Causes and Liability for Bedsores

Causes and Liability for Bedsores
Bedsores are one of the most common topics in the discussion around malpractice, negligence, and elder abuse in nursing homes. Not only do bedsores likely indicate poor treatment, but they can also lead to severe consequences, including death, if left untreated. If you’ve discovered that a loved one has a bedsore, please contact us for a free consultation to get answers about:

• Getting your loved one immediate care
• Having a medical provider check on them
• What nursing home insurance is available
• What your legal rights are

Read on to learn what causes bedsores (also known as pressure ulcers), common
reasons they develop, and the liability that nursing homes may face for causing
these potentially fatal injuries.

The injury attorneys at Thompson Law Firm in Phoenix have significant experience in helping clients who have experienced nursing home abuse, including developing bedsores.  Our offices are conveniently located in Chandler, Peoria, and North Phoenix, and we can meet in-person or over the phone or video call.  You can contact us for a free consultation, or read on to find out more.

If you are unsure whether or not you can afford an attorney, don’t worry. We only get paid when you settle. Check out our Attorney Fees Calculator to find out more.

What Are Bedsores?
Bedsores are injuries to skin and underlying tissue resulting from a prolonged pressure on the skin. They are also called pressure sores, pressure ulcers, or decubitus ulcers. Bedsores can appear anywhere on the body, but they most often develop on skin that covers bony areas of the body, including heels, ankles, hips, and the tailbone.

To find out more about bedsores, including who’s most likely to develop them, please read our Bedsore FAQs.

How Do Bedsores Develop?
Here are some reasons a bedsore can develop:

• Friction, sliding, or rubbing: When the skin rubs against another material, like a bedsheet, it can cause damage to blood vessels and deprive skin of blood, oxygen, and necessary nutrients.
• Pressure: When the skin is compressed between bone and surfaces for too long, the blood flow stops, depriving the skin tissue of nutrients and oxygen. Lack of blood flow can cause the skin to die in just a matter of hours.
• Not enough muscle or fat: Layers of muscle and fat add padding to protect the skin from the bone.
• Shear: Skin moving away from the bone or skin moving in opposite directions can occur if staff members aren’t careful and gentle when moving a patient.
• Dehydration and Malnutrition: Without proper nutrition, the skin can become fragile, especially in the elderly population. This makes the skin more susceptible to pressure sores.
• Failure to regularly reposition residents: If the same area of the skin is under pressure for a long time, it could prevent blood flow to that area.
• Unsanitary conditions: Unclean bed sheets, beds that cannot evenly distribute pressure, as well as uncomfortable clothes and shoes can all lead to the development of pressure ulcers due to friction.
• Moisture imbalance: While the skin must remain moisturized to stay healthy, if the skin is not clean and dry, the risk of friction is increased.
• Decreased Sensitivity: A resident with decreased sensitivity or medical conditions relating to blood flow is at a higher risk of developing bedsores because they may not be able to detect pain caused from staying in one place too long.

How Do You Identify Bedsores?
Bedsores are diagnosed by inspecting the skin of those most at risk. They are then labeled from Stage I to Stage IV according to the appearance. At Stage I, the area is red and warm to the touch. Stage I is often accompanied by complaints of a burning, painful, or itching sensation. At Stage IV, the area is severely damaged, and a large wound is present. At this stage, the bones, muscles, joints, and tendons may also be involved. The risk for infection is very high.

Key symptoms to look for are:
• Unusual changes in skin color or texture
• Swelling
• Pus draining from the wound
• Temperature changes in the infected area
• Tender areas
• Blisters
• Open wounds

Are There Laws Protecting My Loved Ones if They Develop Bedsores?
Yes, all nursing homes in Arizona and across the US have a duty of care to their residents. Neglecting residents to an extent that they develop bedsores or failing to treat bedsores is not acceptable.

Under Quality of Care rules (42 C.F.R. §483.25(c) (2011)) every nursing home facility must ensure that:
• 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
• A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.”

The Federal Nursing Home Reform Act (“FNHRA”) – enacted by Congress in 1987, after a review from the Institute of Internal Medicine on the conditions of nursing homes, states that nursing homes must: “Provide each resident with sufficient fluid intake to maintain proper hydration and health.” (42 CFR §483.25).

The presence of pressure ulcers, and the use of physical restraints and urinary catheters, have all decreased since the act passed. This indicates that the NHRA was somewhat effective in improving the quality of care at nursing homes. ARS 46-451(A)6.

“Informed consent” means any of the following:
• A written expression by the person that the person fully understands the potential risks and benefits of the withdrawal of food, water, medication, medical services, shelter, cooling, heating, or other services necessary to maintain minimum physical or mental health and that the person desires that the services be withdrawn.
A written expression is valid only if the person is of sound mind and if the consent is witnessed by at least two individuals who do not benefit by the withdrawal of services.
• Consent to withdraw food, water, medication, medical services, shelter, cooling, heating, or other services necessary to maintain minimum physical or mental health as permitted by an order of a court of competent jurisdiction.
• A declaration made pursuant to title 36, chapter 32.
• Consent by another person under a durable power of attorney relating to health care services to withdraw food, water, medication, medical services, shelter, cooling, heating, or other services necessary to maintain minimum physical or mental health.

“Neglect” means the deprivation of food, water, medication, medical services, shelter, supervision, cooling, heating, or other services necessary to maintain a vulnerable adult’s minimum physical or mental health.

Who is Liable for Other Conditions Caused by Bedsores?
Bedsores are often preventable. This means that infections resulting from bedsores may be due to caregiver negligence. If osteomyelitis stemmed from a severe bedsore infection, the patient may have grounds for a personal injury claim against his or her nursing home, hospital, or caregiver. Someone else may be liable for osteomyelitis-related medical expenses, pain and
suffering, lost wages, loss of limb, and permanent disabilities.

If you’re unsure if you can bring a case for related conditions, discuss you or a loved one’s bedsore case with an attorney today to learn more.

Why Can a Facility be Liable for a Patient Developing a Bedsore?
Nursing homes, long term care facilities, and rehabilitation centers are liable for bedsore injuries because they are preventable injuries (the duty of care to the resident). This means the facility can take action to avoid the injury but has failed to do so (the
facility’s breach of the duty to the resident).

There are multiple and sometimes intertwined reasons behind a facility failing to avoid bedsores:

Failure to Reposition
It is the nursing home or long-term care facility’s responsibility to make sure that residents are repositioned on a regular basis so that bedsores do not develop. The facility must also ensure that staff regularly change bed sheets, make sure they are clean, and ensure the resident is not lying on damp sheets or clothing for prolonged periods of time.

Improper Initial Assessment
At the time of admission, the facility must complete a thorough assessment of the incoming resident. The facility is responsible for determining what condition(s) the resident currently has. and preparing a plan of care. If a resident has a bedsore at the time of admission, the facility must document the bedsore, identify the stage of the sore, and prepare a plan of care to effectively treat the sore.

If a facility knows, based on a thorough assessment during admission, that a resident is more prone to developing bedsores, then the facility should take even more precautions to make sure that the resident is repositioned more often, bed sheets and clothes are examined, and the resident’s nutrition is closely monitored.

Insufficient Staffing
Nursing homes and long-term care facilities often lack enough staff to ensure that all residents are properly repositioned on a regular basis. If a nursing home or long-term care facility is more motivated by profits than the care of its residents, they may keep costs down by hiring less staff. The staff at the facility may be overwhelmed with the needs of the residents, and the residents may not receive the proper care they have been promised.

Another way a facility can keep costs down is by not properly training its staff. If staff members don’t know how to properly identify and treat a bedsore, the resident will likely fail to receive the care he or she needs to recover and heal from the sore.

What to do if You Believe Poor Care has led to Pressure Ulcers:
If you or someone you love has developed a bedsore that you believe is the result of the malpractice or negligence of a nursing home, you can take action to hold them accountable. The best way to do this is to contact Thompson Law, LLC today for a free
consultation at 480-725-4799. You can find more information on these types of cases by reading our Bedsore Settlements article.