The medical term for a bed sore is a decubitus ulcer. You may have also heard them call a pressure sore or a skin sore. Most bedsores start off innocently enough, with a small mark on the skin, often on the lower back or buttocks.
Unrecognized and untreated, these innocuous marks can grow into open wounds. In the worst cases, the flesh becomes necrotic and dies, infecting nearby tissue, organs, and bone. This means that the worst bed sores can be fatal.
In this article:
- Anatomy of bed sores
- Who is at risk of developing bed sores?
- What is the duty of healthcare providers to prevent bedsores?
- Common defenses to bed sore lawsuits
- How our law firm proves that nursing homes were negligent
- Sample bed sore verdicts & settlements
- Hire a lawyer
- Medical literature
- More information
Bed sores result from prolonged periods of inactivity while lying or sitting on a surface. The body’s weight puts pressure on the skin, soft tissue, muscle and bone. Active people do not typically have problems with bed sores because constant, prolonged pressure is required to initiate a sore. In someone less mobile, however, capillaries in the skin become blocked from the pressure, and the lack of blood flow harms the skin.
Bed sores begin to develop after just a few hours. People who are particularly susceptible to bedsores include those who are immobile, who have contractures or spasticity, and who are recovering from certain surgeries. Most bed sore lawsuits are the result of a failure to identify developing bedsores.
There are four stages of decubitus ulcers. Each stage corresponds to the depth of the ulcer. However, not all ulcers follow a clear progression from stage-I to stage-IV.
- Stage-I: Intact skin with signs of impending ulceration. The skin may appear white, indicating a lack of oxygen.
- Stage-II: Partial thickness, loss of skin into the subcutaneous tissue (third layer of skin); looks like an abrasion or blister.
- Stage-III: Full thickness, loss of skin into the subcutaneous tissue; looks like a crater.
- Stage-IV: Full thickness, loss of skin and subcutaneous tissue with extension into muscle, tendon or bone.
Ulcers may cause foul odors, wound drainage, and necrotic tissue. If the wound is necrotic or comes into close contact with urine or feces, life-threatening infection is possible.Treatment
In the best-case scenario, beds sores are simply avoided. Good nutrition and hydration ensure healthy skin and good blood flow, decreasing the risk of bed sores. Keeping the skin clean and moisturized also reduces the risk of developing sores. All patients susceptible to bed sores should frequently be repositioned.
When they do develop, the treatment of bed sores depends largely on the stage and severity of the wound. For minor sores, the solution is to keep pressure off of the developing ulcer to prevent it from worsening.
Sometimes, getting a patient off of a standard mattress or wheelchair and onto specialized bedding or padding can help the wound to heal and prevent reoccurrence. It is critically important to reposition the body frequently, preventing sustained pressure on vulnerable areas. Placing a pillow between the legs is a simple way to prevent sores around the knees, for example.
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If a bed sore progresses past the initial stage, caretakers must ensure that the wound is kept dry clean. Antibiotics may be necessary in the case of infection. In more severe cases, a specialized dressing should be applied to the wound. If necessary, the wound may need debridement, the removal of dead, damaged or infected tissue, to avoid sepsis, necrotizing fasciitis, and gangrene. Surgery, too, may be necessary in severe cases.
Treatment can be made more difficult when patients are malnourished or anemic. Doctors must monitor the whole patient, not just the sores themselves, keeping an eye on nutrition and other health measures. It is also vital that all of a patient’s health care providers are informed about the situation.Statistics
Around 2.5 million Americans suffer from bed sores each year. Researchers estimate that bed sores are the proximate or originating cause of 60,000 deaths each year. The fatality rate for patients admitted to the hospital for the treatment of bed sores is around 13%. Recent studies have also established that there is a causal link between bed sores and general patient mortality and prognosis.
Pressure sores are particularly common among nursing home residents. 8-28% of all nursing home residents suffer from pressure ulcers. This means that at least 1 out of every 10 nursing home residents can expect to suffer from bed sores. Almost 6% of nursing home patients have at least a stage-II bed sore.
The elderly are not the only members of the population who get bed sores. 7-8% of all paraplegics die because of pressure sores. Pressure sores are also a common problem in hospital ICU units. Around 41% of ICU patients are estimated to have bed sores.
Hospital and nursing home acquired bed sores increase national healthcare costs significantly. Their burden on the healthcare system may be as high as $26.8 billion a year.
Approximately 17,000 pressure sore lawsuits are filed in the U.S. each year. This ranks pressure sores as one of the most frequently litigated injuries in the country. In contrast to other types of medical malpractice cases, data on pressure sore lawsuits suggests that plaintiffs prevail over 85% of the time. The national average for pressure sore lawsuit settlements is reported to be $250,000.
People with restricted or limited movement are at the greatest risk of developing bed sores. For example, those who use a wheelchair or are confined to bed are at greater risk. For those who use wheelchairs, bed sores can develop on the tailbone, buttocks, shoulders, spine, arms, or legs. For those confined to bed, sores commonly develop on the heels, ankles, buttocks, tailbone, and hips.
There are also test results and symptoms that are warning signs of bed sores. Serum albumin below 3.4 g/dl, weight loss of more than 10% during last month, and Hgb less than 12 mg per dl are all warning signs. Malnutrition, dehydration, and anemia are significant risk factors. Other warning signs include pale skin, a dry or swollen tongue, red or swollen lips, swollen skin, poor skin turgor, bilateral edema, muscle wasting, calf tenderness, and reduced urinary output.
Hospitals frequently use a tool known as the Braden Scale (also called or Braden Skin Assessment) to document the risk that a patient might develop a bed sore. The Braden Scale consists of a number of criteria, each of which has a numerical value. The total score determines the level of risk.
The overwhelming majority of our law firm's bed sore cases are nursing home cases. In nursing homes, around 12.5% of individuals with mobility impairments, malnourishment, or who are in a coma experience bed sores. The number decreases to 2.5% for those who do not suffer from those conditions.
Nobody, however, should ever have a stage-III pressure ulcer or beyond. When patients and nursing home residents do have a severe ulcer, it is likely that they are the victims of negligence on the part of their health care or nursing home care provider.
The reality is that developing bedsores is not always avoidable. Exacerbation of bedsores, however, is preventable. Nursing homes and other assisted care facilities have a duty to prevent severe bedsores. Their staff must be trained and given enough time to thoroughly check their patients and residents for signs of bedsores.
At the first sign of danger, if appropriate measures are taken, more severe medical complications can be avoided. Failure to properly treat these ulcers, which may require a physician or surgical intervention, can cause serious injuries and death.
Federal regulations set the minimum standard of care for hospitals and nursing homes when it comes to bedsores. Health care providers must "ensure that (1) a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and, (2) a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing." 42 C.F.R. § 483.25(c).
Bed sores present a problem in the medical community considering how quickly a wound or infection can spread throughout the body. Clinical guidelines that provide recommendations on how patients should be treated once pressure sores are present must be followed.
The biggest factor is assessment, meaning that care providers need to determine the size, location, and severity of the sore before developing a plan of action for its treatment. The failure to properly assess bedsores is the mother of so many nursing home injury and wrongful death cases.
- Look at nursing home ratings and other information for every Maryland nursing home
These are some of the common defenses we see in bed sore cases:
- The bed sores could not have been prevented in light of the plaintiff's poor health
- Someone else was responsible. For example, the nurse or the nursing home, and not the doctor, was responsible.
- The bed sore was not there when the patient was at the hospital/nursing home/doctor's office.
However, these cases are hard to defend because it is rare to find significant bed sores if the nursing home or hospital is doing their job well.How our Law Firm Proves that Nursing Homes were Negligent
Nursing home records help us tell a complete story. These records include extensive intake documents. In most of the cases we have litigated, our patients entered the nursing home with no skin problems.
Records will frequently document regular skin checks and rotation, yet somehow a stage-IV ulcer is suddenly found with no warning signs. A proper inspection would have revealed such a wound well before it became a life-threatening problem, revealing that the nursing home was lying about carrying out regular checks.
One prime area of discovery in nursing home cases in some states, especially when punitive damages are available, is the nursing home’s financial records and staffing records. Poor staffing means that inadequate attention is paid to patients. Where a nursing home is understaffed, a jury is allowed to infer a financial motive to provide inadequate care.Sample Bed Sore Verdicts & Settlements
Below we provide samples of verdicts and settlements from bed sore lawsuits. However, the value of a particular case depends on the particular facts and circumstances of each victim. It is hard to gauge the value of your case based solely on the value of similar cases because there are so many different variables involved.
- 2019, Georgia: $1,300,000 Verdict A 74-year-old woman is transferred to the defendant hospital for continuing care for injuries she sustained from a car accident. She develops pressure ulcers that develop into stage-IV ulcers and become infected. Nurses failed to turn her every two hours as planned. As a result of the ulcers, she requires debridement and skin grafts. She is unable to participate in activities she previously enjoyed, such as traveling, due to an inability to sit for long periods of time. She sues the hospital, which claims that her injuries were hard to detect due to the other injuries she had from the car accident. After a four-day trial, a jury finds with the plaintiff, and she is awarded $1.3 million.
- 2019, Louisiana: $710,000 Verdict A 68-year-old man is admitted to a medical center. He has dementia, weakness, respiratory distress, and previous renal failure. He is immobile, and when he is admitted, he is assessed as being high-risk for pressure ulcers. He develops a severe pressure ulcer that becomes septic, and he dies. Despite arguments from the defense that his other conditions meant that he was near the end of his life anyway, the jury returned a verdict in favor of the plaintiff, determining that the center had breached the standard of care. The award of $710,000 includes medical bills, the man’s physical and mental suffering, and his wife’s loss of affection, enjoyment of life, and her emotional suffering.
- 2018, New Jersey: $700,000 Verdict A woman is transferred repeatedly between two health facilities for treatment involving a gastrotomy tube. The health facilities do not conduct the checks they are supposed to in order to detect pressure sores. Allegedly, she develops a pressure ulcer that she has for nearly a year. An abscess forms in the sore, which has to be removed. The ulcer is finally treated but does not fully heal for another year. The woman’s estate seeks compensation for her pain and suffering.
- 2017, South Carolina: $75,000 Settlement A man dies due to pressure ulcers he sustained while under the care of a healthcare center for his Alzheimer’s and dementia. The facility failed to prevent, notice, and treat his sores. His wife sues the facility after his death, seeking compensation for the pain and suffering he experienced prior to his death and for her loss of consortium. The parties settle for less than $100,000. Note that, unfortunately, the overwhelming majority of bed sore cases settle with confidentiality clauses that do not allow others to share the details of the case. This is an example of a settlement that was so low that the nursing home did not care if it was published publicly.
- 2016, New Jersey: $300,000 Settlement An 88-year-old man develops lower-back and buttock bed sores over 40 days before he dies. His wife alleges that the pressure ulcers were caused by neglect. The case settles for $300,000. The settlement is so low, by nature of the litigation process, due to the old age of the decedent.
- 2015, New York: $500,000 Verdict An 86-year-old man undergoes surgery to resolve an aneurysm in his aorta. Although the surgery is successful, his recovery involves several complications, including bed sores developing on the man's buttocks. Even though he undergoes treatment for the sores, they continue to worsen and spread. After the man is transferred to a new facility nearly a year after surgery, he dies of kidney failure and septic shock. The man's estate sues the hospital where he was initially treated. Specifically, they allege that the staff could have prevented the bed sores, which may have led to the man's death. Further, his estate alleges that diligent repositioning could have avoided the problem to begin with. After a five-day trial, a jury finds for the man's estate, awarding $500,000 for his pain and suffering.
- 2015, Pennsylvania: $110,000 Settlement After an elderly man falls in his home, he is admitted to a hospital. He is discharged to a nursing facility, which notes that he has a high risk of skin breakdown. Over the next few months, he develops several pressure sores on his body in addition to a bacterial infection and a urinary infection. He is transferred to a hospital multiple times, but eventually dies from the injuries he sustained at the nursing facility. His estate sues the facility, claiming that they were negligent in his care by failing to re-position him to prevent his injuries. The defendants suggest that all of the injuries were pre-existing. Before trial, the parties settle for $110,000.
If someone you love has a bedsore or other injury that you suspect stems from that a nursing home that violated the law or providing improper care, call our Maryland nursing home attorneys at (800) 553-8082 for a free consultation, or get a free internet consultation. There are no fees or expenses unless money damages are obtained for you.Medical Literature
“An overview of co-morbidities and the development of pressure ulcers among older adults” by Efraim Jaul et al., BMC Geriatrics, 2018. Outlines how a number of other conditions put older adults at a higher risk of developing pressure ulcers.
“Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline From the American College of Physicians” Amir Qaseem et al., Annals of Internal Medicine, 2015 Includes key recommendations for the detection and treatment of pressure ulcers, from diagnostic scales to types of mattresses. Dissects what medical researchers know and don’t know about the prevention and healing of pressure ulcers.
“Pressure ulcers: Current understanding and newer modalities of treatment” by Surajit Bhattacharya and R.K. Mishra, Indian Journal of Plastic Surgery, 2015. A sweeping overview of the medicine of pressure ulcers. Warning: article contains graphic images.More Information
- Nursing home lawyers see these three a lot: ManorCare, Genesis, and FutureCare. We tell you about some of the ins and out of suing these nursing homes.
- Sample Nursing Home Legal Complaints
- Braden Scale and Pressure Sores Test
- Make sure you take pictures of the bed sores as they are happening if you think you may need to bring claim down the road
- Skin ulcers
- Kennedy terminal ulcers
- Safety Ratings and Reviews for All Maryland Nursing Homes
- Anne Arundel County, Glen Burnie Operating Center, LLC, 2017
- Annapolis, The Orthopedic and Sports Medicine Center, 2017 (under a cast)
- Anne Arundel County, Spa Creek Center, 2016
- Anne Arundel County, New Annapolis Nursing, LLC
- Anne Arundel County, Glen Burnie Health and Rehabilitation Center, 2017
- Anne Arundel County, Glen Burnie Health and Rehabilitation Center, 2016
- Baltimore City, Good Samaritan Nursing Center, 2016
- Baltimore City, Baltimore Washington Medical Center, 2016
- Baltimore City, Heritage Harbor, Inc, 2017
- Baltimore City, FutureCare
- Baltimore City, FutureCare, 2017
- Prince George’s County, Genesis, 2016
- Prince George’s County, Genesis, 2017
- Prince George’s County, Manor Care, 2018
- Prince George’s County, Medstar Southern Maryland Hospital, 2016
- Harford County, Genesis, 2016
- Montgomery County, Genesis, 2017
- Mitchellville, Villa Rosa Nursing and Rehabilitation Center, 2018