South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

Melvin Raybon died in pain four years ago, and a DeKalb County jury agreed that the cause of his suffering was neglect at the Tucker nursing home where he lived for nine months.  The jury compensated Raybon’s daughter $1.25 million for the pain and suffering her father felt the last year of his life.  

The nursing home provided inadequate care and attention to Raybon. He was admitted in 2002 when he turned 67.  Nine months later, he had to go to a hospital for treatment of a bed sore that infected his left buttock to the bone.  Nursing assistants from the nursing home testified there weren’t enough staff to provide adequate care to Raybon.   The staff neglected him by failing to follow standard protocol of turning and repositioning him every two hours which is necessary to prevent and treat his pressure ulcers.

Raybon also suffered from malnutrition as a result of the infection, which sent his body into a death spiral that led to more bed sores and infections and finally his death in June 2004.

Kindred Healthcare was the company that owned the nursing home at the time. The facility was sold to a new owner last year.

• Email This
• Print
• Comments
• Trackbacks

I found this cool website called Aboutlawsuits.com that had an article about a wrongful death lawsuit filed in Chicago alleging the nursing home's neglect caused fatal pressure ulcers or bedsores. 

The lawsuit states that Stanley “Ted” Dancy, 77, was admitted to the nursing home. However, after one month in the nursing home for rehabilitation, he was transferred to Mount Sinai Hospital, where he was diagnosed with four advanced stage bed sores, as well as malnutrition and a urinary tract infection

As a result of the injuries sustained at the nursing home, Dancy’s health continued to deteriorate and the wrongful death lawsuit alleges that the bedsores and other injuries he sustained at Washington Heights Nursing Home were the contributing factors that lead to his death on December 12, 2007.

Nursing home bedsores, which are also commonly referred to as decubitus ulcers or pressure sores, are caused by prolonged pressure on one area of the body.  This is typically caused by the staff's failure to move the residents.  This pressure results in a lack of blood flow to the skin in that area, which turn into an open would that progress to a serious and fatal infection.

When immobile residents are not repositioned for long periods of time, pressure can accumulate on one area of the skin, typically involving the thin layers of skin around the tailbone, shoulder blades, elbows or heels.  Many residents do not get moved or repositioned for days because of inadequate and incompetent staff.

Many nursing home lawsuits involve circumstances where the nursing home was not properly monitoring the resident for signs of the pressure ulcers and leaving the resident in one position for extended periods of time. Failure to properly clean the resident, change soiled adult diapers or bed sheets also increases the risk of bedsores developing and getting infected.

Injuries caused by malnutrition and dehydration are a result of a failure to provide adequate amounts of food or fluids to a resident and are linked to negligence and neglect.

 

• Email This
• Print
• Comments
• Trackbacks

Sunrise Senior Living faces another neglect and negligence lawsuit (08/20/08 Orange County Register).  Sunrise was ordered to pay $2 million in damages after the death of a resident in May.  The family of Therese Sperry is suing Virginia-based Sunrise Senior Living which owns and operates Villa Valencia Health Care Center.

Sperry spent two weeks in Villa Valencia's skilled nursing unit in January 2007. She developed avoidable pressure ulcers on her feet that were neglected and went untreated.  The lawsuit alleges negligence by Sunrise Senior Living and says the nursing home failed to provide adequate medical staff for ailing residents - despite five health and safety citations in the last decade by state health regulators.   The most recent violations, from last year, include sexual molestation of a patient during a bath and failure to change a patient's catheter often enough to prevent infection.

After a brief hospital stay, she was sent to Villa Valencia for a week to gain strength.  Four days after her admission, she had redness on both heels, which later developed into ulcers that spread to her muscle and bone. Sperry's family immediately transferred to a different nursing home, where she was properly treated for wounds.  She endured debilitating pain until her death.

The suit argues that the facility "carried out a scheme to place 'profits over people' ... (and) intentionally underfunded and understaffed the facility in order to decrease expenses and increase profits."  Proof of understaffing arose in the trial over the death of Mary Kathleen Adams, who also developed pressure ulcers while at the center in February 2005. She died two months later.  In May, a jury ordered Sunrise to pay $2 million to Adams' family for negligence and punitive damages.

"Big corporations like Sunrise cut down on costs and staffing at the expense of patients," said Kim Valentine, one of the lawyers representing the Sperry family, and who also represented Adams.  Valentine also said court testimony showed employees were quitting because of the poor quality of care - a finding reflected in a report by the independent California Nursing Home Search. The agency found that nursing staff turnover at Villa Valencia was 82 percent in 2006, much higher than the state average of 67 percent.

 

• Email This
• Print
• Comments (5)
• Trackbacks

The Virginia Supreme Court recently affirmed an $850,000 verdict obtained by Jeff Downey in a nursing home case in Danville, Virginia. The case, Musgrove v. Medical Facilities of America Inc., involved pressures sores, an amputation, and death by dehydration, malnutrition and wound complications.

The Defendant asserted numerous assignments of error, many dealing with pertinent nursing home and/or malpractice issues. The Court denied the writ finding no reversible error in the judgment. Some of the issues included:

· Allowing recovery of both survivorship and wrongful death damages in the same cause of action;

· Allowing a medical expert to testify regarding nursing standards of care;

Allowing a nurse expert to testify regarding causation on pressure ulcers and other adverse outcomes;

Allowing a nurse who works part time clinically, and spends a majority of her time as a testifying expert to qualify under Virginia’s clinical practice requirement;

Allowing expert administrative testimony regarding nursing home staffing inadequacies; and

Allowng expert testimony regarding the significance of gaps in the chart.

Defendant filed some 25 motions in limine along with motions to limit expert testimony (on medical cause of death) and summary judgment on punitive damages.

• Email This
• Print
• Comments
• Trackbacks

Knoxville News had an article about a nursing home resident who lost a leg due to the nursing home's neglect.    Neglect of a resident at Hillcrest-West nursing home led to the amputation of her leg last month, according to state reports quoting a doctor who consulted on the case.

The state has censured Hillcrest nursing homes for providing substandard care three times in the past two years.   Obviously the corporate managers ignored the problems and did nothing to correct them.

Now, as in the past, Hillcrest is in danger of losing federal funding if problems aren't corrected. Hillcrest-West has until May 25 to submit a detailed plan of correction, said Lee Millman, a spokeswoman for the Centers for Medicare and Medicaid Services.   During a survey conducted April 28 through May 2, the state found violations of "resident protection, administration, records and reporting, and nursing services standards."

Details in the recent state report on Hillcrest-West state that the amputee's pressure wound was at the most severe level when first noted by staff Feb. 7. The leg was amputated above the knee April 22. Doctors said the bone likely was infected and the wound was "exquisitely (intensely) painful" when manipulated.

A podiatrist said the pressure wound was the "result of neglect ... the worst wound I have seen in 12 years," and the surgeon who removed the leg concurred, the report states.   The same patient didn't get the amount of tube-fed nutrition and saline ordered by her doctor, with feedings skipped repeatedly, the report notes. Also, the family was not informed of the pressure wound and was shocked when they learned of the pending amputation, the state report said.

State inspections from 2006 and 2007 report Hillcrest-West patients found on the floor after apparently falling from beds or wheelchairs, failure to properly use restraints or alarms, patients who were unclean, and inadequate staffing.

• Email This
• Print
• Comments
• Trackbacks

WHEC-TV ran a story about a neglected resident who sued a nursing home for pressure ulcers, bedsores, and gangrene at Blossom South Nursing and Rehabilitation Center.  The nursing home is already facing nearly $150,000 in fines from the state for other deficiencies.

Resident Ruby Myers' right leg was amputated after gangrene had set in.  Myers broke her leg last September. Doctors put her leg into a brace that apparently caused severe pressure ulcers and open sores. The circulation in the leg was stopped.  The woman also suffered from bedsores.

D.A. Mike Green has decided to defer to the state health department for possible action but no penalty has been decided yet.   Over the last three years, Blossom South had 70 standard health deficiencies, while the statewide average was 16. And deficiencies related to "actual harm" or "immediate jeopardy" were 10 for Blossom South, compared to just one for the state average for a nursing home.

• Email This
• Print
• Comments
• Trackbacks

The NY Times has an informative article on the multi-disciplinary approach needed to prevent pressure ulvers in nursing home residents. 

The article defines a pressure ulcer as an area of skin breakdown that occurs when sustained pressure cuts off blood circulation — usually in patients confined to their beds nursing homes — a bedsore can result in a wound so deep (sometimes to the bone) and painful that some patients require narcotics. If a bedsore becomes infected, the complications can be fatal.

Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence.  New research requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. 

Dr. Joanne Lynn, who helped begin the project when she was a senior natural scientist with the RAND Corporation (she has since joined the Medicare centers), said the goal was to educate nursing home workers in bedsore prevention and to encourage them to come up with creative, low-tech solutions of their own. “It was a combination of education, cheerleading and something like systems engineering,” Dr. Lynn recalled.

Nutrition including additional protein, special mattresses made of high-density foam to reduce pressure in key areas, keeping feet elevated, repositioning frequently, keeping incontinent residents dry with routine changes, and proper fitting clothes are easy low tech solutions to preventing the developement or worsening of pressure ulcers. 

Clinicians document four stages of pressure ulcers, in which Stages 1 and 2 are superficial sores and Stages 3 and 4 are deep wounds that result from death of the skin and underlying tissues.

Dr. Horn, of the Institute for Clinical Outcomes Research, praised the collaborative as “the first major national effort driven by Medicare to reduce pressure ulcers.” But she said that better outcomes could be achieved if more nursing homes improved their documentation, so that all of the information on a given resident, including details on eating, urinary and bowel function, appeared on a single sheet, with key reminders to nursing assistants and other staff members about best practices.

Bedsores are “a major quality-of-life issue, and a self-esteem issue,” said Joanie Jones, a nurse at David Place in Nebraska. “No one wants to have sores on their bottom. I don’t care how old you are. You still want your skin intact.”

• Email This
• Print
• Comments
• Trackbacks

In many of our neglect and abuse cases, the victim is unable to testify regarding the bad care because of dementia or death.  I read an article today about a man who is competent and speaking up for his rights and the rights of others at the facility where he lives.  Mr. Crawley is a competent 48 year old man who resides at Sunrise Rehabilitation & Care in Marion, N.C.   "I am not being treated like, I feel, as a human being," said Crawley. 

Crawley became a paraplegic as a result of a car wreck in 1982. His 81-year-old father, Joe Crawley Sr., can no longer take care of him and he started living at Sunrise Rehab on Oct. 15. For the first two weeks there, the staff didn't give him a bath or shower.  "I don't know what is going on here," he said. "It seems like they make a lot of errors in simple things."

Crawley said his elderly roommate will talk incoherently and constantly yell about having to urinate, and, rather than listening to him, the staff will shut the door. With the heater running, that makes the room get hot for both Crawley and his roommate. He said he has called the nurse's station to have the door opened but is ignored.

His sister said the staff once left a feces-soiled blue pad on his wheelchair for more than two hours. His father, who visits him twice a week, found it and thought his son had had an accident. He bagged up the soiled pad and took it to the nurse's desk.  "That's an unsanitary condition and that's neglect," said Pilgrim.

Crawley said he's confined in his bed 21 hours a day.   This will increase the likelihood of developing pressure ulcers. 

Crawley added he's paying $879 a month to stay at Sunrise Rehab, which leaves him with just $30 out of his monthly disability check. He wishes he could go someplace else.

"I don't know if they think I am incoherent or lost my faculties or don't know what is going on," he said. "But I do know what is going on. I need more than anything to be transferred to a place that deals with wound care."

"They are neglecting the people," said Buckner. "That is why there is a waiting list at Autumn Care."

The official Web site for Medicare contains information about nursing homes across the nation. The site states that Sunrise Rehab had 11 health deficiencies, which are above the state and national averages. One of the deficiencies included failure to "write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property."  Another deficiency found on May 10 by inspectors was failure to "give professional services that meet a professional standard of quality."

In addition, inspectors found on Aug. 30 that Sunrise Rehab failed to "make sure that residents are safe from serious medication errors" and it also failed to "make sure that the nursing home area is free of dangers that cause accidents."

See full article here.

• Email This
• Print
• Comments
• Trackbacks

Here is a link to the list of nursing homes that are failing in providing good care for pressure ulcers and physical restraints.  There are over 50 nursing homes located in South Carolina on this list.  South Carolina can certainly do better.  Pages 81 and 82 list the South Carolina nursing homes on the list.

 

• Email This
• Print
• Comments (1)
• Trackbacks

The children of 94-year-old Alice Limbrick claim their mother's legs had to be amputated  because of negligent care during her stay at the Green Acres Parkdale nursing home.

The trial of Roy Limbrick vs. Mariner Health Care Inc. (Green Acres) began Jan. 23.  The defense will attempt to convince the jury that the amputating Alice Limbrick's legs had to be taken because of Alice's medical conditions and old age.

Alice Limbrick was admitted to Green Acres for long-term care with multiple health problems.  During her residency, Alice fell fracturing her left hip.

The plaintiffs say Limbrick was admitted to the hospital as a result of the preventable fall where she developed pressure ulcers (bed sores) and eight blisters on both heels and left leg. She was in stable condition and was discharged back to Green Acres.

A week later, she was readmitted to the hospital with gangrene on both heels.   The decubitus ulcers to her heels and left leg continued to deteriorate.  Limbrick's legs were amputated below her knees. 

In the suit, the plaintiffs allege that Green Acres' nurses were negligent in the following ways:

Failing to properly monitor, treat and care for the decubitus ulcers, which progressed and worsened while Alice was a resident;

Failing to properly assess Alice's risk level in the progression of pressure ulcers;

Failing to prevent the progression of Alice's decubitus ulcers;

And by failing to prevent infection in Alice's decubitus ulcers.

• Email This
• Print
• Comments
• Trackbacks

We have numerous cases where a resident suffered horrible painful pressure ulcers because of the lack of preventative treatment.  The nursing homes always claim that the pressure ulcers were "unavoidable" due to the age of the resident.  A new comprehensive study disproves that claim.

This article discusses the purpose and success of preventing pressure ulcers from forming when nursing homes provide preventative care.

The Pressure Ulcer Collaborative project had been aiming for a 25 percent reduction in new occurrences of bedsores by encouraging health workers to use proven strategies to prevent skin deterioration.  Instead, the 150 hospitals, nursing homes and home health care agencies participating reduced new bedsores on average by just over 70 percent between September 2005 and May 2007.

Bedsores, technically known as pressure ulcers, are painful, occasionally deadly skin lesions caused by unrelieved pressure  that can cause infection and destroy tissue, muscle and bone if not properly treated.  They also can trigger depression, affect a patient's self-image and complicate treatment.

At the beginning of the New Jersey project, 18 percent of newly admitted patients developed a bedsore while receiving care. By the end, the rate had been cut to 5 percent of new patients, Holmes said.

Holmes said the preventive steps started with a prompt evaluation of each new patient, with every square inch of their skin examined and their risk of developing bedsores determined based on a standardized scale.

Hospitals then had to follow strategies to prevent development of bedsores. Options included shifting the patient to a new position every two hours, use of heel cushions and other padding for vulnerable pressure points, even use of special air mattresses that alternately inflate and deflate different areas, spreading pressure around.

Patients not eating or drinking enough water _ a common problem with older patients _ got a nutritional consultation because inadequate caloric intake or protein stores, as well as dehydration, can lead to skin tearing and breaking down.  Frequent follow-up examinations of the skin also were required, along with new ones for patients suddenly bedridden, as after surgery.

 

• Email This
• Print
• Comments (1)
• Trackbacks

15. Treatment of Pressure Ulcers
Treatment of Pressure Ulcers
Clinical Guideline Number 15
AHCPR Publication No. 95-0652: December 1994
Foreword


The incidence of pressure ulcers is sufficiently high, especially among certain high-risk groups, to warrant concern among health care providers. These groups include elderly patients admitted to the hospital for femoral fracture (66-percent incidence) and critical care patients (33-percent incidence). In addition, the prevalence of pressure ulcers in skilled care facilities and nursing homes is reported to be as high as 23 percent. An extensive study of acute care facilities reported a prevalence of 9.2 percent, and in one study of quadriplegic patients the prevalence was 60 percent.

Because prevention of this debilitating condition is believed to be less costly than its treatment, the panel initially produced a guideline entitled, Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, No. 3. Although it is certainly desirable to prevent pressure ulcers, individuals still enter the health care system with ulcers or develop ulcers during periods of increased vulnerability as their physical condition deteriorates. This guideline addresses the treatment of pressure ulcers. It is intended for clinicians who examine and treat persons with pressure ulcers, and the treatment recommendations focus on (1) assessment of the patient and pressure ulcer, (2) tissue load management, (3) ulcer care, (4) management of bacterial colonization and infection, (5) operative repair, and (6) education and quality improvement.

AHCPR appointed an external panel of multidisciplinary experts in this field to develop the guideline. To provide a scientific basis for this guideline, the panel conducted comprehensive literature searches, reviewed more than 45,000 abstracts, evaluated approximately 1,700 papers, and cited 333 references to support this guideline.

The panel solicited input from a broad array of organizations and individuals. Testimony was provided by interested parties at a public forum on April 9, 1992, in Washington, DC. A draft of the guideline was distributed to and analyzed by participants at a conference sponsored by the National Pressure Ulcer Advisory Panel and the Wound Ostomy and Continence Nurses Society in March 1993. The Treatment of Pressure Ulcers Guideline Panel also invited peer review by individual experts, professional organizations, consumers, and Government regulatory agencies. Health care agencies conducted pilot reviews to evaluate the clinical applicability of the guideline. In all, more than 400 reviewers have critiqued various drafts of this guideline.

This first edition of Treatment of Pressure Ulcers will be periodically revised and updated as needed so that future editions reflect new research findings and experience with emerging technologies and innovative approaches. To this end, the panel welcomes comments and suggestions regarding the current guideline. Please send written comments to Director, Office of the Forum for Quality and Effectiveness in Health Care, AHCPR, 6000 Executive Boulevard, Suite 310, Rockville, MD 20852.
Treatment of Pressure Ulcers Guideline Panel

Abstract


This Clinical Practice Guideline offers a comprehensive program for treating adults with pressure ulcers. The recommendations are intended for clinicians who examine and treat individuals in all health care settings.

The guideline was developed by a panel of experts and is based on the best available scientific evidence and clinical expertise. The recommended treatment program focuses on (1) assessment of the patient and pressure ulcer, (2) tissue load management, (3) ulcer care, (4) management of bacterial colonization and infection, (5) operative repair in selected patients with Stage III and IV pressure ulcers, and (6) education and quality improvement.

Accurate, ongoing assessment of the ulcer is essential. Of equal importance are the assessment and management of the individual's overall health, including physical, psychosocial, and nutritional status. Pain should be assessed and managed. Management of tissue loads (i.e., pressure, friction, and shear), through vigilant use of positioning techniques and appropriately selected support surfaces, is critical.

Ulcer care includes (1) debridement of necrotic tissue and debris, (2) wound cleansing using saline and avoiding antiseptics, and (3) application of dressings that maintain a clean, moist environment while keeping the surrounding skin dry. Education and quality improvement are integral to an effective pressure ulcer treatment program.

This document is in the public domain and may be used and reprinted without special permission. AHCPR appreciates citation as to source, and the suggested format is provided below:

Bergstrom N, Bennett MA, Carlson CE, et al. Treatment of Pressure Ulcers. Clinical Practice Guideline, No. 15. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 95-0652. December 1994

• Email This
• Print
• Comments
• Trackbacks