Maryland Nursing Home Negligence Blog

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.

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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].

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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.