Death Secondary to Decubitus Ulcers (Bed Sores) -- Sample Certificate of Merit and Expert Report in Maryland Nursing Home Neglect Wrongful Death Lawsuit

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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.   

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

The good news is that 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."  Unfortunately, many nursing homes fail to provide the necessary and required preventative care, and decubitus ulcers/bedsores remain a serious and common medical problem in nursing homes in this Country. 

Under Maryland law, a nursing home negligence lawsuit is subject to the requirements of the Maryland Health Care Malpractice Claims Statute contained in Section 3-2A-01 et seq. of the Courts and Judicial Proceedings Article of the Maryland Annotated Code.  This statute, among other things, requires Plaintiffs to file a Certificate of Merit and Report from a qualified expert attesting to departures from standards of care proximately resulting and causing the alleged injury.  Creative defense attorneys have made numerous technical challenges regarding Maryland's certificate of merit requirements that have been the subject of several reported Maryland appellate cases and further legislative intervention.  It is therefore crucial that attorneys handling Maryland nursing home negligence cases be familiar with these ever changing certificate of merit requirements in order to avoid potential pitfalls that could ultimately result in the dismissal of meritorious cases. 

A sample Maryland Certificate of Merit and Expert Report involving claims of negligence relating to nursing home bed sores/pressure sores/decubitus ulcers follows:


CERTIFICATE OF MERIT OF [INSERT EXPERT'S NAME]

 I HEREBY CERTIFY and acknowledge that I have reviewed medical records and other documentation pertaining to the facts and circumstances in the above-captioned case.
 I hereby certify and acknowledge that there have been violations of the standards of care committed by [insert names of Defendants], and their respective agents and employees whose identities are contained in the medical records, which have directly and proximately resulted in damages and injuries to the Claimants.
 [Insert names of Defendants], and their respective agents and employees, breached the applicable standards of care in their treatment of [insert name of Plaintiff] and thereby caused the death of [insert name of Plaintiff] and damages and injuries to Claimants, in that they, among other things:
a. failed to adequately and timely diagnose and treat [insert name]'s medical conditions;
b. failed to take reasonable measures to maintain [insert name]'s skin integrity resulting in the development of threatening decubitus ulcers;
c. failed to ensure that [insert name] received adequate wound care, as well as diet and nutrition necessary for wound prevention and healing; 
d. failed to adequately and timely assess, diagnose, and treat [insert name]'s decubitus ulcers and skin breakdown; and
e. were otherwise negligent and violated the applicable standards of care.
 I certify that within the last five years I have been actively engaged in clinical practice, consultation relating to clinical practice, and the teaching of medical residents and nurses, with respect to the care and treatment of nursing home patients and the prevention and treatment of decubitus ulcers.
 I further acknowledge that less than 20% of my annual professional time directly involves testimony in personal injury claims.

_____________________                                         
[Signature line]

REPORT

 I am board-certified in geriatrics and am a Professor of Surgery at [insert name of medical school].  I have served on the editorial board of several professional journals pertaining to wound care, including [insert names of journals].
 This is to acknowledge that after my review of medical records and other documentation pertaining to the facts and circumstances in the above-referenced case, I have concluded to a reasonable degree of medical probability that [insert names of Defendants], and their respective agents and employees whose identities are contained in the medical records, breached the applicable standards of care in their treatment of [insert name of Plaintiff], in that they, failed to adequately and timely diagnose and treat [insert name of Plaintiff]'s medical conditions; failed to take reasonable measures to maintain [insert name of Plaintiff]'s skin integrity, which resulted in the development of life-threatening decubitus ulcers; failed to ensure that [insert name of Plaintiff] received adequate wound care, as well as diet and nutrition necessary for wound prevention and healing; and failed to adequately and timely assess, diagnose, and treat [insert name of Plaintiff]'s pressure wounds and skin breakdown.  I have further concluded that the above-described deviations from the standard of care were the proximate and substantial cause of [insert name of Plaintiff]'s death due to a sacral decubitus ulcer with associated osteomyelitis and sepsis.
 Accordingly, I have concluded that the case to be filed before the Health Care Alternative Dispute Resolution Office of Maryland is meritorious.
 This report is not, nor is it intended to be, an exhaustive description of all opinions and conclusions and their bases.  My opinions regarding the health care providers, and departure from the applicable standards of care, may be modified and/or supplemented upon review of additional information and/or documents.
 Finally, less than 20% of my annual professional time involves testimony in personal injury claims.

_________________        
[Signature line]

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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 administration error/prescription mistake, elder abuse or elder neglect.

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