Failure of Nursing Home Staff to Follow the Facility's Own Decubitus Ulcer (Bed Sore) Prevention Policies and Procedures is Powerful Evidence -- Sample Document Requests in Wrongful Death / Survivorship Lawsuit

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A decubitus ulcer/pressure sore is a bed sore caused by unrelieved pressure on the skin that comes from lying or sitting in the same position too long and is associated with pain.   
Unfortunately, once a bedsore progresses to stage 3 and stage 4 and becomes infected, it is difficult to achieve healing and avoid painful and potentially fatal complications.  These individuals may develop osteomyelitis (infection of the bone) and sepsis (blood infection) ultimately resulting in death. 

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.

Nursing homes develop and implement internal policies and procedures pertaining to the prevention, care, treatment and monitoring of pressure sores /decubitus ulcers.  In our experience litigating decubitus ulcer lawsuits, all too often these policies and procedures are not adhered to by the nursing home staff and elderly residents develop otherwise avoidable fatal bedsores.

It is therefore imperative that Plaintiffs' attorneys request and receive all relevant policies and procedures from defense counsel in the very early stages of litigation through the use of detailed Request for Production of Documents.  (We regularly serve Defendants with such discovery requests along with the Complaint and initial pleading materials).  Sometimes, it may be necessary to seek Court intervention and/or take depositions of corporate designee witnesses in order to ensure that the nursing home timely produces these materials.  Once received, these policies and procedures should be provided to Plaintiffs' medical expert witnesses in order to assess whether the nursing home followed their own policies and procedures and protocol.  The failure of a nursing home to adhere to their own policies and procedures is important evidence that will be taken into consideration when the nursing home's attorneys and in-house representatives evaluate the claim.  This is also very powerful evidence that can be presented to the jury.

A sample Request for Production of Documents in a bedsore/pressure sore/decubitus ulcer nursing home negligence case follows: 

REQUEST FOR PRODUCTION OF DOCUMENTS

1. All skin evaluation practices and procedures in effect during Plaintiff's stay at Defendants' nursing home facility.
2. All policies, practices, and procedures in effect during Plaintiff's stay at Defendants'  nursing home facility pertaining to the prevention of decubitus ulcers/ pressure wounds.
3. All policies, practices, and procedures in effect during Plaintiffs' stay at Defendants' nursing home facility pertaining to the prevention of decubitus ulcers/ pressure wounds via the use of specialty mattresses or beds.
4. All policies, practices, and procedures in effect during Plaintiff's stay at Defendants' nursing home facility pertaining to the care, treatment, and monitoring of decubitus ulcers/ pressure wounds.
5. All policies, practices, and procedures in effect during Plaintiff's stay at Defendants' nursing home facility pertaining to the care, treatment, and monitoring of decubitus ulcers/ pressure wounds via the use of specialty mattresses or beds.
6. All information and documents that discuss or pertain to any specialty mattresses or beds that were used in the care and treatment of Plaintiff's decubitus ulcers/ pressure wounds throughout his stay at Defendants' nursing home facility.
7. All written manuals, guidelines, policies, or procedures in effect at Defendants' nursing home facility from [insert dates] that discuss or in any way relate to the diagnosing, monitoring and/or treatment of pressure wounds and/or decubitus ulcers.
8. Information concerning and copies of all inspection reports or evaluations pertaining to the prevention and care of decubitus ulcers/ pressure wounds generated by any federal or state government agencies that regulated or monitored Defendant's nursing home facility  during the years [insert time period].
9. All information and documents that discuss or pertain to Defendants  procedures, guidelines or policies in effect from [insert dates] concerning the circumstances under which nurses and nursing assistants should consult with the patient's treating physician or other physician regarding the patient's skin integrity or condition, including the development and progression of decubitus ulcers/ pressure wounds.
10. All documents that discuss or pertain to Defendant's procedures, guidelines or policies concerning 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 Defendants' nursing home facility.
11. All texts, treatises, rules, regulations, guidelines, instructions, protocols, recommendations, manuals, handbooks, memoranda, notices or other documents that were in Defendant's possession in [insert time period] pertaining or related to the diagnosing, monitoring and treatment of wounds and/or heal ulcers at Defendants' nursing home facility.
12. All documents that discuss or pertain to Defendant's procedures, guidelines or policies concerning the hiring, training and/or supervision of all employees or independent contractors responsible for patient care, including nurses and nurse practitioners, from [insert time period] at Defendants' nursing home facility.
13. All documents in your possession from the period [insert time period] that in any way mention or discuss staffing shortages and/or the need to hire additional staff to care for patients at Defendants' nursing home facility.
14. Copies of all inspection reports or evaluations generated by any federal or state government agencies that regulated or monitored Defendants' nursing home facility during the years [insert time period].
15. Copies of any citations, warnings, reprimands, or violation notices received by Defendants from any federal or state government agencies that regulated or monitored Defendant's nursing home facility during the years [insert time period].
16. Copies of all insurance policies that provide primary or excess coverage to Defendant for the allegations complained of in the Complaint.
17. All documents in Defendant's possession concerning or relating staffing and/or staffing numbers and/or staffing levels at Defendant's nursing home facility during the period of [insert time period] including but not limited to staffing sheets.
18. All statements of parties and witnesses taken pursuant to any investigation of the facts described in the Plaintiff's Complaint.
19. All reports for expert witnesses who will testify at the trial of the above-captioned matter.
20. All curriculum vitae for expert witnesses who will testify at the trial of the above-captioned matter.
21. All documents upon which experts who will testify at trial have relied in forming their opinions in this case.
22. All discoverable documents obtained by the Defendant pursuant to any investigation of the facts described in the Plaintiffs' Complaint.
23. All documents received by Defendant via subpoena.
24. All documents regarding Plaintiff's care at Defendants' nursing home facility.
25. A complete copy of all of Defendant's file(s) regarding Plaintiff.
26. All photographs or videotapes of the Plaintiff.
27. All documents that are referenced in Defendant's Answers to Interrogatories.

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

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