August 2009 Archives

Nursing home residents may be at risk for falling as a result of cognitive and physical disabilities and muscle weakness, as well as the side effects of medications.  Many falls also occur during transfers of immobile patients from or to beds, wheelchairs or Geri-chairs.  Nursing home residents may also experience falls during physical therapy or occupational therapy treatments.

Hip (or femoral) fractures resulting from nursing homes falls are especially common.  These injuries may require surgical intervention including the placement of plates and bone grafts.  There are significant risks for post-operative complications including infection, pneumonia, blood clots, blood loss, and hip dislocation.  Many of these nursing home fall victims ultimately die as a result of these life-threatening complications. 

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.

A sample redacted Maryland Circuit Court Wrongful Death/Survivorship Complaint involving claims of nursing home negligence relating to nursing home falls follows:

COMPLAINT

Plaintiffs, [insert name], Individually and as Personal Representative of the Estate of [insert name], [insert names of wrongful death beneficiaries], by their attorneys, David L. Feldstein and Dever & Feldstein, LLC, hereby file this Complaint against Defendant Health Care Provider, [insert Defendant], and in support thereof state as follows:

PARTIES AND JURISDICTION

 1.   At all times material to this case, Plaintiff, [insert name], has been a citizen and resident of the State of Maryland.  Plaintiffs [insert names] are surviving children of the decedent, [insert name].  [Insert wrongful death beneficiaries] are wrongful death primary 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 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 Defendant] has been a corporation existing under the laws of the State of Maryland, 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 Defendant] was a licensed nursing home and rehabilitation center in the State of Maryland, holding itself and its agents, servants and employees out to the general public as experienced, competent and capable providers of nursing home and rehabilitation 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 and rehabilitation services.
 6. At all times mentioned and relevant herein, all individuals at [insert Defendant] who participated in the care provided to [insert name] were acting on behalf of [insert Defendant] and within the scope of their employment and/or agency with [insert Defendant].
 7. On or about [insert date], [insert name] was admitted to [insert name] nursing home.  On or about [insert date], Plaintiff's treating orthopedist, [insert name], determined that Plaintiff sustained a mild compression fracture of her spine and he ordered that Plaintiff required the "assistance of two people" to ambulate.
 8. On [insert date], Plaintiff requested assistance so that she could go to the bathroom.  Contrary to the above referenced doctor's order, Plaintiff was assisted by only one individual, a geriatric nursing assistant ("GNA"), who proceeded to twist her to the floor when her back gave out.  The GNA reported that she heard a "pop" sound to Plaintiff's left knee before she touched the ground.    
 9.  Plaintiff was subsequently transported to [insert name] Hospital where she was diagnosed with a complex left distal femoral fracture.  She underwent open reduction and internal fixation surgery on [insert date] requiring the placement of a plate and a bone graft.  Following this surgery, she developed significant complications including ischemic colitis and pneumonia.  She required additional surgery and went on to develop respiratory failure and was placed on a ventilator.  She ultimately expired on [insert date].  The death certificate lists the immediate cause of death as fracture left femur.
 10. The Maryland Department of Health and Mental Hygiene investigated this matter and determined that [insert Defendant] failed to provide Plaintiff with adequate supervision and assistance to prevent accidents. 

COUNT I  (Professional Negligence)

18. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
19. Defendant, individually and through their actual and/or apparent agents, servants and/or employees, owed Plaintiff a duty to exercise reasonable care in their treatment of her.
20. Defendant, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to 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 ambulate Plaintiff with the assistance of two assistants as ordered by her treating physician;
(b) failed to provide adequate supervision and assistance to Plaintiff to prevent accidents; 
(c) were otherwise negligent and violated the applicable standards of care.
21. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendant, Plaintiff was caused to sustain serious, painful and permanent injuries to her body, including great physical and mental pain and suffering, and, ultimately, death.
22. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendant, Plaintiff, among other things, was forced to undergo surgical procedures and 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 her normal and usual pursuits and activities, among other injuries and damages.
23. Had Defendant followed the appropriate and applicable standards of care, Plaintiff would not have suffered the above-identified injuries, damages and death.
24. 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 Plaintiff contributing thereto.

WHEREFORE, Plaintiffs request 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 them entitled.

COUNT II  (Wrongful Death)

 25. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 26. As a direct and proximate result of the Defendant's above-described negligence in causing the death of [insert name], [insert 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 training, loss of guidance and loss of education.  [Insert name]'s death is a tragedy from which they will never recover.

 WHEREFORE, the Plaintiffs request 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 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 nursing home falls, bed sores (also known as pressure sores or decubitus ulcers), dehydration/malnutrition, medication administration error/prescription mistake, elder abuse or elder neglect.

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Dehydration occurs when the amount of water leaving the body is greater than the amount being taken in.  Dehydration occurs frequently in elderly people as a result of physiological changes in the body resulting in loss of protein which holds water, decrease of kidney urine concentrating abilities resulting in frequent urination, and decreasing thirst.  Additionally, many medications, including blood pressure medication, anti-depressants and laxatives, cause dehydration. 

The standard of care for residents in nursing homes requires the nursing home staff to provide each resident with sufficient fluid intake to maintain proper hydration and health.  Nursing homes should develop, implement and (when needed) revise care plans to protect residents from fluid volume deficits and water deprivation.  The potentially fatal consequences of dehydration can be prevented if the nursing home staff takes preventative actions including recording daily food and fluid intake, monitoring body weight on a daily basis and implementing a hydration program that provides water during and between meals.  The nursing home must carefully and thoroughly monitor fluid and nutritional support and initiate appropriate treatment when intake falls below adequate levels.

Elderly dehydration often goes undiagnosed and untreated in nursing home patients.  Fluid volume deficits can have devastating consequences such as causing kidney failure, seizures, swelling of the brain, hypovolemic shock, and increases a resident's susceptibility to urinary tract infections in females.  Ultimately, dehydrated nursing home residents may develop sepsis resulting in death because their ability to fight infections has been compromised.   

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.

A sample Maryland Circuit Court Wrongful Death/Survivorship Complaint involving claims of nursing home negligence relating to dehydration/malnutrition follows:

COMPLAINT

 Plaintiffs, [insert name], individually and as personal representative of the Estate of [insert name], [insert names of wrongful death beneficiaries], by their attorneys, David L. Feldstein and Dever & Feldstein, LLC, 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 the surviving children of the decedent, [insert name].  [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].  The Register of Wills for Baltimore County 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 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 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] 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 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] 7. On or about [insert date], [insert name] was admitted to the [insert Defendant] nursing home located at [insert address].  [Insert name] suffered from dementia and Parkinson's disease and required assistance with the activities of daily living. 
8. On or about [insert date], the staff at [insert Defendant] found [insert name] non-responsive with difficulty breathing and called 911.  Emergency medical technicians arrived and intubated [insert name] before transporting her to the emergency room at [insert name] Hospital where she was immediately noted to be cyanotic and cachectic.  An oral exam revealed that [insert name] tongue was "quite dry" and her mouth was filled with dried food and a copious amount of purulent secretions.  [Insert name] was transferred to the Intensive Care Unit and diagnosed with respiratory failure, severe electrolyte imbalances, and metabolic acidosis, all secondary to massive dehydration.  After lengthy discussions with doctors at [insert name], the family elected to discontinue ventilator support and other aggressive therapy.  [Insert name] died on [insert date].  The Death Certificate lists the primary cause of death as dehydration of 10 days duration.

COUNT I (Professional Negligence)

  9. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 10. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed Plaintiff a duty to exercise reasonable care in their treatment of her.
 11. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to 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 provide [insert name] with adequate fluids and nutrition, resulting in prolonged and massive dehydration and cachexia, severe electrolyte imbalances, metabolic acidosis, multi-organ failure, and ultimately, death;
(b) failed to timely and properly diagnose and treat [insert name]'s dehydration and related complications; 
(c) failed to provide [insert name] with necessary medical monitoring, care and treatment; and
(d) were otherwise negligent and violated the applicable standards of care.

 12. 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.
 13. 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 procedures and 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 her normal and usual pursuits and activities, among other injuries and damages.
 14. Had Defendants followed the appropriate and applicable standards of care, [insert name] would not have suffered the above-identified injuries, damages and death.
 15. 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)

 16. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 17. As a direct and proximate result of the Defendants' above-described negligence in causing the death of the Plaintiff, [insert 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 dehydration/malnutrition, bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, medication error/prescription mistake, elder abuse or elder neglect.

Contact Our Firm
Your Name: Email Address: Phone Number:

A pressure sore/decubitus 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.

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 bedsore 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. 

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.

A sample Maryland Circuit Court Wrongful Death/Survivorship Complaint involving claims of negligence relating to nursing home bed sores/pressure sores/decubitus ulcers follows:

COMPLAINT

 Plaintiff, (insert name), individually and as Personal Representative of the Estate of  (insert name), by his attorneys, David L. Feldstein and Dever & Feldstein, LLC, hereby files 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.  Plaintiff (insert name) is the surviving child of the decedent, (insert name) and is a wrongful death beneficiary 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 also 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 Annotated Code.
 3. At all times material to this case, (insert names) 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) have owned, managed and operated a nursing and rehabilitation center known as (insert name) located at (insert address) in Baltimore City 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 the Plaintiff 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) who participated in the care provided to Plaintiff were acting on behalf of and within the scope of their employment and/or agency with (insert name). 
 7. On or about (insert date), Plaintiff was transferred to (insert name) for short-term rehabilitation following a two-week hospitalization at (insert name) Hospital.  Prior to her admission to (insert name) Hospital, Plaintiff had been living independently at home, and her treating doctors at planned for her to return home following a brief rehabilitation at (insert name) nursing home.  At the time of her admission to the Defendant's nursing home, Plaintiff was examined by the admitting nurse and noted to have no pressure wounds or decubitus ulcers on her sacrum or elsewhere on her body.  The nurse also completed a Braden scale for Plaintiff indicating that she was at mild risk for developing future pressure wounds or decubitus ulcers.
 8. On or about (insert date), nurses at the Defendant's nursing home documented that Plaintiff was suffering from a stage II sacral decubitus ulcer.   The next day, Plaintiff was transferred to (insert name) Hospital for treatment of a coagulopathy, and doctors noted the stage II decubitus ulcer on her sacrum.  Plaintiff was given local wound care before being discharged back to the nursing home on (insert date).  The discharge instructions included repositioning Plaintiff every two hours and providing her with daily wound care for her sacral decubitus ulcer.
 9. Following her re-admission to the nursing home, Plaintiff did not receive adequate wound care and prevention, and as a result, her sacral decubitus ulcer grew larger and became infected, and she developed additional decubitus ulcers on her left buttocks and left heel.
 10. On (insert date), Plaintiff was transferred back to (insert name) Hospital for treatment of her decubituc ulcers. Plaintiff was evaluated by the wound care team and diagnosed with a stage IV sacral decubitus ulcer with purulent drainage, necrosis, and deep tunneling.  As reflected in the records, doctors advised Plaintiff's family that her sacral decubitus would likely never heal and would require chronic care.  Plaintiff was ultimately discharged from the hospital on (insert date) and transferred to (insert name) hospice care center.
 11. Over the next two months, Plaintiff continued to suffer from her stage IV sacral ulcer and related complications until she ultimately succumbed to these conditions on (insert date).  The Death Certificate lists the cause of death as sepsis due to a sacral decubitus ulcer with osteomyelitis.

COUNT 1
(Professional Negligence)

 12. The Plaintiff incorporates all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 13. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed Plaintiff a duty to exercise reasonable care in their treatment of her.
 14. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to 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 adequately and timely diagnose and treat Plaintiff's medical conditions;
b. failed to take reasonable and appropriate measures to maintain Plaintiff's skin integrity, which resulted in the development of multiple decubitus ulcers;
c. failed to ensure that Plaintiff received adequate wound care, as well as the diet and nutrition necessary for wound prevention and healing; 
d. failed to adequately and timely assess, diagnose, and treat Plaintiff's pressure wounds and skin breakdown; and
e. were otherwise negligent and violated the applicable standards of care.
 15. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, Plaintiff was caused to sustain serious, painful and permanent injuries to her body, including great physical and mental pain and suffering, and, ultimately, death.
 16. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, 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 her normal and usual pursuits and activities, among other injuries and damages.
 17. Had Defendants followed the appropriate and applicable standards of care, Plaintiff would not have suffered the above-identified injuries, damages and death.
 18. 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 Plaintiff contributing thereto.
 WHEREFORE, the Plaintiff requests 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 him entitled.

COUNT II
(Wrongful Death)

 19. The Plaintiff incorporates all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 20. As a direct and proximate result of the Defendants' above-described negligence in causing the death of Plaintiff, (insert name) has 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 Plaintiff requests 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 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 bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

Contact Our Firm
Your Name: Email Address: Phone Number:

As the United States' population grows older, more and more individuals become vulnerable and dependent upon others to meet their most basis needs forcing families to place their loved ones in nursing homes.  Unfortunately, many nursing homes are understaffed and/or unable to provide their residents with all of the care that they may require.  According to the United States Centers for Disease Control ("CDC"), a 1996 study found that more than 500,000 people age 60 or older were victims of neglect or abuse during a one-year period.  

For instance, nursing home residents may develop infected stage 3 or infected stage 4 bedsores (also known as pressure sores or decubitus ulcers), dehydration or malnutrition resulting in painful and life-threatening injuries.   These conditions do not happen overnight; rather, they develop over time as the result of the nursing home's failure to provide basic care and attention on an hourly and daily basis.

In our experience, the nursing home staff is able to figure out when a resident does not receive visitors, and the consequences can be fatal.  Family members should make regular nursing home visits (at unpredictable times) in order to check on their loved one, inspect their skin for breakdown and speak with the nursing home staff regarding oral intake.  The failure to do so can have tragic results. 

For instance, we handled a case involving an elderly woman who required assistance with all activities of daily life and was placed into a nursing home.  Her children had busy and hectic lives, and very rarely visited the nursing home.  One day, she was found non-responsive and transported to the hospital where she was diagnosed with respiratory failure, severe electrolyte imbalances, metabolic acidosis, and multi-organ failure all secondary to massive dehydration and malnutrition.  Disturbingly, oral examination revealed that her mouth was filled with dried food and purulent secretions as food was being haphazardly stuffed into her mouth by the nursing home staff.  She died three days later due to dehydration and malnutrition.  Our medical experts concluded that this condition was the result of severe water and food deprivation occurring over an extended time period.  

The lesson to be learned is that family members must be the biggest advocates for their loved ones and make regular nursing home visits at unpredictable times.  As the saying goes, "the squeaky wheel gets the grease."

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 dehydration, malnutrition, bedsores (also known as pressure sores or decubitus ulcers), nursing home falls, medication error/prescription mistake, elder abuse or elder neglect.

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Nursing homes patients are typically at risk for falling as a result of numerous factors including physical and/or cognitive disabilities, muscle weakness, or side effects of medications.  In our nursing home neglect and abuse cases, we have encountered many situations where nursing home residents have experienced falls during transfers from or to beds, wheelchairs or Geri-chairs, and during physical therapy or occupational therapy treatments.  These falls may be the result of improper and/or inadequate supervision or staffing by the nursing home.

According to the United States Centers 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.

In our practice, we have seen many situations where a nursing home resident's fall results 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 too often 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.  According to the CDC, approximately 1.4 million people sustain traumatic brain injuries each year resulting in 50,000 deaths and 235,000 hospitalizations.  

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.   In our experience, nursing home fall victims may not receive the necessary CT scan testing and other medical attention following head trauma with tragic and potentially fatal results. 

A CT scan of the head will quickly reveal blood clots, bleeding or skull fractures that may require immediate medical care and surgical intervention.  As alluded to above, a complicating factor is that head trauma victims may appear awake with no visible symptoms as swelling and bleeding can start slowly giving the nursing home staff a false sense of security regarding the fall victim's condition.  The recent tragic death of actress Natasha Richardson as a result of a blunt impact to her head secondary to a minor skiing accident on a beginner's slope attracted substantial media attention and can be instructive.  Immediately following her fall, Ms. Richardson seemed fine and was reportedly even joking about her fall.  Approximately one hour later she developed a headache and didn't feel well resulting in a significant delay before she was finally transported to the hospital.  Unfortunately, by the time she arrived at the hospital it was too late and she died.        

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.  Traumatic brain injury may be a very treatable condition if the nursing home staff merely takes proper actions to quickly transfer the resident to a hospital.  In this regard, it is better to be safe than sorry, and good practice requires nursing home fall victims with head trauma to be seen by a doctor immediately.  

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. 

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Patients residing in nursing homes may be at risk of developing bed sores (also known as pressure sores or decubitus ulcers) as a result of their underlying health problems and immobility issues.  A pressure sore/decubitus 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.

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."  This paper contained the following key findings and conclusions that are worth repeating.

-Overall, about 159,000 United States nursing home residents, or 11% of nursing home residents, had pressure ulcers in 2004.  

-Various demographic and clinical factors were related to having a pressure ulcer in a nursing home.  Residents who had been in a nursing home for one year or less or who had recent weight loss, or who had high immobility had the highest prevalence of pressure sores.  Nursing home residents aged 64 and under were more likely than older residents to have pressure sores.  One-fifth of nursing home residents with a recent weight loss had pressure sores. 

-Only 35% of those nursing home residents with stage 2 (or higher) pressure sores, received special wound care services.  According to the CDC, this suggests that a minority of nursing home residents with stage 2 (or higher) pressure sores received proper wound care in accordance with clinical practice guidelines.    

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.

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).

Unfortunately, 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.

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

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

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The United States Centers for Disease Control and Prevention ("CDC") has recognized that as the American population grows older, more and more individuals become vulnerable and dependent upon others to meet their most basis needs.  According to the CDC, a 1996 study found that more than 500,000 people age 60 or older were victims of neglect or abuse during a one-year period.  

Sadly, nursing home residents are all too often killed as a result of nursing home neglect or abuse.  For instance, nursing home residents may develop infected stage 3 or infected stage 4 bedsores (also known as pressure sores or decubitus ulcers), experience falls, dehydration, malnutrition, or medication errors/prescription mistakes resulting in painful and life-threatening injuries. 

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

First, the wrongful death claim is a statutory cause of action governed by Sections 3-901 et seq. of the Maryland Courts and Judicial Proceeding Article of the Maryland Annotated Code.  The Maryland Wrongful Death Statute makes clear that there can only be "one action . . . in respect to the death of a person."  See Section 3-904(f).  Section 3-904 sets forth the categories of individuals who are wrongful death beneficiaries.  Generally, the decedent's surviving parents, spouse and surviving biological or legally adopted children are wrongful death beneficiaries who must be included in a claim for wrongful death.  Because there can only be one cause of action for wrongful death, it is required that all wrongful death beneficiaries be joined as plaintiffs and named in the lawsuit.

The wrongful death claim seeks to collect damages suffered by the wrongful death beneficiaries in their own right as a result of losing their loved one.  Wrongful death beneficiaries are generally entitled to seek monetary recovery for their emotional pain and suffering experienced secondary to the loss of their family member.  These damages are subject to Maryland's Noneconomic Damages Cap.

The second cause of action arising following the death of a nursing home resident is the survivorship claim.  This claim is brought on behalf of the decedent's estate by the personal representative of the estate.  In situations where the decedent had a will, the personal representative is named in the will.  In the event the nursing home resident dies without a will (also known as dying intestate), it may be necessary to file a Petition for a Small Estate for litigation purposes in the Orphan's Court of the Maryland County where the decedent resided at the time of his or her death in order to have a personal representative appointed.

The survivorship claim seeks to recover for certain categories of the decedent's individual damages that could have been recovered if he or she had survived, including their conscious pain and suffering resulting from the nursing home neglect (subject to Maryland's Noneconomic Damages Cap), medical bills resulting from the negligence, and funeral bills.  In essence, the personal representative of the estate steps into the shoes of the decedent in order to assert his or her claims of injury and damages.

Importantly, the personal representative does not personally recover for these claims of survivorship damages.  Rather, any monies recovered pursuant to the survivorship action must be deposited into the bank account of the decedent's Estate and distributed in accordance with his or her will (or, if there is no will, distribution is made in accordance with Maryland's laws of intestacy contained in Title 3 of the Trusts and Estates Article of the Maryland Annotated Code). 

Nursing home abuse and negligence lawsuits are vigorously defended by the nursing home and their insurance company and attorneys.  Ultimately, successful recovery in these cases require that the surviving family members and wrongful death beneficiaries unite and work together in cooperation as a team in the pursuit of the case so that the underlying circumstances can be investigated promptly, and then litigated aggressively by the lawyers representing the family.    

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 bedsores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

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Elopement occurs when a nursing home resident leaves the nursing home facility without permission or notice.   

The Nursing Home Reform Act of 1987 requires nursing homes to provide residents with adequate supervision in order to prevent elopement and wandering while a resident is in their care.

Nursing home residents often suffer from dementia, Alzheimer's disease or other cognitive problems that result in memory loss and confusion.  There are estimates that approximately 13% of Americans over the age of 65 have Alzheimer's disease and that 50% of Americans over the age of 85 will develop Alzheimer's disease.  Such cognitively impaired and confused nursing home residents may truly believe that they have to leave the nursing home facility to return home or to work to take care of specific tasks.  In their state of confusion, they may leave the nursing home facility without warning, posing serious risks to their own well-being, as well as to the public safety.

These cognitively impaired nursing home residents must be evaluated in order to assess their risk of elopement and wandering.  For instance, residents may have a history of elopement or wandering; may verbalize plans to leave the facility; may make statements such as "I don't belong here" or "I don't need to be here;" and may repeatedly look for exit doors.

Nursing homes must initiate and (when necessary) revise Care Plans for preventing wandering and elopement.  These preventative measures may include: alarm bracelets and/or tracking devices; monitoring the resident's location at regular intervals; door alarms; window and door locks; installation of monitoring cameras; and redirection during wandering episodes.  The nursing home must also have adequate staffing levels to monitor and oversee all of their residents.  

Nursing homes must also have procedures for quickly responding to elopement incidents including searching the grounds of the facility and notification of local police authorities, family members and possibly the media.  Through interviews with the nursing home staff and family members, it may be possible to determine where the resident may have gone.   

We have seen the fatal consequences that can occur when these preventative measures are not implemented and a vulnerable resident leaves a facility, is hit by a car and suffers serious injury and death.  Fortunately, these tragedies can be avoided so long as the nursing home takes proper preventative measures. 

Please feel free to contact the nursing home 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 elopement, bedsores (also known as pressure sores or decubitus ulcers), nursing home falls, medication error, elderly abuse or elderly neglect.

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According to the Center for Disease Control and Prevention ("CDC"), each year an average nursing home with 100 beds reports 100 to 200 resident falls, and many falls go unreported.  Many nursing home residents fall more than once and the average resident experiences 2.6 falls per year.   The CDC reports further that: (1) approximately 35% of fall injuries involve nursing home residents who cannot walk; (2) approximately 10% to 20% of these falls result in serious injuries; (3) approximately 2% to 6% of these falls result in fractures; and (4) approximately 1,800 nursing home residents die each year as a result of falls.

Nursing home residents are often at risk for falling as a result of cognitive and physical disabilities and muscle weakness, as well as the side effects of medications.  Many falls also occur during transfers of immobile patients from or to beds, wheelchairs or Geri-chairs.  Nursing home residents also experience falls during physical therapy or occupational therapy treatments.

In our law practice, we have seen too many situations where a nursing home resident's fall results in significant disability, functional decline, reduced quality of life and even death.  Of particular concern, are hip (or femoral) fractures resulting from falls.  These injuries may require surgical intervention including the placement of plates and bone grafts.  There are significant risks for post-operative complications including infection, pneumonia, blood clots, blood loss, and hip dislocation.  Sadly, many of these nursing home fall victims ultimately die as a result of these life-threatening complications.  As reported by the Star Phoenix, according to a study published online on August 4, 2009 in the Canadian Medical Association Journal, nearly 25% of all Canadians who break their hip die within five years of being diagnosed.  This percentage is likely even higher with nursing home residents.

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.  

Please feel free to contact the nursing home 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 as a result of a nursing home fall, bedsores (also known as pressure sores or decubitus ulcers), medication error, elder abuse or elder neglect.  
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According to the American Diabetes Association, 8% of the United States population (or 23.6 million Americans) have been diagnosed with diabetes.  The prevalence of the diagnosis of diabetes has increased 13.5% from 2005 through 2007.  This disease often affects elderly nursing home residents and requires careful monitoring of blood sugar and careful administration of insulin or other medications in order to prevent serious complications of the disease including kidney failure, hypoglycemia (also known as insulin shock), amputations of legs or feet, heart attacks, blindness and even death.

Diabetes is a chronic, life long disease involving abnormalities in the body's ability to use sugar and is characterized high levels of sugar in the blood.

Type 1 diabetes (insulin-dependent diabetes) often affects children and others whose bodies do not produce enough insulin.  Insulin is a hormone that is generated by the pancreas and controls blood sugar.  These individuals require daily insulin injections to lower their blood sugar.  There are several different types of insulin that differ based on various factors including onset, peak and duration.

Type 2 diabetes (adult onset diabetes) is a more common, rapidly increasing condition in this County under which the body does not properly respond to insulin.  This form of the disease can result from lifestyle issues including obesity/weight issues, diet, lack of exercise and high blood pressure.  Some people with type 2 diabetes may not even know it because the condition may not produce any symptoms.  Certain types of food that are high in sugar (cake, chocolate, candy) can trigger and compound the problems of type 2 diabetes.  The treatment used for type 2 diabetes depends upon the physiological defects experienced by the individual and may include pill(s) instead of or along with insulin injections.  There are many different types of medications that may be used in combination, requiring careful monitoring and oversight.

The good news is that with proper treatment and medical oversight, blood sugar can be kept at the proper levels to prevent or significantly delay the harsh, potentially life-threatening complications of this treatable disease.  Nursing home patients, however, are often totally dependent upon the nursing home staff to perform this care and treatment as a result of cognitive and physical disabilities.     

Sadly, we have seen too many situations where preventable, serious injury and death has resulted from a nursing home's failure to follow diabetes medication protocols in residents with type 2 diabetes.

One scenario that can be especially dangerous involves patients who require nursing home care following cardiac surgery.  These patients may require insulin therapy and medications such as Glyburide (a drug that lowers blood sugar) in order to tightly control blood sugar in the post-operative period.  The nursing home may be responsible for weaning the patient off insulin therapy as they simultaneously increase the dose of Glyburide to effective levels.  The failure of the nursing home staff to perform these functions properly can prove fatal.  For instance, the nursing home staff's failure to reduce the insulin therapy may result in drug-induced hypoglycemia (low blood sugar).  Unless timely recognized and treated, severe hypoglycemia can lead to generalized convulsions followed by amnesia, unconsciousness and, ultimately, death.  Such complications are entirely avoidable so long as the nursing home staff follows the physician orders and carefully monitors the patient's condition and blood sugar levels.

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