Maryland Nursing Home Negligence Blog

Pursuant to Maryland law, an assisted living program may not provide services to individuals who at the time of initial admission (as established by the initial assessment) would require: (1) more than intermittent nursing care; (2) treatment of stage 3 or stage 4 ulcers; (3) ventilator services; (4) skilled monitoring, testing, and aggressive adjustment of medications and treatments where there is the presence of, or risk for, a fluctuating acute condition; (5) monitoring of a chronic medical condition that is not controllable through readily available medications and treatments; or (6) treatment for a disease or condition which requires more than contact isolation.  See COMAR 10.07.14.22.I. 

This regulation requires assisted living facilities to request and obtain a resident specific waiver of care for a resident who sustains a stage 3 or stage 4 pressure ulcer while in the facility.

A pressure ulcer is a bed sore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain.    Assisted living residents may experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points.  Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection. 

Unfortunately, once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and life-threatening complications.  These patients may develop osteomyelitis (infection of the bone) and sepsis ultimately resulting in death. 

Please feel free to contact the nursing home/assisted living 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.

According to Taber's Medical Dictionary, sepsis is defined as "the spread of an infection from its initial site to the bloodstream, initiating a systemic response that adversely affects blood flow to vital organs."  This condition can prove fatal and is a common cause of death in the elderly population including nursing home residents.

Sepsis can result from numerous conditions including bedsores (also known as pressure ulcers or decubitus ulcers).  A pressure ulcer is a bed sore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain.    Nursing home patients experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points.  Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection. 

Nursing home residents may be at risk for bedsores as a result of their underlying health problems and/or immobility issues.  The United States Centers for Disease Control and Prevention ("CDC") published a paper in February of 2009 entitled "Pressure Ulcers Among Nursing Home Residents: United States, 2004" concluding that "pressure ulcers are serious and common medical conditions in U.S. nursing homes, and remain an important public health problem." 

The standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable.  The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing.  The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.

Unfortunately, once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and life-threatening complications.  These patients may develop osteomyelitis (infection of the bone) and sepsis (blood infection) ultimately resulting in death. 

Oftentimes, the death certificate will list sepsis as the primary cause of death and include osteomyelitis and/or decubitus ulcers as contributing death factors.  In these circumstances, it may be advisable to consult with an attorney if you have reason to believe that the bedsores developed at the nursing home and were not timely diagnosed and/or treated.

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.

Under current Medicare guidelines, hospitals are no longer reimbursed for additional care resulting from pressure ulcers (also known as bed sores or decubitus ulcers) as the government has determined that development of bed sores at a hospital is a so-called "never event."  Additionally, hospitals cannot bill patients directly for such care.  The denial of reimbursement for such reasonably preventable treatment errors should provide hospitals with financial incentive to institute and implement appropriate patient safety measures geared toward preventing the development of bedsores. 

While there has been discussion about extending this policy to include long term care facilities including nursing homes and assisted living centers, nursing homes are not presently subject to these guidelines.  Nursing homes are therefore presently permitted to receive payment for care and treatment related to bedsores that develop in their facilities, while hospitals cannot.  This writer firmly believes that these Medicare "never events" guidelines should be extended to include nursing homes and other long term care facilities so that these facilities will have the same financial incentive as hospitals do to improve patient safety measures relating to preventing the development of bedsores.

Like hospital patients, nursing home residents are often at risk for developing bedsores as a result of their underlying medical problems and/or mobility issues.
 
A pressure sore/decubitus ulcer is a bedsore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain.  Patients experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points.  Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.

A stage 1 ulcer presents as redness of the skin without a break in the skin and represents tissue injury that does not disappear when pressure is relieved.  A stage 1 ulcer is classified as nonblanchable erythema with intact skin.  Erythema is redness of the skin produced by congestion of the capillaries.  Erythema is the initial reactive hyperemia caused by pressure, and nonblanchable erythemia represents stage 1 pressure ulcer.

A stage 2 ulcer is characterized by partial-thickness skin loss, that is, the epidermis is interrupted as an abrasion, blister or shallow crater.

A stage 3 ulcer features full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia.  The ulcer appears as a deep crater, with or without undermining of adjacent tissue. 

A stage 4 ulcer involves full-thickness skin loss (exposing bone or muscle) with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).

Once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and potentially fatal complications.   With stage 3 or stage 4 pressure sores, the extent of the disease may not be evident because of covering necrotic material or eschar.  To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required.  When ulcers develop over bony prominences, osteomyelitis is a potential complication.  Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can be painful and life threatening.

Fortunately, as reflected by Medicare's "never event" guidelines, pressure ulcers may be entirely avoidable so long as proper care and preventative measures are instituted and implemented by the health care provider.  The time is right to extend these "never event" guidelines to include nursing homes and other long term care facilities.

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.

Nursing homes patients often require physical therapy and/or occupational therapy as part of their rehabilitation process.  These residents may be at risk for falling as a result of numerous factors including physical and/or cognitive disabilities, muscle weakness, or side effects of medications.  We have encountered situations where nursing home residents have experienced falls during physical therapy or occupational therapy treatments.  These falls may be the result of improper and/or inadequate supervision by the nursing home staff.

According to the United States Center for Disease Control and Prevention ("CDC"), the average nursing home resident experienced 2.6 falls per year.   The CDC reports further that approximately 10% to 20% of nursing home falls result in serious injuries, and approximately 1,800 nursing home residents die each year as a result of falls.

Sadly, a nursing home resident's fall may result in significant disability, functional decline, reduced quality of life and even death.  Of particular concern, are traumatic head and brain injuries resulting from nursing home falls that do not receive immediate medical attention and treatment. 

Traumatic brain injury (also called intracranial injury) occurs when an outside force traumatically injures the brain and may result when the head suddenly and violently hits an object following a fall.  The severity of traumatic brain injury ranges from mild (a brief change in consciousness or mental status) to severe (extended period of unconsciousness or loss of memory) based upon a scale called Glasgow coma scale. 

The United States National Institute of Health ("NIH") has reported that approximately half of severely injured patients will need surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue).  Even if the fall victim has no visible signs of brain injury, brain bleeding or swelling may begin slowly and result in pressure on the brain as the blood has nowhere to escape.  As the pressure increases, brain cells begin to die with devastating results.  

It is therefore critical to prevent falls in nursing home residents through the use of proper preventative measures and precautions, and carefully monitoring of nursing home residents by the nursing home staff.  In the event that head trauma results from a fall, the nursing home staff must take immediate steps to ensure that the injury is immediately evaluated by the patient's doctor or an outside hospital. 

A sample Maryland Circuit Court Complaint involving claims of nursing home negligence relating to a nursing home fall sustained during physical therapy treatment follows:

COMPLAINT

 Plaintiff, [insert name], by his attorneys, hereby file this Complaint against Defendants, [insert names], and in support thereof states as follows:

PARTIES AND JURISDICTION

 1.   At all times material to this case, Plaintiff has been a citizen and resident of the State of Maryland. 
 2. At all times material to this case, [insert 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.
 3. 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

4. At all times mentioned and relevant herein, [insert Defendant] has been licensed by the State of Maryland to own and operate nursing homes in Maryland and has held itself and its agents, servants and employees out to the general public as experienced, competent and capable providers of medical and rehabilitation services, and in such capacity owed a duty to [insert name] 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. 
5. At all times mentioned and relevant herein, all individuals at [insert Defendant] who participated in the care provided to Plaintiff were acting on behalf of [insert Defendant] and within the scope of their employment and/or agency with [insert Defendant].
6. On or about [insert date], [insert name] was admitted to [insert name of nursing home] for rehabilitation services after being discharged from [insert name of hospital] where he had been treated for a right-sided, middle cerebral artery stroke with resulting left hemiplegia, left hemisensory loss and left neglect.
7. As part of his rehabilitation therapy at the nursing home, [insert name] received physical and occupational therapy.
8. [Insert name]'s initial history and physical examination revealed that he had significant left-sided hemiparesis and neglect with deficits in his sitting balance and gait.  It was also noted that [insert name] had poor insight into his deficits.
9. [Insert name] underwent a physical therapy evaluation on [insert name] during which it was noted that he had poor trunk control and poor sitting balance in a wheelchair.  It was also documented that [insert name] was prone to abrupt position changes in the wheelchair and had a tendency to push himself to the left until he was leaning over the left arm of the wheelchair.  The therapist also noted that [insert name] had decreased vision and impaired perception of spatial relations on the left side.
10. [Insert name] was noted to be at high risk for falls because of the deficits described above, as well as his history of a previous fall in [insert date].  Under these circumstances, the standard of care required the nursing home staff to implement appropriate fall precautions at all times with [insert name].
11. On [insert date], [insert name] fell out his wheelchair while receiving physical therapy.  Predictably, he fell to his left side and struck the left side of his head and body on the floor.  [Insert name] was initially unresponsive following the fall, and a rapid response team was called in to evaluate him. [Insert name] was transported to the hospital and he underwent a CT scan of the head that showed extensive intracranial hemorrhage.  [Insert name]'s mental status was noted be waxing and waning with episodes of somnolence.  [Insert name] also complained of pain in his left side, and a subsequent CT scan of his abdomen revealed a hematoma in his left psoas region.  Over the next few days, [insert name] developed anemia secondary to internal bleeding and required multiple blood transfusions.  He was also noted to have multiple contusions secondary to his fall.
12. [Insert name] was ultimately discharged from the hospital and transferred to nursing home for further rehabilitation.  Since his discharge from the hospital, [insert name] has suffered multiple seizures and continued deficits in his mental status and functioning that his doctors have causally related to the fall and intracranial hemorrhage that he suffered on [insert date].

COUNT I (Professional Negligence)

13. The Plaintiff incorporates all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
14. Defendant, 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.
15. Defendant, individually and through its 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 implement appropriate fall precautions for [insert name] despite the fact that he was know to be at high risk for falls;
b. failed to utilize appropriate restraints on [insert name]'s wheelchair despite the fact that he had poor sitting balance and was observed to be prone to abrupt position changes and leaning heavily toward his left side while in the wheelchair; and
c. 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 Defendant, [insert name] was caused to sustain serious, painful and permanent injuries to his body, including great physical and mental pain and suffering.
17. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendant, [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.
18. Had Defendant followed the appropriate and applicable standards of care, [insert name] would not have suffered the above-identified injuries and damages.
19. The injuries and damages herein complained of were directly and proximately caused by the negligence and want of care of Defendant, with no negligence on the part of [insert name] contributing thereto.
WHEREFORE, Plaintiff requests that a judgment be entered against the Defendant for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds him 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 a nursing home fall, bedsores (also known as pressure sores or decubitus ulcers), medication error/prescription mistake, dehydration, malnutrition, elder abuse or elder neglect.

Gangrene is a serious, life-threatening medical condition requiring immediate medical attention that occurs when body tissue dies as a result of inadequate blood supply depriving the tissue of oxygen.  The affected area may become black and/or green, and give off a foul odor.

Gangrene can be caused by diseases that affect blood vessels (especially arteries) such as peripheral vascular disease.  Patients at nursing homes may also develop gangrene as a result of infected bedsores (also known as pressure sores or decubitus ulcers) that form on their sacrum, buttocks, heels or other areas. 

Once gangrene develops, the tissue death cannot be reversed.  In the early stages, gangrene may be treatable with antibiotics and/or surgical intervention.  Without timely medical intervention the patient may require amputation of the affected area.  Unfortunately, the development of gangrene may ultimately result in the death of the nursing home resident.

Gangrene develops over time and may be avoidable in nursing home residents so long as proper monitoring, proper care and proper preventative measures are instituted and implemented by the nursing home staff.

A sample Maryland Circuit Court Wrongful Death/Survivorship Complaint involving claims of negligence relating to development of gangrene follows:

COMPLAINT

Plaintiffs, [insert names], by their undersigned attorneys, hereby file this Complaint against Defendants, [insert names] 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 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 of Plaintiff].  The Register of Wills for [insert name of County] issued Letters of Administration to [insert name] on [insert date]. The Estate of [insert name of Plaintiff] 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, managed and/or operated a nursing and rehabilitation center known as [insert name of nursing home] located at [insert address] and have held themselves and their agents, servants and employees out to the general public as experienced, competent and capable providers of 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 of the individuals at [insert name of nursing home] who participated in the care provided to [insert name of Plaintiff] were acting on behalf of and within the scope of their employment and/or agency with [insert names of Defendants]. 
 7. On or about [insert date], [insert name of Plaintiff] was admitted to [insert name of nursing home] for short-term rehabilitation following a hospitalization at [insert name of hospital].  [Insert name of Plaintiff]'s doctors planned for her to return home following a brief rehabilitation at the [insert name of nursing home]. 
 8. The [insert name of nursing home] nursing staff initiated a Care Plan for [insert name of Plaintiff] that addressed the potential for altered peripheral tissue perfusion secondary to peripheral vascular disease.  The Care Plan goal was for [insert name of Plaintiff] to avoid complications of peripheral vascular disease. 
 9. Over the next few weeks, the nursing staff at [insert name of nursing home] failed to follow and implement the Care Plan for [insert name of Plaintiff]. 
 10. The records indicate that the staff at [insert name of nursing home] was aware that [insert name of Plaintiff] was at risk for the development of pressure ulcers, but the staff failed to create an appropriate Care Plan addressing the wounds on her heels.  Although there was a physician's order to elevate both of her lower extremities while she was in bed, according to the Treatment Record there were multiple failures by the staff to carry out this order.  Additionally, as documented in the records, a pressure relieving device was not provided for [insert name of Plaintiff]'s bed.
 11. On [insert date], it was documented in the records that [Plaintiff]'s family had complained that the wounds on her feet had a foul odor and blood was noted by the nurse who had changed the heel dressings.  Despite this change in [Plaintiff]'s condition, there is no evidence that a physician was notified.  On [insert date], [Plaintiff]'s right leg appeared swollen and she complained of pain.  An arterial Doppler study of the right lower extremity conducted revealed occlusion of the proximal and mid-superficial femoral arteries.
 12. [Plaintiff] was transferred to [insert name of hospital].  It was noted in the hospital records that [Plaintiff] had not been feeling well for the last few days and that she was found unresponsive at the nursing home.  [Plaintiff] was ultimately diagnosed with extensive gangrene of the right leg and passed away on [insert date].  The cause of death was sepsis due to leg gangrene.

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 of Plaintiff] 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 of Plaintiff], thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:
a. failed to timely diagnose and treat [insert name of Plaintiff]'s medical conditions;
b. failed to properly monitor and evaluate [insert name of Plaintiff]'s skin integrity;
c. failed to properly monitor and evaluate [insert name of Plaintiff] for compromised blood flow to her extremities;
d. failed to alert physicians regarding the changes in [insert name of Plaintiff]'s skin and underlying tissues;
e. failed to monitor and evaluate [insert name of Plaintiff]'s peripheral pulses and capillary refill times;
f. failed to provide adequate pressure relief for [insert name of Plaintiff]'s lower extremities;
g. failed to properly implement and revise [insert name of Plaintiff]'s care plan; and
h. 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 of Plaintiff] 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 of Plaintiff], 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.
 18. Had Defendants followed the appropriate and applicable standards of care, [insert name of Plaintiff] would not have suffered the above-identified injuries, damages and death.
 19. 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 of Plaintiff] contributing thereto.

 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.

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 of Plaintiff], the Plaintiffs 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 the development of gangrene, bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

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.