Recently in Bedsores / Pressure Ulcers / Decubitus Ulcers Category

Nursing home residents are often at risk for developing bedsores (also known as decubitus ulcer or pressure sores) as a result of their underlying health problems and immobility issues.  A pressure sore/decubitus ulcer is a bedsore caused by unrelieved pressure on the skin from lying or sitting in the same position too long and are associated with pain and can be deadly.   As these bedsores deteriorate and progress to stage 3 (appear as a deep crater) and to stage 4 (involve full-thickness skin loss exposing bone or muscle), they become gruesome images for family members and loved ones to view.   

Nursing home residents who have developed bedsores typically receive treatment at wound clinics or hospitals.  As part of their treatment, some wound clinics and hospitals take photographs of the condition to monitor the progress of the wounds.  In our experience, such photographs may not be mentioned in the medical records and health care providers may not produce these wound photographs in response to medical record requests unless they are specifically requested.  Our law firm therefore sends specific requests for the production of wound photographs to wound clinics and hospitals in our bedsore cases and have been able to uncover the existence of very helpful evidence. 

If a family member or loved one has developed wounds/pressure sores/decubitus ulcers, it is also advisable to take photographs of the condition and to be able to state the dates of the photographs.

As the saying goes, a picture really is worth a thousand words.

Please feel free to contact the Maryland 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/pressure sores or decubitus ulcers.

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Staffing levels should be the subject of discovery in nursing home negligence cases.  Studies have suggested that 90% of nursing homes are understaffed.  Such staffing shortages create the potential for serious injury (or even death) to nursing home residents. 

For instance, many immobile nursing home residents require turning and repositioning at least every two hours by the nursing home staff in order to relieve pressure.  Failure to receive such care may result in the resident developing otherwise avoidable decubitus ulcers (also known as pressure sores).  Understaffed nursing homes are less likely to regularly provide such necessary pressure relief and may increase the chances that residents go on to develop potentially fatal bedsores.

In our cases, we routinely engage in discovery aimed at obtaining information regarding the target nursing home's staffing levels during the time period of the alleged negligent conduct.  We start by propounding Request for Production of Documents requesting the following:

1. All documents in Defendant's possession concerning or relating to staffing and/or staffing numbers and/or staffing levels at [insert name of nursing home] during the period of _____ through _____ including but not limited to staffing sheets.

2. All documents in your possession from the period_____ through _____ that in any way mention or discuss staffing shortages and/or the need to hire additional staff to care for patients at [insert name of nursing home].

3. All documents that discuss or pertain to Defendant's procedures, guidelines or policies concerning staffing, staffing numbers and staffing levels at [insert name of nursing home] during the period of _____  through _____.

4. Copies of all inspection reports or evaluations generated concerning or involving [insert name of Plaintiff] by any federal or state government agencies that regulated or monitored [insert name of nursing home].

5. Copies of any citations, warnings, reprimands, or violation notices received by [insert name of nursing home] concerning or involving [insert name of Plaintiff].

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, we provide these documents to Plaintiffs' medical expert witnesses so that staffing issues can be analyzed.

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 nursing home neglect, bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, or medication administration error/prescription mistakes.

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Placing a family member or loved one in a nursing home or assisted living facility is a very difficult decision.  Nursing home residents typically require assistance with many activities of daily living and require careful monitoring and attention by the facility's staff.  These vulnerable nursing home residents are at risk for serious injury if they do not receive proper and adequate care.  For instance, nursing home residents may suffer serious life-threatening injuries resulting from falls, bedsores, medication errors or failures to monitor the resident.       

Most physicians would agree that the minimal standards of care applicable to such nursing homes facilities is:
(1) 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;
(2) to prevent the resident from experiencing falls, including but not limited to the development and implementation of fall prevention mechanisms;
(3) to develop, document, implement and monitor the efficacy of a comprehensive care plan to achieve the highest practical physical, mental and psychosocial well-being consistent with the resident's condition and advance directives and revise the care plan as needed;
(4) to perform a comprehensive assessment of the resident's physical, mental, and psychosocial needs on initial admission and any subsequent admissions;
(5) to maintain an accurate and complete clinical record that reflects (a) the care and treatment provided to the resident; (b) the resident's current condition and any changes in the clinical condition; (c) any responses to interventions; and (d) a record of communication between the physician and the facility staff regarding the resident's condition and care and treatment plan;
(6) to promptly and thoroughly assess all changes in the resident's physical, mental and psychosocial condition, and communicate such changes to the attending physician;
(7) to implement any care and treatment ordered by the attending physician;
(8) to ensure that all significant, non-emergent changes in the resident's physical, mental and psychosocial condition are promptly communicated to the physician;
(9) to maintain an accurate and complete clinical record that reflects (a) the care and treatment provided to the resident; (b) the resident's current condition and any changes in the clinical condition; (c) any responses to interventions; and (d) a record of communication between the physician and the facility staff regarding the resident's condition and care and treatment plan;
(10) to follow up and report diagnostic study reports to the attending physician in a timely manner.


Patients residing at nursing homes are often at risk of developing pressure sores/decubitus ulcers as a result of their underlying health problems and immobility issues.  A pressure sore/decubitis ulcer is a bedsore that comes from lying in the same position too long and is associated with pain. 

Nursing home patients experience pressure from the 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.

Pressure is a primary contributing factor to the development of pressure ulcers.  Since the development of pressure ulcers depends on the length of time pressure is applied, immobility is the major risk factor.  Pressure must be relieved.  Malnutrition and adequate hydration have been linked to the development of pressure ulcers. 

A stage one ulcer presents as redness of the skin and represents tissue injury and heralds skin ulceration.  A stage one 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 s stage one pressure ulcer.

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

A stage three 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 crater, with or without undermining of adjacent tissue.

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

With stage 3 or 4 pressure ulcers, 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.

Ultimately, pressure ulcers are avoidable so long as proper care and preventative measures are instituted and implemented by the nursing home.  In fact, under new Medicare guidelines, hospitals are no longer reimbursed for additional care resulting from bed sores and several other "reasonably preventable" errors including objects left in the body after surgery. The government has determined that development of bedsores 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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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/or sepsis (blood infection) ultimately resulting in death. 

Nursing homes develop and implement internal policies and procedures pertaining to the prevention, care, treatment and monitoring of pressure sores /decubitus ulcers.  For instance, such policies and procedures generally require that the nursing home staff must relieve pressure by turning and repositioning residents at least every two hours while in bed and every hour while in a Geri-chair or wheelchair.

Under Maryland law, such policies and procedures may be admissible at trial as evidence of the applicable standard of care in nursing home/bedsore negligence cases.  See Wilson v. Morris, 317 Md. 284 (1989) (finding that  a Day Care Center's patient monitoring policy was admissible evidence that was relevant to the jury's consideration of the appropriate standard of care).

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.

* * *

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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More nursing homes have implemented electronic medical record systems and this trend will certainly continue as the cost decreases, technology improves and financial incentives in the form of higher reimbursement rates for treating Medicare patients are offered. 

Lawyers handling nursing home negligence cases must be sure to update their form discovery requests to make sure that certain types are electronic/computerized records are specifically requested or they risk exclusion of potentially helpful evidence of negligence. 

For instance, in litigating bedsore cases (also known as pressure sores or decubitus ulcers), we have encountered situations with nursing homes that utilize a computer/kiosk record keeping system requiring the nursing home geriatric nursing assistants who provide care (including turning and repositioning) to the patient to make an entry in a computer kiosk each and every time the patient is turned and repositioned.  In the event that such records do not document that the patient was turned and repositioned every two hours, this can be powerful evidence of negligence. 

Unfortunately, these electronic records may not always physically make their way into a patient's chart.  It is possible that nursing homes and their lawyers may try to read Plaintiffs' discovery requests narrowly to support a decision not to produce these records if they are not specifically requested. 

Our firm therefore includes the following Request in Plaintiffs' Request for Production of Documents in bedsore/pressure sore/decubitus ulcer nursing home negligence cases:

A complete copy of all of Defendant's files regarding Plaintiff including but not limited to medical records, nursing home admission records, computer records, electronic records, kiosk records, log records or other documents containing written or computer entries regarding Plaintiff made by geriatric nursing assistants, certified nursing assistants or other nursing assistants that were/are maintained separately from Plaintiff's medical records at [insert name of nursing home].

* * *

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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Your Name: Email Address: Phone Number:

Elderly nursing home patients may be 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 and can be deadly.   As these bedsores deteriorate and progress to stage 3 (appear as a deep crater) and to stage 4 (involve full-thickness skin loss exposing bone or muscle), they become gruesome images for family members and loved ones to view.   

In nursing home neglect/wrongful death cases involving pressure ulcers, however, graphic photographs of these wounds are powerful evidence, and nursing home defendants and their lawyers will factor such photographs into their evaluation of claims.  If a family member or loved one has developed wounds/pressure sores/decubitus ulcers, it is therefore advisable to take photographs of the condition and to be able to state the dates of the photographs.

As the saying goes, a picture really is worth a thousand words.

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/pressure ulcers or decubitus ulcers.

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

Nursing home residents may be at risk of developing bedsores (also known as pressure ulcers or decubitus ulcers) as a result of their underlying health problems and immobility issues.  A pressure sore/decubitis ulcer is a bedsore that comes from lying or sitting in the same position too long and is associated with pain.  These pressure sores are generally avoidable so long as the nursing home staff: (1) provides proper preventative care (including turning, or repositioning, residents); and (2) develops, implements and (when necessary) updates a comprehensive care plan to prevent pressure ulcers from occurring and to prevent pressure sores from deteriorating. 

In order to comply with the minimum standards of care, nursing homes must: (1) ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were unavoidable; and (2) ensure that a resident having pressure ulcers receives necessary treatment and services to promote healing, prevent infection and prevent new ulcers from developing.  This includes turning and repositioning the resident at least every two hours while in bed.

Nursing home residents are often placed in chairs (including wheelchairs or Geri-chairs) for long time periods and even allowed to nap in these chairs for hours at a time.  Sitting residents experience more pressure to their buttocks area than they would experience if lying down, preventing the blood from flowing into those points.  Pressure must be relieved by turning or repositioning such residents more frequently than residents lying in bed.

The federal government has developed clinical practice guidelines requiring residents who are sitting to be repositioned at least every hour.  According to Clinical Practice Guideline Number 15 for Treatment of Pressure Ulcers published by the United States Department of Health and Human Services in December of 1994:

While Sitting.  Interface pressure may be particularly high over sitting surfaces.  When a pressure ulcer has formed on such a surface, the individual should avoid sitting.  If pressure on the ulcer can be totally relieved, the person can sit for a limited time.  Proper postural alignment, distribution of weight, balance, stability, and continuous pressure relief are important positioning considerations for the sitting individual.  A written plan for the use of positioning devices should be developed and implemented.  An individually prescribed seat cushion should be used and donut-type devices should be avoided.  Sitting individuals should be repositioned at least every hour and should shift their weight every 15 minutes if possible.  If hourly repositioning is not feasible, the individual should be returned to bed.

(Emphasis added).

Unfortunately, in our cases, we have encountered situations where nursing home residents were allowed to sit for hours at a time without being repositioned and pressure sores developed.  Once a bedsore/pressure ulcer/decubitis ulcer develops, it can be difficult to reverse, become infected and quickly progress to a stage 3 or stage 4 decubitus ulcer.  A stage three ulcer involves full-thickness skin loss and damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia.  The ulcer appears as a crater, with or without undermining of adjacent tissue.  A stage four ulcer involves full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).

With stage 3 or 4 pressure ulcers, the extent of the disease may not be evident because of covering necrotic material.  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 result in sepsis and death.   

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 bedsores/pressure sores/decubitus ulcers or elderly abuse or neglect

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Maryland COMAR Regulation 10.07.02.12 sets forth the responsibilities of the Director of Nursing in Maryland nursing homes.  Pursuant to Maryland COMAR Regulation 10.07.02.12G, the Director of Nursing is responsible for, among other duties, "planning for the total nursing needs of patients to be met" and "execution of patient care policies."  This section may ultimately support a cause of action against the Director of Nursing in a nursing home negligence case involving bedsores (also known as decubitus ulcers or pressure ulcers). 

Under Maryland's nursing home regulations, nursing homes are required to file a signed copy of the agreement between the Nursing Home Administrator and the Director of Nursing that, among other things, specifies the duties of the Director of Nursing.  This information can be obtained from the State via public information request and we routinely obtain this information in our cases.

Most qualified medical experts would agree that 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 can be difficult to achieve healing and avoid painful and life-threatening complications such as osteomyelitis (infection of the bone) and sepsis (blood infection). 

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:

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 oftentimes have pre-printed turning and repositioning forms that are filled out/checked at the end of every shift by nurses who may not personally do the actual turning and repositioning of the patient.  In these circumstances, the nursing home's lawyers may then try to use these forms to support their contention that the patient was turned and repositioned every two hours as ordered by the physician.

In litigating nursing home negligence cases, we have learned that many nursing homes utilize a computer/kiosk record keeping system requiring the nursing home geriatric nursing assistants who provides care (including turning and repositioning) to the patient to make an entry in a computer kiosk each and every time they turned and repositioned a patient.  These computer entries may be even used by registered nurses when they submit monthly MDS (Minimum Data Set) records to the State, but these records may not physically make their way into a patient's chart.  We have encountered situations where the nursing home and their lawyers do not produce these records unless Plaintiffs' counsel propounds discovery requests specifically requesting these computer/kiosk records.  In the event that the nursing home is not subsequently able to produce computer/kiosk records showing that the patient was turned and repositioned every two hours, this will be very powerful evidence of negligence. 
 
It is therefore advisable to include the following Request in Plaintiffs' Request for Production of Documents in a bedsore/pressure sore/decubitus ulcer nursing home negligence case:

A complete copy of all of Defendant's files regarding Plaintiff including but not limited to medical records, nursing home admission records, computer records, kiosk records, log records or other documents containing written or computer entries regarding Plaintiff made by geriatric nursing assistants, certified nursing assistants or other nursing assistants that were/are maintained separately from Plaintiff's medical records at [insert name of nursing home].

* * *

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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Your Name: Email Address: Phone Number:

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

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

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

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

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

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