Recently in Sample Complaints / Discovery Category

Nursing homes patients often require physical therapy and/or occupational therapy as part of their rehabilitation process.  These residents may be at risk for falling as a result of numerous factors including physical and/or cognitive disabilities, muscle weakness, or side effects of medications.  We have encountered situations where nursing home residents have experienced falls during physical therapy or occupational therapy treatments.  These falls may be the result of improper and/or inadequate supervision by the nursing home staff.

According to the United States Center for Disease Control and Prevention ("CDC"), the average nursing home resident experienced 2.6 falls per year.   The CDC reports further that approximately 10% to 20% of nursing home falls result in serious injuries, and approximately 1,800 nursing home residents die each year as a result of falls.

Sadly, a nursing home resident's fall may result in significant disability, functional decline, reduced quality of life and even death.  Of particular concern, are traumatic head and brain injuries resulting from nursing home falls that do not receive immediate medical attention and treatment. 

Traumatic brain injury (also called intracranial injury) occurs when an outside force traumatically injures the brain and may result when the head suddenly and violently hits an object following a fall.  The severity of traumatic brain injury ranges from mild (a brief change in consciousness or mental status) to severe (extended period of unconsciousness or loss of memory) based upon a scale called Glasgow coma scale. 

The United States National Institute of Health ("NIH") has reported that approximately half of severely injured patients will need surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue).  Even if the fall victim has no visible signs of brain injury, brain bleeding or swelling may begin slowly and result in pressure on the brain as the blood has nowhere to escape.  As the pressure increases, brain cells begin to die with devastating results.  

It is therefore critical to prevent falls in nursing home residents through the use of proper preventative measures and precautions, and carefully monitoring of nursing home residents by the nursing home staff.  In the event that head trauma results from a fall, the nursing home staff must take immediate steps to ensure that the injury is immediately evaluated by the patient's doctor or an outside hospital. 

A sample Maryland Circuit Court Complaint involving claims of nursing home negligence relating to a nursing home fall sustained during physical therapy treatment follows:

COMPLAINT

 Plaintiff, [insert name], by his attorneys, hereby file this Complaint against Defendants, [insert names], and in support thereof states as follows:

PARTIES AND JURISDICTION

 1.   At all times material to this case, Plaintiff has been a citizen and resident of the State of Maryland. 
 2. At all times material to this case, [insert Defendants] have been operating nursing homes and engaging in the practice of medicine and rehabilitation services in Baltimore City and throughout Maryland, acting through actual and/or apparent agents, servants and/or employees.
 3. The venue for this claim is proper in Baltimore City, Maryland.  The amount in controversy exceeds Thirty Thousand Dollars ($30,000.00).

FACTS COMMON TO ALL COUNTS

4. At all times mentioned and relevant herein, [insert Defendant] has been licensed by the State of Maryland to own and operate nursing homes in Maryland and has held itself and its agents, servants and employees out to the general public as experienced, competent and capable providers of medical and rehabilitation services, and in such capacity owed a duty to [insert name] to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine and rehabilitation services. 
5. At all times mentioned and relevant herein, all individuals at [insert Defendant] who participated in the care provided to Plaintiff were acting on behalf of [insert Defendant] and within the scope of their employment and/or agency with [insert Defendant].
6. On or about [insert date], [insert name] was admitted to [insert name of nursing home] for rehabilitation services after being discharged from [insert name of hospital] where he had been treated for a right-sided, middle cerebral artery stroke with resulting left hemiplegia, left hemisensory loss and left neglect.
7. As part of his rehabilitation therapy at the nursing home, [insert name] received physical and occupational therapy.
8. [Insert name]'s initial history and physical examination revealed that he had significant left-sided hemiparesis and neglect with deficits in his sitting balance and gait.  It was also noted that [insert name] had poor insight into his deficits.
9. [Insert name] underwent a physical therapy evaluation on [insert name] during which it was noted that he had poor trunk control and poor sitting balance in a wheelchair.  It was also documented that [insert name] was prone to abrupt position changes in the wheelchair and had a tendency to push himself to the left until he was leaning over the left arm of the wheelchair.  The therapist also noted that [insert name] had decreased vision and impaired perception of spatial relations on the left side.
10. [Insert name] was noted to be at high risk for falls because of the deficits described above, as well as his history of a previous fall in [insert date].  Under these circumstances, the standard of care required the nursing home staff to implement appropriate fall precautions at all times with [insert name].
11. On [insert date], [insert name] fell out his wheelchair while receiving physical therapy.  Predictably, he fell to his left side and struck the left side of his head and body on the floor.  [Insert name] was initially unresponsive following the fall, and a rapid response team was called in to evaluate him. [Insert name] was transported to the hospital and he underwent a CT scan of the head that showed extensive intracranial hemorrhage.  [Insert name]'s mental status was noted be waxing and waning with episodes of somnolence.  [Insert name] also complained of pain in his left side, and a subsequent CT scan of his abdomen revealed a hematoma in his left psoas region.  Over the next few days, [insert name] developed anemia secondary to internal bleeding and required multiple blood transfusions.  He was also noted to have multiple contusions secondary to his fall.
12. [Insert name] was ultimately discharged from the hospital and transferred to nursing home for further rehabilitation.  Since his discharge from the hospital, [insert name] has suffered multiple seizures and continued deficits in his mental status and functioning that his doctors have causally related to the fall and intracranial hemorrhage that he suffered on [insert date].

COUNT I (Professional Negligence)

13. The Plaintiff incorporates all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
14. Defendant, individually and through their actual and/or apparent agents, servants and/or employees, owed [insert name] a duty to exercise reasonable care in their treatment of him.
15. Defendant, individually and through its actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to [insert name], thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:
a. failed to implement appropriate fall precautions for [insert name] despite the fact that he was know to be at high risk for falls;
b. failed to utilize appropriate restraints on [insert name]'s wheelchair despite the fact that he had poor sitting balance and was observed to be prone to abrupt position changes and leaning heavily toward his left side while in the wheelchair; and
c. were otherwise negligent and violated the applicable standards of care.
16. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendant, [insert name] was caused to sustain serious, painful and permanent injuries to his body, including great physical and mental pain and suffering.
17. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendant, [insert name], among other things, was forced to undergo medical treatment, and, as a result, was obliged to expend sums of money for medical, hospital and other care and treatment and was precluded from engaging in his normal and usual pursuits and activities, among other injuries and damages.
18. Had Defendant followed the appropriate and applicable standards of care, [insert name] would not have suffered the above-identified injuries and damages.
19. The injuries and damages herein complained of were directly and proximately caused by the negligence and want of care of Defendant, with no negligence on the part of [insert name] contributing thereto.
WHEREFORE, Plaintiff requests that a judgment be entered against the Defendant for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds him entitled.

*  *  *

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

Gangrene is a serious, life-threatening medical condition requiring immediate medical attention that occurs when body tissue dies as a result of inadequate blood supply depriving the tissue of oxygen.  The affected area may become black and/or green, and give off a foul odor.

Gangrene can be caused by diseases that affect blood vessels (especially arteries) such as peripheral vascular disease.  Patients at nursing homes may also develop gangrene as a result of infected bedsores (also known as pressure sores or decubitus ulcers) that form on their sacrum, buttocks, heels or other areas. 

Once gangrene develops, the tissue death cannot be reversed.  In the early stages, gangrene may be treatable with antibiotics and/or surgical intervention.  Without timely medical intervention the patient may require amputation of the affected area.  Unfortunately, the development of gangrene may ultimately result in the death of the nursing home resident.

Gangrene develops over time and may be avoidable in nursing home residents so long as proper monitoring, proper care and proper preventative measures are instituted and implemented by the nursing home staff.

A sample Maryland Circuit Court Wrongful Death/Survivorship Complaint involving claims of negligence relating to development of gangrene follows:

COMPLAINT

Plaintiffs, [insert names], by their undersigned attorneys, hereby file this Complaint against Defendants, [insert names] and in support thereof, state as follows:

PARTIES AND JURISDICTION

 1.   At all times material to this case, Plaintiffs have been citizens and residents of the State of Maryland.  Plaintiffs, [insert names], are wrongful death beneficiaries in this action pursuant to Section 3-904(a) of the Courts and Judicial Proceedings Article of the Maryland Annotated Code.

 2. [Insert name] is the duly-appointed Personal Representative of the Estate of [insert name of Plaintiff].  The Register of Wills for [insert name of County] issued Letters of Administration to [insert name] on [insert date]. The Estate of [insert name of Plaintiff] is bringing this survival action pursuant to Section 7-401(x) of the Estates and Trusts Article of the Maryland Annotated Code.
 3. At all times material to this case, [insert names of Defendants] have been corporations engaging in the practice of medicine and rehabilitation services in Baltimore City, Maryland, and acting through actual and/or apparent agents, servants and/or employees.
 4. The venue for this claim is proper in Baltimore City, Maryland.  The amount in controversy exceeds Thirty Thousand Dollars ($30,000.00).

FACTS COMMON TO ALL COUNTS

 5. At all times mentioned and relevant herein, [insert names of Defendants] have owned, managed and/or operated a nursing and rehabilitation center known as [insert name of nursing home] located at [insert address] and have held themselves and their agents, servants and employees out to the general public as experienced, competent and capable providers of medical and rehabilitation services, and in such capacity owed a duty to [insert name of Plaintiff] and the Plaintiffs to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine and rehabilitation services.
6. At all times mentioned and relevant herein, all of the individuals at [insert name of nursing home] who participated in the care provided to [insert name of Plaintiff] were acting on behalf of and within the scope of their employment and/or agency with [insert names of Defendants]. 
 7. On or about [insert date], [insert name of Plaintiff] was admitted to [insert name of nursing home] for short-term rehabilitation following a hospitalization at [insert name of hospital].  [Insert name of Plaintiff]'s doctors planned for her to return home following a brief rehabilitation at the [insert name of nursing home]. 
 8. The [insert name of nursing home] nursing staff initiated a Care Plan for [insert name of Plaintiff] that addressed the potential for altered peripheral tissue perfusion secondary to peripheral vascular disease.  The Care Plan goal was for [insert name of Plaintiff] to avoid complications of peripheral vascular disease. 
 9. Over the next few weeks, the nursing staff at [insert name of nursing home] failed to follow and implement the Care Plan for [insert name of Plaintiff]. 
 10. The records indicate that the staff at [insert name of nursing home] was aware that [insert name of Plaintiff] was at risk for the development of pressure ulcers, but the staff failed to create an appropriate Care Plan addressing the wounds on her heels.  Although there was a physician's order to elevate both of her lower extremities while she was in bed, according to the Treatment Record there were multiple failures by the staff to carry out this order.  Additionally, as documented in the records, a pressure relieving device was not provided for [insert name of Plaintiff]'s bed.
 11. On [insert date], it was documented in the records that [Plaintiff]'s family had complained that the wounds on her feet had a foul odor and blood was noted by the nurse who had changed the heel dressings.  Despite this change in [Plaintiff]'s condition, there is no evidence that a physician was notified.  On [insert date], [Plaintiff]'s right leg appeared swollen and she complained of pain.  An arterial Doppler study of the right lower extremity conducted revealed occlusion of the proximal and mid-superficial femoral arteries.
 12. [Plaintiff] was transferred to [insert name of hospital].  It was noted in the hospital records that [Plaintiff] had not been feeling well for the last few days and that she was found unresponsive at the nursing home.  [Plaintiff] was ultimately diagnosed with extensive gangrene of the right leg and passed away on [insert date].  The cause of death was sepsis due to leg gangrene.

COUNT I (Professional Negligence)

 13. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 14. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed [insert name of Plaintiff] a duty to exercise reasonable care in their treatment of her.
 15. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to [insert name of Plaintiff], thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:
a. failed to timely diagnose and treat [insert name of Plaintiff]'s medical conditions;
b. failed to properly monitor and evaluate [insert name of Plaintiff]'s skin integrity;
c. failed to properly monitor and evaluate [insert name of Plaintiff] for compromised blood flow to her extremities;
d. failed to alert physicians regarding the changes in [insert name of Plaintiff]'s skin and underlying tissues;
e. failed to monitor and evaluate [insert name of Plaintiff]'s peripheral pulses and capillary refill times;
f. failed to provide adequate pressure relief for [insert name of Plaintiff]'s lower extremities;
g. failed to properly implement and revise [insert name of Plaintiff]'s care plan; and
h. were otherwise negligent and violated the applicable standards of care.
 16. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name of Plaintiff] was caused to sustain serious, painful and permanent injuries to her body, including great physical and mental pain and suffering, and, ultimately, death.
 17. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name of Plaintiff], among other things, was forced to undergo medical treatment, and, as a result, was obliged to expend sums of money for medical, hospital and other care and treatment and was precluded from engaging in his normal and usual pursuits and activities, among other injuries and damages.
 18. Had Defendants followed the appropriate and applicable standards of care, [insert name of Plaintiff] would not have suffered the above-identified injuries, damages and death.
 19. The injuries and damages herein complained of were directly and proximately caused by the negligence and want of care of Defendants, with no negligence on the part of [insert name of Plaintiff] contributing thereto.

 WHEREFORE, the Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

COUNT II (Wrongful Death)

 20. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 21. As a direct and proximate result of the Defendants' above-described negligence in causing the death of [insert name of Plaintiff], the Plaintiffs have sustained, among other things, pecuniary loss, mental anguish, emotional pain and suffering, loss of society, loss of companionship, loss of comfort, loss of protection, loss of parental care, loss of filial care, loss of attention, loss of advice, loss of counsel, loss of guidance and loss of education. 
 WHEREFORE, the Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

*  *  *

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

Nursing home residents may be at risk for digestive disease.  Diverticulitis is a fairly common disease found in the colon (large intestine) which occurs when protruding pouches coming out of the wall of the colon become inflamed or infected.  Patients suffering from diverticulitis may experience the following symptoms:  (1) lower abdominal pain; (2) diarrhea; (3) constipation; (4) fever; (5) bleeding from rectum; and/or (6) nausea/vomiting.

Fortunately, this condition can oftentimes be treated with antibiotics and dietary measures so long as it is timely diagnosed. 

The nursing home staff must alert the patient's treating physician if the resident experiences symptoms of digestive disease including diverticulitis.  The failure to do so can have fatal consequences.  For instance, the patient may develop peritonitis or intestinal obstruction requiring emergency surgery and treatment.  Sadly, under these circumstances, the nursing home's failure to timely alert the physician and/or transfer the patient to the hospital may result in serious medical complications or even death. 

A sample Maryland Wrongful Death/Survivorship Complaint involving claims of negligence relating to nursing home failures to make arrangements for the patient to receive necessary medical evaluations and treatment for diverticulitis follows:

COMPLAINT

Plaintiffs, [insert names of Plaintiffs], by their attorneys, hereby file this Complaint against Defendants, [insert names of Defendants], and in support thereof state as follows:

PARTIES AND JURISDICTION

1.   At all times material to this case, Plaintiffs have been citizens and residents of the State of Maryland.  Plaintiffs [insert names] are the surviving children of the decedent, [insert name].  [Insert name of wrongful death beneficiaries] are wrongful death beneficiaries in this action pursuant to Section 3-904(a) of the Courts and Judicial Proceedings Article of the Maryland Annotated Code.
2. [Insert name] is the duly appointed Personal Representative of the Estate of [insert name].  The Register of Wills for Baltimore City issued Letters of Administration to [insert name] on [insert date].  The Estate of [insert name] is bringing this survival action pursuant to Section 7-401(x) of the Estates and Trusts Article of the Maryland Code.
3. At all times material to this case, [insert names of Defendants] have been operating nursing homes and engaging in the practice of medicine and rehabilitation services in Baltimore City and throughout Maryland, acting through actual and/or apparent agents, servants and/or employees.
4. The venue for this claim is proper in Baltimore City, Maryland.  The amount in controversy exceeds Thirty Thousand Dollars ($30,000.00).

FACTS COMMON TO ALL COUNTS

5. At all times mentioned and relevant herein, [insert names of Defendants] have been licensed by the State of Maryland to own and operate nursing homes iand assisted living facilities in Maryland and have held itself and its agents, servants and employees out to the general public as experienced, competent and capable providers of nursing home, assisted living, and medical and rehabilitation services, and in such capacity owed a duty to [insert name of Plaintiff] and the Plaintiffs to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine and rehabilitation services.
6. At all times mentioned and relevant herein, all individuals at [insert name of nursing home] who participated in the care provided to [insert name] were acting on behalf of [insert names of Defendants] and within the scope of their employment and/or agency with [insert names of Defendants].
7. On or about [insert date], [insert name] was admitted to [insert name of nursing home].  
8. According to the medical records, on or about [insert date], [insert name of Plaintiff] complained to the nursing home staff of diarrhea, abdominal pain, cramps, and back pain.  Subsequent care notes failed to document that the staff had assessed [insert name]'s abdomen or monitored her condition for improvement or worsening of the diarrhea.
9. A care note dated [insert date] documented that [insert name] continued to complain of nausea.   Once again, however, the care note failed to document any assessment of [insert name]'s abdomen or bowel function.
10. A care noted dated [insert date] documented that [insert name] was continuing to complain of nausea and diarrhea.  The note further documented that [insert name]'s abdomen was distended and tender to the touch, and that there was a foul BM (bowel movement) odor in [insert name]'s room.   Despite these findings, the nursing home staff failed to obtain necessary medical assistance for [insert name].
11. On [insert date], [insert name] continued to complain of nausea and abdominal pain.   [Insert name]'s physician was finally notified and [inset name] was transported to the emergency room at [insert name of hospital].
12. Doctors at [insert name of hospital] ran preliminary tests and determined that [insert name] was severely dehydrated and anemic.  After admitting [insert name] to the hospital and running additional tests, doctors determined that [insert name] had an acute sigmoid diverticulitis that had produced multiple large pelvic abscesses.  Doctors initially attempted to drain the abscesses but were unsuccessful.   [Insert name] subsequently underwent a major abdominal surgery and colon resection.  By this point, however, [insert name] had developed peritonitis and acute renal failure.  [Insert name] died on [insert date].  The Death Certificate lists the primary cause of death as sepsis related to perforated diverticular disease.

COUNT I (Professional Negligence)

13. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
14. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed [insert name] a duty to exercise reasonable care in their treatment of her.
15. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to [insert name], thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:

a. failed to appropriately monitor and evaluate [insert name]'s ongoing medical condition;
b. failed to timely and properly diagnose [insert name]'s diverticulitis;
c. failed to make arrangements for [insert name] to receive necessary medical evaluations and treatment for her diverticulitis, which resulted in [insert name] developing large pelvic abscesses, peritonitis and renal failure, conditions that ultimately caused her death; and
d. were otherwise negligent and violated the applicable standards of care.

16. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name] was caused to sustain serious, painful and permanent injuries to her body, including great physical and mental pain and suffering, and, ultimately, death.
17. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name], among other things, was compelled to undergo medical procedures and treatment and, as a result, was obliged to expend sums of money for medical care and was precluded from engaging in her normal pursuits and activities, among other injuries and damages.
18. Had Defendants followed the appropriate and applicable standards of care, [insert name] would not have suffered the above-identified injuries, damages and death.
19. The injuries herein complained of were directly and proximately caused by the negligence and want of care of Defendants, with no negligence on the part of [insert name] contributing thereto.

WHEREFORE, Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

COUNT II (Wrongful Death)

20. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.

21. As a direct and proximate result of the Defendants' above-described negligence in causing the death of [insert name], [insert names of wrongful death beneficiaries] have sustained, among other things, pecuniary loss, mental anguish, emotional pain and suffering, loss of society, loss of companionship, loss of comfort, loss of protection, loss of parental care, loss of filial care, loss of attention, loss of advice, loss of counsel, loss of guidance and loss of education. 

WHEREFORE, the Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

*  *  *

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

A tracheostomy is a surgically created opening in the windpipe (trachea) that may be used (for among other things) for patients who require breathing support with a ventilator (breathing machine). 

Regular tracheostomy care is essential in order to prevent complications including infection, windpipe damage, narrowing or collapsing of the airway and prevention of skin breakdown.  The good news is that tracheostomy care is a fairly benign process and complications may be preventable so long as proper care is provided.  Elderly nursing home patients and their families must attempt to locate nursing home facilities that are able to provide this level of care.  There are certain nursing home facilities that have Ventilator Units and hold themselves out as competent and able to provide the care required for such patients.

Unfortunately, we have seen situations where human error involving accidental or inadvertent removal of the tracheostomy tube results in permanent injury to the nursing home resident or even death.  In these circumstances, time is of the essence and the nursing home staff must timely and appropriately respond to the patient's respiratory distress.

A sample Maryland Wrongful Death/Survivorship Complaint involving claims of negligence relating to tracheostomy/ventilator care follows:

COMPLAINT

Plaintiffs, [insert names of Plaintiffs], by their attorneys, hereby file this Complaint against Defendants, [insert names of Defendants], and in support thereof, state as follows:

PARTIES AND JURISDICTION

1.At all times material to this case, Plaintiffs have been citizens and residents of the State of Maryland.  Plaintiffs [insert names] are the surviving children of the decedent, [insert name].  [Insert names of wrongful death beneficiaries] are wrongful death beneficiaries in this action pursuant to Section 3-904(a) of the Courts and Judicial Proceedings Article of the Maryland Annotated Code.
2.[Insert name] is the duly appointed Personal Representative of the Estate of [insert name].  The Register of Wills for Baltimore City, Maryland issued Letters of Administration to [insert name] on [insert date].  The Estate of [insert name] is bringing this survival action pursuant to Section 7-401(x) of the Estates and Trusts Article of the Maryland Annotated Code.
3.At all times material to this case, [insert names of Defendants] have been corporations engaging in the practice of medicine and rehabilitation services in Baltimore City, Maryland, and acting through actual and/or apparent agents, servants and/or employees.
4.The venue for this claim is proper in Baltimore City, Maryland.  The amount in controversy exceeds Thirty Thousand Dollars ($30,000.00).

FACTS COMMON TO ALL COUNTS

5. At all times mentioned and relevant herein, [insert names of Defendants] have owned and operated the nursing home facility located at [insert address] in Baltimore City, Maryland, and have held themselves and their agents, servants and employees out to the general public as experienced, competent and capable providers of medical, rehabilitation, and nursing home services, and in such capacity owed a duty to [insert name] and the Plaintiffs to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine, rehabilitation, and nursing home services.
6. At all times mentioned and relevant herein, all of the individuals at [insert names of Defendants] who participated in the care provided to [insert name] were acting on behalf of and within the scope of their employment with [insert names of Defendants].
7. On or about [insert date], [insert name] was admitted to the [insert name of nursing home] nursing home facility.  At the time of his admission, [insert name] suffered from chronic obstructive pulmonary disease and required ventilator support via a tracheostomy.  [Insert name] and his family selected [insert name of nursing home] facility because the facility represented that it had the equipment and trained staff necessary for the care of a ventilator-dependent patient.
8. On or about [insert date], [insert name] was evaluated by a nurse at approximately [insert time] and was noted to be awake and alert and in no distress.  Later that evening, [insert name] was found unresponsive in his bed by a respiratory technician. The technician noted that [insert name]'s tracheostomy tube was half way out, and he had no pulse.  The technician called 911, and paramedics arrived on the scene at approximately [insert time].  The paramedics were able to restore [insert name]'s breathing, and they immediately transported him to [insert name of hospital].
9. Upon admission to [insert name of hospital], [insert name] was diagnosed with continuous seizure activity secondary to anoxic encephalopathy.  [Insert name] never recovered neurologically, and life support was withdrawn on [insert date].  [Insert name] was pronounced dead at [insert time] on [insert date].  The Death Certificate lists the cause of death as anoxic brain injury.

COUNT I (Professional Negligence)

10. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
11. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed [insert name] a duty to exercise reasonable care in their treatment of him.
12. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to [insert name], thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:

a. failed to properly monitor and manage [insert name]'s tracheostomy;
b. failed to properly monitor and manage [insert name]'s ventilator support;
c. failed to respond in a timely and appropriate manner to [insert name]'s respiratory distress; and
d. were otherwise negligent and violated the applicable standards of care.

13. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name] was caused to sustain serious, painful and permanent injuries to his body, including great physical and mental pain and suffering, and, ultimately, death.
14. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, [insert name], among other things, was forced to undergo medical treatment, and, as a result, was obliged to expend sums of money for medical, hospital and other care and treatment and was precluded from engaging in his normal and usual pursuits and activities, among other injuries and damages.
15. Had Defendants followed the appropriate and applicable standards of care, [insert name] would not have suffered the above-identified injuries, damages and death.
16. The injuries and damages herein complained of were directly and proximately caused by the negligence and want of care of Defendants, with no negligence on the part of [insert name] contributing thereto.

 WHEREFORE, Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

COUNT II (Wrongful Death)

17. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
18. As a direct and proximate result of the Defendants' above-described negligence in causing the death of [insert name], [insert names of wrongful death beneficiaries] have sustained, among other things, pecuniary loss, mental anguish, emotional pain and suffering, loss of society, loss of companionship, loss of comfort, loss of protection, loss of parental care, loss of filial care, loss of attention, loss of advice, loss of counsel, loss of guidance and loss of education. 

 WHEREFORE, Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

* * *

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

Elderly nursing home patients are at risk for developing bedsores (also known as pressure sores or decubitus ulcers).  Decubitus ulcers are bed sores caused by unrelieved pressure on the skin from lying or sitting in the same position too long and are associated with pain.   

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

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

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

In our nursing home bedsore cases, we routinely serve Corporate Designee Deposition Notices upon the Defendants along with the Complaint and other discovery requests at the outset of the case.  In this regard, Maryland Rule 2-412(c) and (d) requires nursing homes to produce documents (including medical records and policies and procedures) and to designate individuals to testify as to matters set forth in the deposition notice.  The testimony given will bind the nursing home on the subjects described. 

Our Corporate Designee Deposition Notices are targeted to obtain records and information concerning important issues including: (1) ensuring that the proper corporate entities have been named as Defendants; (2) ensuring that the healthcare providers at issue are employees or agents of the Defendants; (3) ensuring that information contained in medical records or other documents is accurate; (4) potential defense motions to transfer venue; (5) the treatment provided to the plaintiff; (6) the nursing home's policies and procedures concerning a variety of areas including wound prevention and wound care; and (7) potential nursing home staffing shortages.  These Corporate Designee Depositions also force the nursing homes and their lawyers to focus on and evaluate the circumstances of the case at an early stage as they have to identify and produce witnesses for deposition, and may help to facilitate early mediation or settlement.
 
A sample Corporate Designee Deposition Notice in a wrongful death/survivorship lawsuit involving claims of negligence relating to nursing home bed sores/pressure sores/decubitus ulcers follows:

NOTICE TO TAKE DEPOSITION

Pursuant to Maryland Rule 2 412(c) and (d), you are requested to do the following:
(a) designate one or more officers, directors, managing agents, or other persons who will testify on your behalf regarding the following matters known or reasonably available to the organization, and
(b) produce for inspection and copying at the deposition all documents or tangible things within your possession, custody or control regarding the following matters:

1. The corporate structure of [INSERT NAMES OF DEFENDANTS], and their parent corporations, subsidiaries, and affiliated entities from 2005 to the present.
2. The nature and scope of all operations and business activities of [INSERT NAMES OF DEFENDANTS] from 2005 to the present.
3. The corporate structure and scope of operations of all facilities owned, operated, managed, or supervised by [INSERT NAMES OF DEFENDANTS] from 2005 to the present.
4. The nature and scope of all advertising activities of [INSERT NAMES OF DEFENDANTS] within the City of Baltimore from 2005 to the present.
5. The nature and scope of all services, including but not limited to, nursing home, assisted living, in-patient and outpatient rehabilitation, hospice, and home health care services provided by [INSERT NAMES OF DEFENDANTS] and their parent corporations, subsidiaries, and affiliated entities, within the City of Baltimore from 2005 to the present.      
6. The care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY] during the time period of [INSERT DATES OF ADMISSION], including but not limited to efforts to turn and reposition the patient, and monitor, prevent and treat decubitus ulcers.
7. The skin care and wound care, prevention and treatment provided to [INSERT NAME OF PLAINTIFF] at [INSERT NAME OF NURSING HOME FACILITY] from [INSERT DATES].
8. All skin evaluation practices and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY].
9. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the prevention of decubitus ulcers/ pressure wounds.
10. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the prevention of decubitus ulcers/ pressure wounds via the use of specialty mattresses or beds.
11. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the care, treatment, and monitoring of decubitus ulcers/ pressure wounds.
12. All information and documents that discuss or pertain to any specialty mattresses or beds that were used in the care and treatment of [INSERT NAME OF PLAINTIFF]'s decubitus ulcers/ pressure wounds throughout her stay at [INSERT NAME OF NURSING HOME FACILITY].
14. All written manuals, guidelines, policies, or procedures in effect at [INSERT NAME OF NURSING HOME FACILITY] from 2005 through the present that discuss or in any way relate to the diagnosing, monitoring and/or treatment of pressure wounds and/or decubitus ulcers.
15. All information and documents that discuss or pertain to [INSERT NAME OF NURSING HOME FACILITY]'s  procedures, guidelines or policies in effect from 2005 through the present concerning the circumstances under which nurses and nursing assistants should consult with the patient's treating physician or other doctor regarding the patient's skin integrity or condition, including the development and progression of decubitus ulcers/ pressure wounds.
16. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the circumstances under which nurses and nurse practitioners should consult with the resident's treating physician or other physician regarding the patient's status and/or ongoing care needs at [INSERT NAME OF NURSING HOME FACILITY].
17. The identity of all individuals who provided care to [INSERT NAME OF PLAINTIFF]'s during his stay at [INSERT NAME OF NURSING HOME FACILITY] during the time period of [INSERT DATES OF ADMISSION] including but not limited to efforts to monitor, prevent and treat decubitus ulcers.
18. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to incident reporting.
19. Information concerning and copies of all incident reports generated by Defendants and their agents or employees pertaining to the care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY].
20. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY pertaining to or relating to documenting a resident's medical records.
21. Information concerning and copies of all inspection reports or evaluations pertaining to the care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY] generated by any federal or state government agencies (including but not limited to Adult Protective Services) that regulated or monitored [INSERT NAME OF NURSING HOME FACILITY].
22. Information regarding staffing levels, staffing sheets and staffing shortages at [INSERT NAME OF NURSING HOME FACILITY] during the time period during which [INSERT NAME OF PLAINTIFF] resided at [INSERT NAME OF NURSING HOME FACILITY].

* * *

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.

It can be difficult for Plaintiffs' attorneys to obtain timely discovery responses from Defendants in nursing home negligence cases.  It is not uncommon for months to elapse before Plaintiffs' counsel is able to even receive responses to written discovery and documents requests from the nursing home's lawyers. 

Maryland Rule 2-424, entitled "Admission of acts and genuineness of documents," provides Plaintiffs' lawyers with a powerful discovery tool that can help streamline the issues in the case in the early phases of litigation.  This Rule requires a party to admit or deny the truth of matters of fact set forth in separate requests for admission.  Importantly, a party must file responses to requests for admission of facts within thirty (30) days or the request shall be deemed admitted.  See Maryland Rule 2-424(b).  Nursing home defendants are therefore forced to take a position on various factual issues at the outset of the case before their attorneys and in-house risk managers have an opportunity to fully evaluate the issues.  In the event that defense counsel does not file timely responses, the value of the case can potentially increase. 

Our firm regularly serves Defendant nursing homes with detailed Requests for Admission of Facts along with the Complaint and initial pleadings in all of our nursing home neglect cases.  These requests cover a range of important topics such as: (1) ensuring that the proper corporate entities have been named as Defendants; (2) ensuring that the healthcare providers at issue are employees or agents of the Defendants; and (3) ensuring that information contained in medical records or other documents is accurate.  Detailed requests for admission of facts also force defense lawyers to focus on and evaluate the factual circumstances of the case at an early stage and may help to facilitate early mediation or settlement.

A sample set of Requests for Admission of Facts in a nursing home neglect bedsore/pressure sore/decubitus ulcer wrongful death lawsuit follows:

1. [Insert name of defendant] owns [insert name of nursing home facility].
2. [Insert name of defendant] operates [insert name of nursing home facility].
3. [Insert name of defendant] owned [insert name of nursing home facility] during the time period of [insert time period at issue in case].
4. [Insert name of defendant] operated [insert name of nursing home facility] during the time period of [insert time period at issue in case].
5. All of the individuals at [insert name of nursing home facility] who participated in the care provided to Plaintiff during his stay in [insert dates] as alleged in the Complaint were acting on behalf of and within the scope of their employment and/or agency with [insert name of Defendant].
6. On or about [insert date], Plaintiff was transferred to [insert name of nursing home facility] for short-term rehabilitation.
7. At the time of his admission to [insert name of nursing home facility], Plaintiff was examined by the admitting nurse who noted that his skin integrity was intact with no  skin breakdown, wounds or pressure ulcers.
8. At the time of his admission to [insert name of nursing home facility], Plaintiff was examined by the admitting nurse and noted to have no pressure wounds or decubitus ulcers on his sacrum.
9. At the time of his admission to [insert name of nursing home facility], Plaintiff was examined by the admitting nurse and noted to have no pressure wounds or decubitus ulcers on his sacrum or elsewhere on his body.
10. Around the time of Plaintiff's admission to [insert name of nursing home facility] a nurse completed a Braden scale for Plaintiff indicating that he was at mild risk for developing future pressure wounds or decubitus ulcers.
11. Physician orders at the time of admission to [insert name of nursing home facility] called for the nursing staff to reposition and turn Plaintiff every two hours and perform a full body inspection every week.
12. Over the next several months, [insert name of nursing home facility] failed to reposition Plaintiff every two hours and/or perform a full body inspection every week, as ordered by his physicians.
13. Over the next few months, the family found Plaintiff in soiled undergarments that had not been changed for long periods of time. 
14. On or about [insert date], nurses at [insert name of nursing home facility] documented that [Plaintiff] was suffering from a stage II sacral decubitus ulcer.
15. On or about [insert date], nurses at [insert name of nursing home facility] documented that [Plaintiff] was suffering from a stage III decubitus ulcer on his buttocks.
16. Plaintiff's sacral decubitus ulcer subsequently grew larger and became infected.
17. Plaintiff developed additional decubitus ulcers on his left buttocks and left heel.
18. Plaintiff was not assessed by a dietician at [insert name of nursing home facility].
19. Plaintiff was evaluated by the wound care team at [insert name of hospital] and diagnosed with a stage IV sacral decubitus ulcer.
20. Plaintiff was evaluated by the wound care team at [insert name of hospital] and diagnosed with a stage IV sacral decubitus ulcer with purulent drainage, necrosis, and deep tunneling.
21. Hospital records dated [insert date] indicate that doctors advised Plaintiff's family that his sacral decubitus would likely never heal and would require chronic care.
22. Plaintiff was ultimately discharged from [insert name of hospital] on [insert date] and transferred to [insert name of facilty].
23. Over the next six months, Plaintiff continued to suffer from his stage IV sacral ulcer and related complications.
24. Over the next six months, Plaintiff continued to suffer from his stage IV sacral ulcer and related complications until he ultimately succumbed to these conditions on [insert date].
25.  The Death Certificate lists the cause of death as sepsis due to a sacral decubitus ulcer with osteomyelitis.
26. Defendant failed to take reasonable and appropriate measures to maintain Plaintiff's skin integrity, which resulted in the development of multiple decubitus ulcers.
27. Defendant failed to ensure that Plaintiff received adequate wound care, as well as the diet and nutrition necessary for wound prevention and healing.
28. Defendant failed to adequately and timely assess, diagnose, and treat Plaintiff's pressure wounds and skin breakdown.

*  *  *

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.

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]

*  *  *

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.

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.

*  *  *

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.

As a result of their cognitive and physical disabilities, nursing home patients are often totally dependant upon the nursing home staff to provide assistance with all activities of daily living, including medication administration. 

Medication errors can result in serious medical complications and ultimately result in death.  According to the Institute of Medicine's 2000 report entitled "To Err is Human - Building a Safer Health System," medication errors result in approximately 7,000 deaths of Americans annually.  These medication errors are often preventable and result from common medication administration and prescribing errors including: administering the wrong dosage; using the wrong drug; failing to monitor and document the patient's response; and failing to follow doctor's orders.

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 medication errors involving the drug Coumadin follows:

COMPLAINT

Plaintiffs, [insert name], individually and as personal representative of the Estate of [insert name], [insert 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 [inset names] are the surviving children of the decedent, [insert name], and 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 [insert County], Maryland issued Letters of Administration to [insert name] on [insert date].  The Estate of [insert name] is bringing this survival action pursuant to Section 7-401(x) of the Estates and Trusts Article of the Maryland Annotated Code.
 3. At all times material to this case, [insert Defendants] have been corporations engaging in the practice of medicine and nursing home 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 Defendants] have owned and operated the nursing home facility known as [insert name of nursing home] located at [insert address], and have held themselves and their agents, servants and employees out to the general public as experienced, competent and capable providers of medical and nursing home services, and in such capacity owed a duty to [insert name] and the Plaintiffs to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine and nursing home services.
 6.  At all times mentioned and relevant herein, all of the individuals at [insert name of nursing home] who participated in the care provided to [insert name] were acting on behalf of and within the scope of their employment with [insert names of Defendants]. 
 7. On or about [insert date], [insert name] suffered a fall at home and was taken to [insert name of hospital] for evaluation and treatment.  [Insert name] was diagnosed with a small pulmonary embolism and was started on Coumadin therapy for anticoagulation.
 8. On [insert date], [insert name] was transferred to the [insert name of nursing home] for continuing rehabilitation.  [Insert name] attending physician noted on the transfer summary that [insert name] could be continued on Coumadin therapy at the nursing home provided his anticoagulation would be closely monitored and as long as someone is watching him and he is not at risk for fall.
 9.  At the time of her admission to the [insert name of nursing home], [insert name] was assessed to be at high risk for falls due to his history. Despite this assessment, the staff at the [insert name of nursing home] failed to initiate proper fall precautions for [insert name], and as a result, he suffered serious falls at [insert name of nursing home] on three separate occasions.  Following his third fall, [insert name] was taken to emergency department of [insert name of hospital] where he was diagnosed with head trauma and fractures of his right hip and right femur.  Emergency room physicians examined [insert name] and found three Fentanyl patches on his body.  Fentanyl is a powerful narcotic with a potency many times that of morphine.  A single Fentanyl patch may be applied every three days after removing the old patch.  The emergency room doctors quickly determined that [insert name] had been given excessive amounts of Fentanyl at [insert name of nursing home] and ordered that [insert name] be given Narcan, a drug used to reverse the effects of narcotic intoxication.       
 10. Emergency room physicians also quickly determined that [insert name] had been given excessive amounts of Coumadin at [insert name of nursing home].  Laboratory tests showed that that [insert name]'s anticoagulation, as measured by his INR, or international normalized ratio, was 50, or approximately 20 times higher than his target range of 2.5.  This excessive anticoagulation, along with the trauma from the fall, caused [insert name] to suffer severe internal hemorrhaging. [Insert name] was promptly evaluated by a cardiologist who noted the following in his chart: "the reason for blood loss is likely the very high INR and I would recommend correcting the coagulopathy with fresh frozen plasma and transfusing to control the hematocrit.  Nevertheless, given his present condition, the chances of meaningful survival are poor, and I have communicated this to the family, who understand."
 11. Doctors at [insert name of hospital] attempted to reverse [insert name] anticoagulation by urgently transfusing multiple units of plasma and blood products, but [insert name] was simply too unstable, and he quickly deteriorated to hemorrhagic shock, kidney failure, and respiratory failure.  [Insert name] was ultimately pronounced dead at 8:29 p.m. with members of his family at his bedside.  

COUNT I  (Professional Negligence)

 12. The Plaintiffs incorporate 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 him.
 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 [insert name] medical conditions;
(b) failed to properly manage [insert name]'s pain medications; 
(c) failed to properly manage [insert name]'s anticoagulation therapy;
(d) failed to respond in a timely and appropriate manner to the results of [insert name] coagulation studies; 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 his 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 his 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, 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)

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

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.