Calls to our law firm by bedsore victims and their families have ballooned in recent months. We have a few more law firms sending all of their nursing home cases to us and our Internet presence has increased the number of calls we get directly from victims.
There are a lot of questions about how bedsore cases and which cases typically get compensation, the type of cases our firm will take, and what really is the deal with bed sore cases.
I try to address some more common questions below.
What exactly is a bedsore?
You know what a bedsore looks like. But what is it? A bedsore is a breakdown of the skin. The skin is made of three components: the epidermis (surface skin), the dermis, and subcutaneous tissue. A breakdown occurs when there is a destruction of the skin resulting in the ulceration of the skin and supporting tissues. This results from inadequate blood supply caused by prolonged pressure, which occludes the local blood supply.
How does a bedsore form?
I’m typing this from my chair. When I get uncomfortable, I move around and redistribute my weight. We do the same thing when we are sleeping. We stay in one spot until our body becomes uncomfortable and then we move. This is how robust, healthy people fend off bedsores before they arise. A bedsore starts as soon as the skin is even modestly disrupted. We all theoretically have bedsores that develop.
Patients who are immobile, especially those unable to change their positions in bed themselves, are at risk of developing bedsores. If you’re in a chair or bed immobilized, you do not have this immediate correcting mechanism that eliminates the pressure ulcer.
So what happens is there an area between the skin and the bone gets squeezed and it squeezes the blood out of it causing dead tissue. This is pretty benign. The breach of the skin’s integrity looks insignificant at first. You have a little sore that is dead tissue. But if the patient remains immobile, bacteria loves dead tissue because they will grow and thrive in it. So bacteria comes to the sore, grabs hold of the dead tissue, and creates an infection. If there is no intervention, this process continues at an accelerating rate.
Can bedsores be prevented?
Bedsores are almost always preventable with proper care. The number one preventative method is frequently getting the resident or patient to move. Preventative measures include special mattresses, cushions, and even gel cushions. But the number one solution and the source of most nursing home bedsore lawsuits is failing to start and follow a protocol for frequent, regular changes of the patient’s position to relieve the pressure on the area that is receiving the trauma.
Is there a test for bedsore risk?
Hospitals frequently use a tool known as the Braden Scale, or Braden Skin Assessment, to document the risk that a patient might develop a bedsore. The Braden Scale comprises several criteria, each of which has a numerical value. The total score determines the level of risk.
What other mistakes do nursing homes make in bed sore cases?
Here is a partial list:
- Perform a thorough and complete medical history and physical examination
- Failure to follow physician’s orders to turn the patient
- Failure to consult a wound care team or specialist to help prevent bedsores or at the first signs of redness at pressure points
- Failure to assess for pressure sore’s size depth and color every week
- Failure to encourage adequate food and fluid intake and otherwise find out that the resident was at risk for pressure sores because of compromised nutrition, swelling, and edema, immobility because of medications and restraints
- Failure to get and properly use all available equipment, such as beds, mattresses, pads, boots, and other devices specifically designed and intended to prevent pressure sores or bedsores
- Failure to effectuate the use of the proper bed for the patient, including the use of a bed which automatically and mechanically turns the patient at the proper intervals
- Failure to ensure that excessive medication is not used, which would impede the patient from shifting body position
- Failure to inspect the patient’s body for signs consistent with the formation of decubitus ulcers at least every four hours (or as required by the patient’s condition)
- Failure to assist the resident out of bed several times daily
- Failure to turn and reposition frequently to reduce pressure points
- Failure to avoid tight-fitting shoes/socks
- Failure to keep the patient clean
- Failure to keep the patient from sliding down in bed (e.g. gatch knees slightly when the head of the bed is elevated 30° or higher) to reduce the risk of skin surface abrasion and shearing
- Failure to promote a high protein diet and vitamins to promote healing
- Failure to maintain the resident’s body alignment with weight distributed evenly
- Failure to moisturize skin with lotion or use protective barrier cream such as Tegaderm or other types of skin protection to prevent skin breakdown
- Failure to notify health care providers up the chain if the skin becomes compromised so that the patient can get prompt intervention
- Failure to keep bed sore elevated off of the bed when in bed
- Failure to use prompt peri care after each incontinence episode which requires cleaning the perineum (which some health care providers resist because of the discomfort and embarrassment) and otherwise protect the skin from urine and feces with regular changing of sheets and other preventive measures
- Failure to perform skin assessment daily and notify the treatment nurse as necessary
What causes bedsore to progress to death?
When pressure is exerted over prolonged periods of time, the circulation of blood causes ischemic necrosis (a fancy word for bedsore) that can cause an infection that can lead to sepsis. Sepsis occurs because the resident’s body has had an infection that continues unabated. The events leading up to sepsis can vary, but bedsores from neglectful hospital and nursing home care can eventually cause this often fatal bacterial condition.
My mom had an awful bedsore. It is better now, but it was really bad. Does she have a case?
She might. But our law firm would not take that case. Our criteria for a bedsore case is that there must be a permanent injury or death. We do not want to take a case if there is not a significant chance for a meaningful recovery for the client. In what we call “small” cases, their amount of pain and suffering involved is anything but small. The result is a client who is not happy.
What is the settlement value of a Maryland nursing home?
The settlement value of the great majority of these cases is between $300,000 and $1 million. Because of Maryland’s cap on pain and suffering damages in nursing home cases, the only way you can get more than $1 million in a nursing home case is if you have meaningful economic damages. In nursing home cases, this usually involves a patient that lives but has significant ongoing medical needs or patient who still have an expectation of future income but was temporarily in a nursing home.
How does a nursing home claim work in Maryland?
In Maryland, a bedsore nursing home case is a medical malpractice case which means you have to jump through a greater number of hoops to file a claim and you must file first in Maryland Health Claims Arbitration with an expert certification and report.