Maryland Nursing Home Negligence Blog

Legionnaires' disease is caused by a bacteria known as Legionella that is often found in water.  People may contract this disease if they breathe in mist or vapor, or drink water containing Legionella bacteria.  The most common result of an infection is acute pneumonia.   

Legionnaires' disease is not contagious and has a 2 to 14 day incubation period.  Symptoms of the disease include fever, cough, headaches, muscle aches, nausea, vomiting and chills.  Legionnaires' disease is treated with antibiotics and can be fatal especially in the elderly.

Legionella bacteria often develops and grows in warm water environments including hot water tanks, cooling towers, plumbing systems, air conditioning systems, and hot tubs. 

Legionnaires' disease outbreaks may occur at long-term care facilities including nursing homes or assisted living facilities.  There was an outbreak at the Stadium Place Apartments, an assisted living facility located in Baltimore City, Maryland, first reported in October of 2009.  There have been seven confirmed cases of Legionnaire's disease, including one death.  The Baltimore City Health Department is investigating these cases along with the Maryland Department of Health and Mental Hygiene and the United States Centers for Disease Control ("CDC").  Very recently, a Stadium Place visitor was diagnosed with Legionnaires' disease and special measures regarding use of water were re-implemented in one of the Stadium Place buildings known as Venable II.

Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if a family member or loved one has contracted Legionnaire's disease secondary to nursing home and/or assisted living facility exposure. 

Nursing home residents may be at risk for digestive disease.  Diverticulitis is a fairly common disease found in the colon (large intestine) which occurs when protruding pouches coming out of the wall of the colon become inflamed or infected.  Patients suffering from diverticulitis may experience the following symptoms:  (1) lower abdominal pain; (2) diarrhea; (3) constipation; (4) fever; (5) bleeding from rectum; and/or (6) nausea/vomiting.

Fortunately, this condition can oftentimes be treated with antibiotics and dietary measures so long as it is timely diagnosed. 

The nursing home staff must alert the patient's treating physician if the resident experiences symptoms of digestive disease including diverticulitis.  The failure to do so can have fatal consequences.  For instance, the patient may develop peritonitis or intestinal obstruction requiring emergency surgery and treatment.  Sadly, under these circumstances, the nursing home's failure to timely alert the physician and/or transfer the patient to the hospital may result in serious medical complications or even death. 

A sample Maryland Wrongful Death/Survivorship Complaint involving claims of negligence relating to nursing home failures to make arrangements for the patient to receive necessary medical evaluations and treatment for diverticulitis follows:

COMPLAINT

Plaintiffs, [insert names of Plaintiffs], by their attorneys, hereby file this Complaint against Defendants, [insert names of Defendants], and in support thereof state as follows:

PARTIES AND JURISDICTION

1.   At all times material to this case, Plaintiffs have been citizens and residents of the State of Maryland.  Plaintiffs [insert names] are the surviving children of the decedent, [insert name].  [Insert name of wrongful death beneficiaries] are wrongful death beneficiaries in this action pursuant to Section 3-904(a) of the Courts and Judicial Proceedings Article of the Maryland Annotated Code.
2. [Insert name] is the duly appointed Personal Representative of the Estate of [insert name].  The Register of Wills for Baltimore City issued Letters of Administration to [insert name] on [insert date].  The Estate of [insert name] is bringing this survival action pursuant to Section 7-401(x) of the Estates and Trusts Article of the Maryland Code.
3. At all times material to this case, [insert names of Defendants] have been operating nursing homes and engaging in the practice of medicine and rehabilitation services in Baltimore City and throughout Maryland, acting through actual and/or apparent agents, servants and/or employees.
4. The venue for this claim is proper in Baltimore City, Maryland.  The amount in controversy exceeds Thirty Thousand Dollars ($30,000.00).

FACTS COMMON TO ALL COUNTS

5. At all times mentioned and relevant herein, [insert names of Defendants] have been licensed by the State of Maryland to own and operate nursing homes iand assisted living facilities in Maryland and have held itself and its agents, servants and employees out to the general public as experienced, competent and capable providers of nursing home, assisted living, and medical and rehabilitation services, and in such capacity owed a duty to [insert name of Plaintiff] and the Plaintiffs to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine and rehabilitation services.
6. At all times mentioned and relevant herein, all individuals at [insert name of nursing home] who participated in the care provided to [insert name] were acting on behalf of [insert names of Defendants] and within the scope of their employment and/or agency with [insert names of Defendants].
7. On or about [insert date], [insert name] was admitted to [insert name of nursing home].  
8. According to the medical records, on or about [insert date], [insert name of Plaintiff] complained to the nursing home staff of diarrhea, abdominal pain, cramps, and back pain.  Subsequent care notes failed to document that the staff had assessed [insert name]'s abdomen or monitored her condition for improvement or worsening of the diarrhea.
9. A care note dated [insert date] documented that [insert name] continued to complain of nausea.   Once again, however, the care note failed to document any assessment of [insert name]'s abdomen or bowel function.
10. A care noted dated [insert date] documented that [insert name] was continuing to complain of nausea and diarrhea.  The note further documented that [insert name]'s abdomen was distended and tender to the touch, and that there was a foul BM (bowel movement) odor in [insert name]'s room.   Despite these findings, the nursing home staff failed to obtain necessary medical assistance for [insert name].
11. On [insert date], [insert name] continued to complain of nausea and abdominal pain.   [Insert name]'s physician was finally notified and [inset name] was transported to the emergency room at [insert name of hospital].
12. Doctors at [insert name of hospital] ran preliminary tests and determined that [insert name] was severely dehydrated and anemic.  After admitting [insert name] to the hospital and running additional tests, doctors determined that [insert name] had an acute sigmoid diverticulitis that had produced multiple large pelvic abscesses.  Doctors initially attempted to drain the abscesses but were unsuccessful.   [Insert name] subsequently underwent a major abdominal surgery and colon resection.  By this point, however, [insert name] had developed peritonitis and acute renal failure.  [Insert name] died on [insert date].  The Death Certificate lists the primary cause of death as sepsis related to perforated diverticular disease.

COUNT I (Professional Negligence)

13. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
14. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed [insert name] a duty to exercise reasonable care in their treatment of her.
15. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to [insert name], thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:

a. failed to appropriately monitor and evaluate [insert name]'s ongoing medical condition;
b. failed to timely and properly diagnose [insert name]'s diverticulitis;
c. failed to make arrangements for [insert name] to receive necessary medical evaluations and treatment for her diverticulitis, which resulted in [insert name] developing large pelvic abscesses, peritonitis and renal failure, conditions that ultimately caused her death; and
d. were otherwise negligent and violated the applicable standards of care.

16. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name] was caused to sustain serious, painful and permanent injuries to her body, including great physical and mental pain and suffering, and, ultimately, death.
17. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name], among other things, was compelled to undergo medical procedures and treatment and, as a result, was obliged to expend sums of money for medical care and was precluded from engaging in her normal pursuits and activities, among other injuries and damages.
18. Had Defendants followed the appropriate and applicable standards of care, [insert name] would not have suffered the above-identified injuries, damages and death.
19. The injuries herein complained of were directly and proximately caused by the negligence and want of care of Defendants, with no negligence on the part of [insert name] contributing thereto.

WHEREFORE, Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

COUNT II (Wrongful Death)

20. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.

21. As a direct and proximate result of the Defendants' above-described negligence in causing the death of [insert name], [insert names of wrongful death beneficiaries] have sustained, among other things, pecuniary loss, mental anguish, emotional pain and suffering, loss of society, loss of companionship, loss of comfort, loss of protection, loss of parental care, loss of filial care, loss of attention, loss of advice, loss of counsel, loss of guidance and loss of education. 

WHEREFORE, the Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

*  *  *

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of failure to diagnose and/or treat digestive disease such as diverticulitis, bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication administration error/prescription mistake, elder abuse or elder neglect.

A tracheostomy is a surgically created opening in the windpipe (trachea) that may be used (for among other things) for patients who require breathing support with a ventilator (breathing machine). 

Regular tracheostomy care is essential in order to prevent complications including infection, windpipe damage, narrowing or collapsing of the airway and prevention of skin breakdown.  The good news is that tracheostomy care is a fairly benign process and complications may be preventable so long as proper care is provided.  Elderly nursing home patients and their families must attempt to locate nursing home facilities that are able to provide this level of care.  There are certain nursing home facilities that have Ventilator Units and hold themselves out as competent and able to provide the care required for such patients.

Unfortunately, we have seen situations where human error involving accidental or inadvertent removal of the tracheostomy tube results in permanent injury to the nursing home resident or even death.  In these circumstances, time is of the essence and the nursing home staff must timely and appropriately respond to the patient's respiratory distress.

A sample Maryland Wrongful Death/Survivorship Complaint involving claims of negligence relating to tracheostomy/ventilator care follows:

COMPLAINT

Plaintiffs, [insert names of Plaintiffs], by their attorneys, hereby file this Complaint against Defendants, [insert names of Defendants], and in support thereof, state as follows:

PARTIES AND JURISDICTION

1.At all times material to this case, Plaintiffs have been citizens and residents of the State of Maryland.  Plaintiffs [insert names] are the surviving children of the decedent, [insert name].  [Insert names of wrongful death beneficiaries] are wrongful death beneficiaries in this action pursuant to Section 3-904(a) of the Courts and Judicial Proceedings Article of the Maryland Annotated Code.
2.[Insert name] is the duly appointed Personal Representative of the Estate of [insert name].  The Register of Wills for Baltimore City, Maryland issued Letters of Administration to [insert name] on [insert date].  The Estate of [insert name] is bringing this survival action pursuant to Section 7-401(x) of the Estates and Trusts Article of the Maryland Annotated Code.
3.At all times material to this case, [insert names of Defendants] have been corporations engaging in the practice of medicine and rehabilitation services in Baltimore City, Maryland, and acting through actual and/or apparent agents, servants and/or employees.
4.The venue for this claim is proper in Baltimore City, Maryland.  The amount in controversy exceeds Thirty Thousand Dollars ($30,000.00).

FACTS COMMON TO ALL COUNTS

5. At all times mentioned and relevant herein, [insert names of Defendants] have owned and operated the nursing home facility located at [insert address] in Baltimore City, Maryland, and have held themselves and their agents, servants and employees out to the general public as experienced, competent and capable providers of medical, rehabilitation, and nursing home services, and in such capacity owed a duty to [insert name] and the Plaintiffs to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine, rehabilitation, and nursing home services.
6. At all times mentioned and relevant herein, all of the individuals at [insert names of Defendants] who participated in the care provided to [insert name] were acting on behalf of and within the scope of their employment with [insert names of Defendants].
7. On or about [insert date], [insert name] was admitted to the [insert name of nursing home] nursing home facility.  At the time of his admission, [insert name] suffered from chronic obstructive pulmonary disease and required ventilator support via a tracheostomy.  [Insert name] and his family selected [insert name of nursing home] facility because the facility represented that it had the equipment and trained staff necessary for the care of a ventilator-dependent patient.
8. On or about [insert date], [insert name] was evaluated by a nurse at approximately [insert time] and was noted to be awake and alert and in no distress.  Later that evening, [insert name] was found unresponsive in his bed by a respiratory technician. The technician noted that [insert name]'s tracheostomy tube was half way out, and he had no pulse.  The technician called 911, and paramedics arrived on the scene at approximately [insert time].  The paramedics were able to restore [insert name]'s breathing, and they immediately transported him to [insert name of hospital].
9. Upon admission to [insert name of hospital], [insert name] was diagnosed with continuous seizure activity secondary to anoxic encephalopathy.  [Insert name] never recovered neurologically, and life support was withdrawn on [insert date].  [Insert name] was pronounced dead at [insert time] on [insert date].  The Death Certificate lists the cause of death as anoxic brain injury.

COUNT I (Professional Negligence)

10. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
11. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed [insert name] a duty to exercise reasonable care in their treatment of him.
12. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to [insert name], thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:

a. failed to properly monitor and manage [insert name]'s tracheostomy;
b. failed to properly monitor and manage [insert name]'s ventilator support;
c. failed to respond in a timely and appropriate manner to [insert name]'s respiratory distress; and
d. were otherwise negligent and violated the applicable standards of care.

13. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name] was caused to sustain serious, painful and permanent injuries to his body, including great physical and mental pain and suffering, and, ultimately, death.
14. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name], among other things, was forced to undergo medical treatment, and, as a result, was obliged to expend sums of money for medical, hospital and other care and treatment and was precluded from engaging in his normal and usual pursuits and activities, among other injuries and damages.
15. Had Defendants followed the appropriate and applicable standards of care, [insert name] would not have suffered the above-identified injuries, damages and death.
16. The injuries and damages herein complained of were directly and proximately caused by the negligence and want of care of Defendants, with no negligence on the part of [insert name] contributing thereto.

 WHEREFORE, Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

COUNT II (Wrongful Death)

17. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
18. As a direct and proximate result of the Defendants' above-described negligence in causing the death of [insert name], [insert names of wrongful death beneficiaries] have sustained, among other things, pecuniary loss, mental anguish, emotional pain and suffering, loss of society, loss of companionship, loss of comfort, loss of protection, loss of parental care, loss of filial care, loss of attention, loss of advice, loss of counsel, loss of guidance and loss of education. 

 WHEREFORE, Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

* * *

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of substandard tracheostomy/ventilator care, bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication administration error/prescription mistake, elder abuse or elder neglect.

Family members who wish to complain regarding the care and treatment provided to their family member or loved at nursing homes in Maryland have several potential options.

First, the family can complain to the nurse in charge of the unit, and then to the Director of Nursing, Administration or Medical Director of the nursing home.  Under Maryland law, the Nursing Home Administrator is required to investigate complaints within thirty days.

If there is a concern that such complaints to the nursing home could negatively impact the patient's safety or well-being, it may be advisable to contact the Maryland Office of Health Care Quality/ Department of Health and Mental Hygiene.  To make a complaint, call the Maryland Office of Health Care Quality at (410) 402-8000.

The State's nursing home inspection results are considered public information and can be obtained from the Maryland Office of Health Care Quality.  Requests for such results should be forwarded to:

Office of Health Care Quality
Spring Grove Hospital Center
Bland Bryant Building
55 Wade Avenue
Catonsville, Maryland 21228
Attn: Public Information Request
(410) 402-8000

Finally, families can make complaints to their local county nursing home ombudsman.  
Under the Maryland Long Term Care Ombudsman Program, each county in Maryland is served by a local nursing home ombudsman.  An ombudsman is a government official  who helps people resolve problems with nursing homes and assisted living facilities. 

The Maryland State Ombudsman's Office can provide the contact information for the local county Ombudsman office.  The contact information for the Maryland State Ombudsman's Office and several local county offices follow:

Maryland Department of Aging
State Long Term Care Ombudsman
Patricia Bayliss--Chief Ombudsman
301 West Preston Street, Room 1007
Baltimore, Maryland 21201
(410) 767-1100
(800) 243-3425, ext. 71108 (toll free)

Baltimore City   (410) 396-2273
Baltimore County  (410) 887-2594
Prince George's County (301) 265-8450
Anne Arundel County  (410) 222-4527
Howard County  (410) 313-5980
Montgomery County  (240) 777-3000
Harford County  (410) 638-3025

Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of elder neglect or abuse.

Section 14-302 of the Family Law Article of the Maryland Annotated Code requires Maryland health practitioners, police officers or human service workers who have reason to believe that the a vulnerable adult has been subject to abuse, neglect, self-neglect, or financial exploitation to report such abuse immediately to the local department of social services.  This statute would include reporting of nursing home abuse/neglect.  Any other person (other than health practitioners, police officers or human service workers) who has reason to suspect elder abuse/neglect may also make a Complaint.  

To make a complaint, call the following telephone number - 1-800-917-7383.   

A State investigation is conducted in response to every complaint of neglect/abuse.  If abuse is substantiated, Maryland Adult Protective Services may intervene.

Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury as a result of nursing home neglect or abuse.

Elderly nursing home patients are at risk for developing bedsores (also known as pressure sores or decubitus ulcers).  Decubitus ulcers are bed sores caused by unrelieved pressure on the skin from lying or sitting in the same position too long and are associated with pain.   

Once a bed sore becomes infected and progresses to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and life-threatening complications.  These individuals may develop sepsis (blood infection) and/or osteomyelitis (infection of the bone) requiring surgical wound debridement, and ultimately resulting in death.     

Fortunately, decubitus ulcers are entirely avoidable as long as proper care and preventative measures are instituted and carried out by the nursing home staff.  Under new Medicare guidelines, hospitals are no longer even reimbursed for additional care resulting from bed sores as the government has determined that development of bed sores at a hospital is a so-called "never event." 

Under Maryland law, when a nursing home resident dies as a result of nursing home negligence, two causes of action arise: (1) a wrongful death claim; and (2) a survivorship claim. 

In our nursing home bedsore cases, we routinely serve Corporate Designee Deposition Notices upon the Defendants along with the Complaint and other discovery requests at the outset of the case.  In this regard, Maryland Rule 2-412(c) and (d) requires nursing homes to produce documents (including medical records and policies and procedures) and to designate individuals to testify as to matters set forth in the deposition notice.  The testimony given will bind the nursing home on the subjects described. 

Our Corporate Designee Deposition Notices are targeted to obtain records and information concerning important issues including: (1) ensuring that the proper corporate entities have been named as Defendants; (2) ensuring that the healthcare providers at issue are employees or agents of the Defendants; (3) ensuring that information contained in medical records or other documents is accurate; (4) potential defense motions to transfer venue; (5) the treatment provided to the plaintiff; (6) the nursing home's policies and procedures concerning a variety of areas including wound prevention and wound care; and (7) potential nursing home staffing shortages.  These Corporate Designee Depositions also force the nursing homes and their lawyers to focus on and evaluate the circumstances of the case at an early stage as they have to identify and produce witnesses for deposition, and may help to facilitate early mediation or settlement.
 
A sample Corporate Designee Deposition Notice in a wrongful death/survivorship lawsuit involving claims of negligence relating to nursing home bed sores/pressure sores/decubitus ulcers follows:

NOTICE TO TAKE DEPOSITION

Pursuant to Maryland Rule 2 412(c) and (d), you are requested to do the following:
(a) designate one or more officers, directors, managing agents, or other persons who will testify on your behalf regarding the following matters known or reasonably available to the organization, and
(b) produce for inspection and copying at the deposition all documents or tangible things within your possession, custody or control regarding the following matters:

1. The corporate structure of [INSERT NAMES OF DEFENDANTS], and their parent corporations, subsidiaries, and affiliated entities from 2005 to the present.
2. The nature and scope of all operations and business activities of [INSERT NAMES OF DEFENDANTS] from 2005 to the present.
3. The corporate structure and scope of operations of all facilities owned, operated, managed, or supervised by [INSERT NAMES OF DEFENDANTS] from 2005 to the present.
4. The nature and scope of all advertising activities of [INSERT NAMES OF DEFENDANTS] within the City of Baltimore from 2005 to the present.
5. The nature and scope of all services, including but not limited to, nursing home, assisted living, in-patient and outpatient rehabilitation, hospice, and home health care services provided by [INSERT NAMES OF DEFENDANTS] and their parent corporations, subsidiaries, and affiliated entities, within the City of Baltimore from 2005 to the present.      
6. The care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY] during the time period of [INSERT DATES OF ADMISSION], including but not limited to efforts to turn and reposition the patient, and monitor, prevent and treat decubitus ulcers.
7. The skin care and wound care, prevention and treatment provided to [INSERT NAME OF PLAINTIFF] at [INSERT NAME OF NURSING HOME FACILITY] from [INSERT DATES].
8. All skin evaluation practices and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY].
9. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the prevention of decubitus ulcers/ pressure wounds.
10. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the prevention of decubitus ulcers/ pressure wounds via the use of specialty mattresses or beds.
11. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the care, treatment, and monitoring of decubitus ulcers/ pressure wounds.
12. All information and documents that discuss or pertain to any specialty mattresses or beds that were used in the care and treatment of [INSERT NAME OF PLAINTIFF]'s decubitus ulcers/ pressure wounds throughout her stay at [INSERT NAME OF NURSING HOME FACILITY].
14. All written manuals, guidelines, policies, or procedures in effect at [INSERT NAME OF NURSING HOME FACILITY] from 2005 through the present that discuss or in any way relate to the diagnosing, monitoring and/or treatment of pressure wounds and/or decubitus ulcers.
15. All information and documents that discuss or pertain to [INSERT NAME OF NURSING HOME FACILITY]'s  procedures, guidelines or policies in effect from 2005 through the present concerning the circumstances under which nurses and nursing assistants should consult with the patient's treating physician or other doctor regarding the patient's skin integrity or condition, including the development and progression of decubitus ulcers/ pressure wounds.
16. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the circumstances under which nurses and nurse practitioners should consult with the resident's treating physician or other physician regarding the patient's status and/or ongoing care needs at [INSERT NAME OF NURSING HOME FACILITY].
17. The identity of all individuals who provided care to [INSERT NAME OF PLAINTIFF]'s during his stay at [INSERT NAME OF NURSING HOME FACILITY] during the time period of [INSERT DATES OF ADMISSION] including but not limited to efforts to monitor, prevent and treat decubitus ulcers.
18. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to incident reporting.
19. Information concerning and copies of all incident reports generated by Defendants and their agents or employees pertaining to the care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY].
20. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY pertaining to or relating to documenting a resident's medical records.
21. Information concerning and copies of all inspection reports or evaluations pertaining to the care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY] generated by any federal or state government agencies (including but not limited to Adult Protective Services) that regulated or monitored [INSERT NAME OF NURSING HOME FACILITY].
22. Information regarding staffing levels, staffing sheets and staffing shortages at [INSERT NAME OF NURSING HOME FACILITY] during the time period during which [INSERT NAME OF PLAINTIFF] resided at [INSERT NAME OF NURSING HOME FACILITY].

* * *

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

A recent Clinical Research Study entitled "The Safety of Warfarin Therapy in the Nursing Home Setting" published in the American Journal of Medicine, Volume 120, No. 6 (June 2007) examined the preventability of adverse warfarin (also known as Coumadin) events in the nursing home setting.  This study concluded that the use of warfarin (Coumadin) "in the nursing home setting presents substantial safety concerns for patients.  Adverse events associated with warfarin therapy are common and often preventable in the nursing home setting.  Prevention strategies should target the prescribing and monitoring stages of warfarin management."   

Coumadin (generic name: warfarin) is an anticoagulant, or blood thinning medication, that is prescribed to many nursing home patients who are at risk for developing blood clots that could result in heart attacks or strokes.  It is a very powerful drug that is also still used as rat poison and requires careful monitoring in humans.  In our practice, we have seen the devastating results when nursing homes fail to take the proper steps to ensure that their residents receive proper administration and/or monitoring of their Coumadin therapy. 

Patients taking Coumadin require periodic blood samples to measure their clotting time, or INR (International Normalized Ratio), and may require periodic adjustments of their daily dosage of Coumadin in order to ensure that their blood remains within their predetermined therapeutic range.  The physician overseeing a patient's Coumadin therapy will set a target INR range usually between 2.0 to 3.0.  Patient's with mechanical heart valves may require target INR in the range of 2.5 to 3.5.    

If a patient takes too much Coumadin, they can suffer life-threatening complications due to excessive bleeding.  If a patient takes too little, their blood will clot and they can suffer a heart attack or stroke. 

The nursing home staff must ensure that the resident takes the appropriate dosage and receives regular INR testing.  The nursing home staff must also ensure that the doctor overseeing the care timely receives the testing results, and is immediately made aware of all significant changes in the patient's condition.  In the event that the physician cannot be reached, residents experiencing significant changes in condition should be transported to a hospital immediately.

The nursing home staff must also ensure that patients taking Coumadin are provided with the appropriate diet because some foods interact with the drug.  Many commonly used medications such as antibiotics also interact with Coumadin.  Additionally, the nursing home staff must institute and implement fall precautions because residents taking Coumadin may have increased bleeding risk.

Ultimately, Coumadin administration and/or monitoring errors may be avoidable so long as nursing homes develop and implement policies and protocols aimed at: (1) ensuring that the resident receives proper INR testing, and that the results are timely analyzed and acted upon; and (2) ensuring there is a clear flow of information provided to all health care providers (especially the prescribing doctor) who interact with the resident.

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of Coumadin administration and/or monitoring errors, bed sores (also known as pressure sores or decubitus ulcers), dehydration/malnutrition, nursing home falls, elder abuse or elder neglect.

I just read a disturbing article in the October 1, 2009 online edition of the Chicago Tribune entitled "Nursing Homes a Risky Business - Dozens of Mentally Ill Felons Are Housed in Facilities Tied to 2 Executives."  This article discusses the practice of nursing homes admitting mentally ill criminals (often in order to receive Medicaid reimbursement) who go on to harm other residents.  The incidents cited in the article include allegations of physical assault and rape.

As if families forced to put their loved ones into nursing homes didn't already have enough to worry about, they must now consider the possibility that dangerous, mentally ill fellow nursing home residents may harm their loved one.

Ultimately, a nursing home may be responsible for injuries caused by fellow nursing home residents as the nursing home must institute appropriate protocols and policies that protect the safety and welfare of their residents.

Please feel free to contact the attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injuries inflicted by a fellow nursing home resident. 

Non-ambulatory patients residing in nursing homes are at risk of developing pressure sores on their heel and ankle areas as a result of unrelieved pressure and friction.

Once these sores develop, it can be difficult to achieve healing and avoid potentially painful and fatal complications including sepsis (blood infection), osteomyelitis (bone infection), amputation, surgical wound debridement and even ultimately death.

It is therefore critical that nursing homes develop and implement wound prevention care plans and perform risk assessments at the time of admission.  In addition to daily monitoring and regular skin assessments, the nursing home staff must ensure that pressure and friction in the heel and ankle areas are reduced and relieved.  This may be accomplished as simply as through the use of pillows to offload the heels.  The nursing home staff must, however, be on the lookout for patient movement that may displace the pillow.  Other preventative measures include heel protectors, boots and pressure relieving mattresses.  Heel protectors may help to provide continuous pressure relief, and also act to minimize friction and shear on feet, ankles and heels. 

Families must be advocates for their loved ones and they should be on alert for these issues and regularly visit the nursing home resident and inspect their skin.  Families should also discuss preventative heel ulcer care with the nursing home staff.  As the saying goes, "the squeaky wheel gets the grease."

In our practice, we have seen the tragic results of the failure of nursing homes to implement effective and proper heel pressure ulcer prevention protocols.  In one situation, a vulnerable, mentally challenged individual was admitted to the nursing home with no skin breakdown for short-term rehabilitation services.  He had previously resided in a group home environment and was able to participate in an adult day program.  The plan was for him to return to his previous living arrangements and level of functioning upon his discharge from the nursing home.    During his stay at the nursing home, he did not receive visits from family members.  He was not provided with heel ulcer preventative care and, unfortunately, developed a heel wound that became infected and necrotic, and progressed to stage 4.  He went on to develop severe osteomyelitis of his heel.  In an effort to prevent the potentially fatal spread of osteomyelitis, doctors performed an above-the-knee amputation of his leg.  Sadly, this mentally challenged individual became bed-ridden, requiring permanent nursing home care and never returned to his previous level of functioning.

The good news is that heel pressure ulcers are entirely avoidable so long as proper care and preventative measures are instituted and implemented by the nursing home.  Under new Medicare guidelines, hospitals are no longer even reimbursed for additional care resulting from pressure ulcers as the government has determined that development of bed sores at a hospital is a so-called "never event."

Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.