosis is made. Generally, treatment consists of antibiotics and surgical drainage. Nutritional supplements are also suggested as treatment for sepsis.

Continue reading "Is Sepsis Related to Bed Sores?" »

Bedsores, also called decubitus ulcers, pressure ulcers, or pressure sores, begin as tender, inflamed patches that develop when a person's weight rests against a hard surface, exerting pressure on the skin and soft tissue over bony parts of the body. For example, skin covering a weight-bearing part of the body, such as a knee or hip, is pressed between a bone and a bed, chair, another body part, splint, or other hard object says California Nursing Home Abuse and Neglect Attorney Steven Peck.

This is most likely to happen when the person is confined to a bed or wheelchair for long periods of time and is relatively immobile. Usually, mobile individuals, when either conscious or unconscious, will receive nerve signals from the compressed part of the body and will automatically move to relieve the pressure. Pressure sores do not usually develop in people with normal mobility and mental alertness. However, people compromised through acute illness, heavy sedation, unconsciousness, or diminished mental functioning, may not receive signals to move, and as a result of the constant pressure, tissue damage may progress to bedsores in these individuals.

Each year, about one million people in the United States develop bedsores at a treatment cost of $1 billion. Pressure sores are most often found in elderly patients; records show that two thirds of all bedsores occur in people over age 70. People who are neurologically impaired, such as those with spinal injuries or paralysis, are also at high risk. Pressure sores have been noted as a direct cause of death in about 8% of paraplegics.

Continue reading "Bed Sores Caused By Immobility Will Result In Death To Compromised Elders" »

The distraught family of a grandmother who died after suffering horrific pressure sores in a care home said today the tragedy must never be repeated.

The Elder died from blood poisoning due to infected sores on her feet says California Nursing Home Abuse and Neglect Attorney Steven Peck. The Bed Sores, Pressure Sores also known as Decubitus Ulcers had become so severe her skin had worn through to the bone.

The Pathologist who carried out the post-mortem examination, said the sores on her left foot were the worst grade they could be, and penetrated so deeply they reached the bone causing the infection. The elder was also suffering severe dehydration and renal failure and died. The cause of death was sepsis - an infection of the blood due to pressure sores.

Continue reading "Tragic Death From Horrific Bed Sores Were Casued By Infection Down to The Bone Says San Francisco Nursing Home Abuse and Neglect Lawyer Steven Peck" »

During your research of proper skilled nursing facilities for your elderly or disabled family member, you may have learned about nursing home abuse. One issue that results from abuse and neglect is infections. Infections can occur through lack of proper hygiene, improper food safety, and building safety. There are two highly common infections that are seen in nursing homes: MRSA and VSRA. These are not the only two infections and health problems. Focus are on these two because they are the more common issues.
MRSA stands for Methicillin-resistant Staphylococcus aureus. It is a bacterium that is highly difficult to treat once a patient is infected. It is known by other names like Oxacillin-resistant Staphylococcus aureus and multidrug-resistant Staphylococcus aureus. By definition it means the strain is resistant to antibiotics like penicillin. It is found in hospitals and skilled nursing facilities (SNFs) because these individuals may have open wounds or susceptible immune systems.

Signs of MRSA:

Signs of MRSA include respiratory issues, infections around open wounds, and urinary tract issues. To discover if a resident has this bacterium a swab of the nostrils and a microscope examination for the bacterium is needed. It does not take long for MRSA to worsen. Usually the initial symptoms appear in 24 to 48 hours, and after 72 hours it is resistant to treatment. MRSA can be prevented with proper cleaning and care of patients. Treatment is through vancomycin or teicoplanin and if used early enough can stop the infection before death can occur.

Continue reading "MRSA Infections Are Caused By Nursing Home Abuse And Neglect" »

Three workers at the Quadrangle nursing home in Haverford, Pennsylvania who were caught on camera abusing an elderly woman with dementia have been arrested. The family of the victim installed a hidden camera in the woman's room after they suspected nursing home abuse.

Video from the hidden camera shows one worker hitting the elderly woman in the face and head while trying to pull a shirt over her head. Video also shows the dementia patient without a shirt on, trying to cover herself as the three workers taunted her and pull at her ears, which were very sensitive without her hearing aids. The victim is also shown trying to leave the room repeatedly but being pulled back by the workers.

Among the charges against the workers are aggravated assault, simple assault, criminal conspiracy, harassment, and neglect of a care-dependent person.

The family of the victim, who has noticed bruises on the elderly woman in the past, say she has suffered lasting physical issues from the abuse.

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Decubitus ulcers are also known as bedsores and pressure ulcers transpire due to continuous contact of the body with a hard surface, like a bed or a wheelchair. The bedsore is a pressure ulcer and there are common places where these sores can occur, due to the bone pressure against the skin, when the body is on a hard surface for an extended amount of time says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck.

Bedridden nursing home patients and parapeligecs that are not repositioned on a regular basis, which is usually every two hours according to protocol of most Nursing Homes and long term care facilities, are at a high risk to develop bedsores, pressure sores or decubitus ulcers, or for them to become worse.

Immobility places the patient at risk and without proper repositioning the risk triples, especially if the bedding is not kept clean of urine or if they have been soiled, which will add to the stress on the tissue. Doctor's orders and nursing home rules order proper repositioning to redistribute the weight, to keep proper blood flow supplied to the tissue. This prevents or minimizes bedsores in patients that are bedriddenand those completely unable to reposition themselves without the help of others.

Continue reading "The Bedridden and Paraplegics Are At A High Risk To Develop Bed Sores, Pressure Sores and Decubitus Ulcers Indicates California Nursing Home Abuse and Neglect Attorney Steven Peck" »

Bedsores, also known as pressure sores or pressure ulcers, are parts of the skin and tissue that are damaged. Bedsores are a concern for people confined to a bed. Oftentimes, sleeping in the same position causes bedsores, as does moisture in the bed and resting on joints. If you are looking for ways to prevent bedsores, either for yourself, a loved one or a patient, consider the following suggestions.

Avoid bedsores by changing lying positions every couple of hours. Repositioning someone who is unable to move can be made easier by using bed linens. With this method, you can roll someone gently to a side position from a back position, or vice versa, without causing any friction to the skin.

Consider investing in a special mattress if you are caring for a person confined to a bed on a full-time basis. Check with the doctor for a recommendation on whether you should opt for an air, water, foam or some other type mattress. There are also cushions you can purchase specifically designed to prop a person in different positions.

Be sure to avoid pressure sores by not positioning the body on a bony area. You can make good use of pillows or special cushions to position the body at an angle or float areas between the legs. Keep the body straight, and avoid certain areas being aggravated by joints.

Incorporate as much activity as possible for bedridden people, the extent of which is dependent on what the person is capable of. Exercise keeps the blood flowing and maintains muscle. Additionally, keeping active rouses the appetite. All of this leads to healthy skin, and healthy skin is less prone to bedsores.

Inspect the skin all over the body for sore areas on a daily basis. If you find some, treat the area to prevent it from getting worse. Maintaining healthy skin means bathing it gently and applying a little lotion to dry areas. If the person can check the skin with a mirror, have him do it regularly, especially areas that feel uncomfortable. If the bedridden person uses diapers, change diapers regularly to avoid moisture irritating the skin.

Maintain healthy skin by incorporating a nutritional diet that will improve the skin and protect against bedsores. Focus on fruits, vegetables, proteins and dairy. Cut out fats and sugar. Ask the doctor about supplemental vitamins and minerals that the bedridden person may be lacking.

Make sure that the bedridden person increases fluid intake, specifically water. Hydration is necessary for healthy skin, and healthy skin is less likely to get agitated with bedsores.

Cut out or cut back on alcohol, cigarettes and caffeine. All of these habits are bad for your skin, which will make it vulnerable to pressure sores.

Continue reading "Bed Sores, Pressure Sores aka Decubitus Ulcers Can Be Prevented With Proper Care" »

MRSA stands for methicillin-resistant Staphylococcus aureus, a type of infectious bacterium resistant to the antibiotic methicillin and other related antibiotics of the penicillin class. MRSA infections are a particular problem in hospitals. Some patients have MRSA on their skin or nose without it doing them any harm (colonised patients). However, these patients may develop infections if the MRSA spreads from the colonised skin area to an open wound says Los Angeles Nursing Home Abuse and Neglect Lawyer Stevenh Peck.

MRSA mostly affects hospital patients and can be a serious, even fatal, infection. MRSA-related deaths are commoner among the elderly and people with damaged or depressed immune systems, either from chronic disease, such as HIV, or those undergoing chemotherapy, which represses the activity of the immune system.

MRSA can cause fatal blood infections, such as septicaemia, that are hard to treat due to the bacteria's resistance to many antibiotics Peck says.

The history of MRSA
MRSA belongs to the Staphylococcus aureus (S. aureus, staph or SA) family of bacteria, which is a common cause of wound and blood stream infections.

SA infections were serious and often fatal before penicillin (an antibiotic) was introduced in the 1940s.

More and more strains of SA became resistant to penicillin and by the end of the 1950s the bacteria evolved the ability to develop an enzyme to destroy penicillin's antibacterial activity.

In the early 1960s, however, a more powerful type of antibiotic, methicillin, was developed for use in penicillin-resistant SA infections. Within a short time, however, some SA strains had again started to adapt to become methicillin resistant too.

Despite being relatively uncommon during the 1960s, 1970s and 1980s, MRSA infection grew dramatically in the mid-1990s, when new strains that were easily transmitted from person to person became established in hospitals across the UK, causing an increasing number of cases.

Health Protection Agency figures on MRSA blood stream infections reveal there were 1,087 cases reported in England during the fourth quarter of 2007, or a 0.6 per cent increase on the previous quarter when 1,080 reports were received (1).

How is MRSA transmitted?
Around 30 per cent (2) of people are colonised by SA naturally, which means bacteria live normally in the nose and throat, and on the surface of the skin, particularly in areas where there are folds, such as the armpit or the groin - without it causing any problems.

When SA bacteria get into the body through a wound, they can cause skin infections, such as boils or abscesses. If they get into the blood stream, they can cause potentially fatal infections, such as septicaemia.

Many SA infections can be treated with common antibiotics, but if you become infected with an MRSA strain, clearing up the infection becomes far more difficult, as the availability of drugs that can treat it is limited.

Hospital patients are usually the most likely to develop MRSA since some may have pressure sores, for instance, or surgical wounds after having operations, such as hip replacements or heart surgery, or are being treated with intravenous drips or urinary catheter - all of which offer opportunities for bacteria to enter the body and cause infection.

How do you get infected with MRSA?
Exogenous infection
You can catch MRSA if you have had contact with someone who either has the infection or who is colonised with MRSA bacteria, or by having contact with something that has been contaminated with MRSA bacteria, such as sheets, clothing, sinks, towels and even door handles.
Endogenous infection
You can infect yourself, if you are colonised by MRSA and suffer a cut, wound or other type of break in your skin where the bacteria can invade your body.
What are the symptoms of MRSA?
The majority of MRSA infections start as skin infections, such as a wound that does not heal and develops into a boil or an abscess. Ulcers, such as pressure sores, varicose ulcers and diabetic ulcers can often be colonised by MRSA infection.

MRSA is far more serious when it enters the blood stream, causing septicaemia, septic shock, septic arthritis, deep (or internal) abscesses, meningitis, pneumonia, osteomyelitis (bone infection) and endocarditis (infection of the heart lining) (3).

Deeper abscesses can affect parts of the body, such as the kidneys, liver and spleen, causing low blood pressure, shivers, weight loss and organ failure (4).

Septicaemia, which is the type of MRSA infection that has the highest death rate, includes severe symptoms such as high body temperature, shaking and organ failure.

How is MRSA treated?
MRSA infection is detected by a blood or urine test. Also, sometimes a wound swab can check for the presence of MRSA bacteria. If the diagnosis is confirmed, you may need further tests to check to which types of antibiotics the bacteria are resistant.

Certain antibiotics, such as vancomycin, teicoplanin or linezolid, are still effective in treating MRSA. These drugs are usually injected directly into a vein or fed into the blood stream via a drip. The doses are much higher than those given for other types of infection and you may need several weeks' worth of hospital-based treatment.

Can MRSA be prevented?
Steps are being taken in hospitals around the country to control and minimise the spread of MRSA in patients.

For example, hospital workers are expected to wash their hands thoroughly before and after having contact with patients. Visitors also are encouraged to wash their hands before entering the wards and on their way out too.

If you are going to visit somebody in hospital, there should be antibacterial gels in dispensers near patients' beds, as well as next to main and ward doors.

If you see antibacterial gel dispensers on a ward or hospital door use them.

If you are going into hospital for treatment, a few sensible measures may reduce your risk. Make sure your hands are clean at all times. Keep a pack of antibacterial hand wipes by your bed and use them each time you come into contact with anyone or anything that could possibly be contaminated with bacteria (after using the toilet, for instance), as well as before and after having a meal.

Make sure anyone who visits you washes their hands thoroughly too, when they first arrive and before they leave.

Many hospitals also routinely test new patients for MRSA colonisation, and you may have swabs taken from your skin and nose, as well as being required to give urine and blood samples before you can receive any treatment.

If you test positive, you will be given an antibiotic skin cream and antiseptic shampoo and soap to get rid of the bacteria, so that you are clear before you are admitted.

Continue reading "MRSA stands for Methicillin-Resistant Staphylococcus Aureus, and can be fatal and deadly for elder Hospital Patients" »

High-quality nursing homes get sued almost as often as low-quality nursing homes, a new study shows.

Researchers say the finding illustrates that litigation, or the threat of litigation, doesn't lead to improvements in patient care. Nor does it appear that better nursing homes are rewarded for superior care in terms of fewer lawsuits.

"Nursing homes that are at the very top of the heap in terms of quality don't experience that much less litigation than nursing homes that are at the bottom of the heap," said lead study author David Studdert, a law professor at the University of Melbourne in Australia. "It's not clear that by improving your quality dramatically you will lessen your risk of being sued."

That's a problem, said study co-author David Stevenson, an associate professor of health care policy at Harvard Medical School, because one objective of litigation, other than compensating victims of medical malpractice, is encouraging high-quality care.

In other words, if a nursing home is good, it ought to face less of a threat of lawsuits than one that's sub-standard. But the research didn't bear that out.

"The results are sobering," Stevenson said. "One of the fundamental things that the risk of a malpractice claim is supposed to spur is deterring poor quality care. What we found was that the return on being a high-quality facility relative to a low-quality facility isn't great."

The study is published in the March 31 issue of the New England Journal of Medicine.

Five large U.S. nursing home chains provided the researchers with information on lawsuits brought against them between 1998 and 2006. Researchers looked at the alleged reason for the suit and the outcome, not whether the lawsuits had merit or not.

During that period, plaintiffs filed 4,716 claims against 1,465 nursing homes. On average, each nursing home was sued once every two years.

The most common harms alleged were fall-related injuries (27 percent) and pressure ulcers or bedsores (16 percent). Other claims were for dehydration, malnutrition and excessive weight loss, physical or verbal abuse and medication errors says California Nursing Home Abuse and Neglect Attorney Steven Peck.

Sixty-one percent of the claims resulted in a payment, which averaged nearly $200,000.

Researchers then analyzed the likelihood of a nursing home being sued based on 10 measures of quality gleaned from two national databases, including one that tracks the health of nursing home residents on a monthly basis.

Nursing homes that did the best on quality measures were only a little less likely to be sued. In any given year, nursing homes with the best records (the top 10 percent) had a 40 percent risk of being sued, while the worst 10 percent of nursing homes had a 47 percent chance of being sued.

Nursing homes that had the most nurse's aide hours per resident-day -- a measure of how well staffed a nursing home is -- were also slightly less likely to get sued, but again, not by much -- 45 percent compared to 41 percent annually for those with the lowest staffing levels.

One measure for which there was a significant difference in the likelihood of lawsuits was pressure ulcers or bedsores. Nursing homes with the lowest pressure ulcer rates had a 6 percent chance of being sued in a given year because of bedsore-related complaints compared to 11 percent for the worst-performing nursing homes.

Overall, for half of the 10 measures of quality, top nursing homes were slightly less likely to be sued than the worst nursing homes, but for five of the measures there was no significant connection.

Concluding that lawsuits have little effect on quality of care, the authors say that other long-term efforts, such as public reporting of nursing home conditions and performance-based reimbursement schedules, may be needed to encourage improvements.

The authors said their study doesn't specifically address tort reform, and their research shows that even in regions where there is less litigation -- one of the aims of tort reform -- there is no strong connection between a high-quality versus a low-quality nursing home's likelihood of being sued.

"The tort system is not working well in terms of deterrence, and it's not looking like you can fix that by any tweak to the system," Studdert said. "It looks fundamental."

But industry representatives said the study underscores the need for medical liability reform.

"The report's findings that a facility's quality of care does not affect the frequency of litigation demonstrates that comprehensive tort reform is essential," said Teresa Cagnolatti, director of government relations for the American Health Care Association, a Washington, D.C-based nursing home industry group.

"These legal distractions demoralize providers and employees, threaten staffing ratios and most importantly diminish resources from facilities providing good quality of care," Cagnolatti said.

Stevenson said the lawsuits likely added to the cost of housing the frail and elderly, although the study did not determine how much.

And although the study was in nursing homes, "it's very reasonable to assume there is a similar situation happening in the acute care sector, with hospitals and doctors," Studdert said.

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