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

The Madison Record had an article about a recent complaint filed by Steven Steiner against Caseyville Nursing and Rehabilitation Center and Caseyville Property.  Theresa Mary Steiner died after employees at an Illinois nursing home allowed her pressure sores to deteriorate, causing sepsis to flow throughout her blood.

On Dec. 12, 2008, Caseyville Nursing and Rehabilitation Center admitted Theresa Steiner as its patient, according to the complaint. At the time of her admission, Theresa Steiner had three stage II pressure sores on her buttocks and one pressure sore on each of her heels, the suit states.   However, by the time of her discharge on Dec. 19, 2008, Theresa Steiner had three stage IV pressure sores on her buttocks and multiple pressure sores on her heels, the complaint says.

"Steiner sustained personal injuries, including, but not limited to, development and deterioration of her pressure sores on her buttocks and bilateral heels which, in turn, led to Steiner developing sepsis throughout her bloodstream," the suit states. "On December 19, 2008, Theresa Steiner was hospitalized at Memorial Hospital in Belleville, Illinois, where she subsequently died on January 7, 2009, due to sepsis and acute respiratory failure."

Before her death, Theresa Steiner experienced severe pain and suffering, mental anguish, emotional distress and loss of dignity.  Steven Steiner blames the defendants for a number of negligent acts, including their failure to properly screen Theresa Steiner before admitting her, their failure to have an adequate wound care nurse on staff, their failure to develop an appropriate plan to treat Theresa Steiner's pressure sores, their failure to advise Theresa Steiner's physician of the deterioration of her pressure sores and their failure to adopt appropriate policies to treat pressure sores.

In the six-count complaint, Steven Steiner is seeking a judgment of more than $300,000, plus attorney's fees, costs and other relief the court deems just. William P. Gavin of Gavin Law Firm in Belleville will be representing him.

 

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The Herald-News had an article about a recent jury verdict against Rosewood Care Center.  The jury awarded $51,000 and attorney's fees.    Resident Catherine Taylor died after suffering a huge bedsore that ate through her skin to the bone causing her death.  Taylor, who was 88 when she died in December 2004, was a resident of Rosewood in July and August 2004, On Aug. 19, 2004, Taylor, a former teacher, was taken to Provena Saint Joseph Medical Center and six days later "underwent a procedure to remove bedsores and treat bone infections brought on by her confinement to her bed and her exposure to urine and other bodily fluids during (her) care," according to the complaint against Rosewood.

"She had a hole in her backside the size of my fist," said Scott Pyles, the other attorney representing Taylor's estate.  And Pyles said the bedsore was the fault of the nursing home staff.

"Rosewood screwed up on 8/18 (2004)," he said. "Everybody who testified in this case has told you about it, and it caused Catherine Taylor's death."

"We feel vindicated that we proved that they did something wrong," said Frank Cservenyak, one of the attorneys representing Taylor's daughter, Mary Pat Barney, who was acting as the administrator of her mother's estate.

 

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The Southeast Texas Record had an article about a recent case filed against a nursing home for causing the death of a resident.  Lynda Calloway accuses Harborview Care Center of improperly looking after Doris Beard who suffered from neglect that caused bedsores, dehydration, and malnutrition.  She was a resident for 6 months.   Calloway contends that Harborview repeatedly violated the law by failing to assure and provide sufficient nursing care to Beard.  Nutrition and hydration are essential for preventing bedsores.  necessary staff is needed to turn and reposition residents and to change bandages to prevent infection.

"The defendant failed to implement proper infection control procedures, failed to intervene with appropriate medication, failed to treat Doris Beard for pain, and failed to keep Doris Beard's family of changes in Doris Beard's condition," the suit says.

"The defendant knowingly and willfully made numerous material representations to the plaintiff, upon which misrepresentations the plaintiff relied upon to their detriment.

"Material misrepresentations were made by the defendant with the intent to induce reliance thereon by the plaintiff."

"The defendant acted with conscious indifference and endangered Doris Beard's rights, safety, and welfare," the suit says.

 

 

 

 

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Often when maggotts are found in a resident's pressure ulcer (normally caused by the lack of proper wound care and cleaning), the nursing home tries to argue to the family that the maggotts are a method of cleaning the wound and that the nursing home intended the maggotts to clean the wound (despite no physician order typically).  Well, that frivolous argument has now been proved wrong.

Reuters had an article about a recent study in the British Medical Journal of the world's first controlled clinical trial of maggot medicine.  Maggotts may clean wounds quicker than normal treatment but this does not lead to faster healing. Some patients also found so-called "larval therapy" more painful. 

To find out more, researchers at Britain's University of York recruited 267 patients with venous leg ulcers and treated them either with maggots or hydrogel, a standard wound-cleaning product. They found no significant difference in outcomes or cost.  Larval therapy works because maggots eat only dead and rotting tissue, leaving a clean wound. They do not burrow into healthy flesh, preferring to eat each other when they run out of food. 

 

 

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A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.

McKnight's had a recent note about the most recent study analyzing the data of pressure ulcers in nursing homes.  More than one in 10 nursing home residents had a pressure ulcer in 2004, according to newly released statistics from the Centers for Disease Control and Prevention.

The report proves widespread neglect related to wound care.  Roughly 159,000 nursing home residents—11% of the total—had some form of pressure ulcer. Stage two pressure ulcers were the most prevalent, the report found.   However, many nursing home employees have no training in wound care and do not know how to properly stage a pressure ulcer.  

Younger residents who experienced shorter lengths of stay also were more likely to have pressure ulcers.   This disproves the defense argument that "old" people get pressures ulcers and that they are "unavoidable".  

A total of 35% of those with pressure ulcers stage two or higher (more severe) received "special" wound care treatment, according to the CDC.   There were no significant differences in pressure ulcer rates between white and non-white residents, according to the report.

The report, "Pressure Ulcers Among Nursing Home Residents: United States, 2004," was released Wednesday.   Authors gathered data for the report from the 2004 National Nursing Home Survey, which sampled responses from more than 14,000 nursing home residents around the country. The CDC report can be found online at http://www.cdc.gov/nchs/pressroom/upcoming.htm.

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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.”

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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.

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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

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