Bedsores, Pressure Sores, Decubitus Ulcers

Wrongful Death Lawsuit Against Maryland’s Largest Nursing Home Raises Unsettling Questions

October 30, 2024 | Lebowitz & Mzhen

The statistics speak for themselves: Elder abuse in nursing homes is much too commonplace across Maryland… and the nation. Sadly, too, the trend is not only limited to second- and third-tier nursing facilities. As personal injury specialists, the attorneys at Lebowitz & Mzhen, LLC, are very familiar with the uncomfortable fact that seniors living in elder care facilities may be at greater risk of abuse, injury or death than their loved ones may know.

It’s so very unfortunate that a large segment of our aging population residing in nursing homes, elder care facilities and long-term care operations are likely to experience some kind of physical or mental abuse, or simply poor care or neglect at the hands of nursing home employees — and even medical professionals charged with their well-being. Again, this is not surprising to those who follow the elder care industry; studies by the National Council on Aging indicate that one in 10 American citizens 60 years and older have experienced some form of elder abuse — shockingly, more than 95 percent of incidents involving abused residents of assisted living facilities, long-term care operations and nursing homes typically go unreported.

Not long ago, a news story revealed some terrible facts surrounding the apparent abuse and ultimately the death of an elderly resident at the Hebrew Home of Greater Washington, located in Rockville, MD. The information came to light as part of a multiple-count wrongful death lawsuit filed by the estate of Sara McAlpin, who died at the age of 96 from complications related to a Stage 4 pressure ulcer (also known as a bed sore). Bed sores in patients who reside at elder care facilities are considered evidence of neglect and Ms. McAlpin’s medical condition featured one of the worst kinds of decubitus ulcers — a large open wound greater than “the diameter of a teacup” exhibiting exposed bone and damage to the tissues underneath.

Nursing Home Patients and the Risk of Bedsores

March 31, 2023 | Lebowitz & Mzhen

When sending a loved one to a nursing home or a long-term care facility, we expect and hope that the facility team members will do their job and do it well. Putting the care of a loved one in the hands of others is an act of trust, but when facilities fail to effectively care for patients, this goes against federal and state laws that serve to protect patients. In a recent case from Florida, a Florida jury awarded $12.5 million in damages after a wrongful death lawsuit involving an assisted living facility. The deceased’s family brought the suit against the facility, alleging that the facility’s negligent care resulted in their family member developing a fatal bloodstream infection from a bedsore. The deceased, an elderly woman with Alzheimer’s, was alleged to be physically healthy when she entered the facility, according to the lawsuit. However, two months after moving to the facility, the elderly woman developed severe bedsores and pneumonia, which required emergency medical care.

The lawsuit alleged that the woman developed a severe bedsore on her back, which caused an open wound deep enough to expose the bone. The wrongful death lawsuit claimed that the facility was understaffed and negligent, which caused the deceased to develop a severe and fatal stage of pressure ulcer. In the end, the jury sided with the plaintiff, and the family was awarded a $12.5 million verdict.

What Are the Risks of Bedsores?

Bed sores, which may also be referred to as pressure sores or decubitus ulcers, are skin lesions that can develop in a hospital, nursing home, or long-term care facility due to a lack of blood flow to an area of skin that is exposed to prolonged pressure. In long-term care facilities, it is standard protocol to pay close attention to those who have a higher risk of bedsores, either by changing the patient’s position every two hours or using pillows, for example. In cases involving bed sores due to neglect of the nursing home provider, the neglect may be that they failed to monitor or reposition patients who have limited mobility.

The Dangers of Bedsores to Residents of Maryland Long-Term Care Facilities

May 3, 2022 | Lebowitz & Mzhen

Abuse in neglect in nursing homes and long-term care facilities can sometimes be hard to detect. Families often place their loved ones in a facility after the elder has experienced some form of cognitive decline or illness. The symptoms of aging may mirror those of nursing home abuse, and as elderly residents may suffer from communication, memory, or cognition issues, it can be difficult to determine if a loved one is being properly cared for while living in a nursing home or long-term care facility. Bedsores, also known as pressure ulcers, are one condition that is noticeable to family and may be a sign of serious abuse or neglect.

A recently published article in a legal trade publication discusses bedsores in nursing homes and the abuse or neglect that the condition may be evidence of. Initially, bedsores are a skin condition that develops in patients as a result of being left in the same position for an extended period of time. Nursing home residents who spend all day in a bed or wheelchair without changing positions may develop bedsores. Some symptoms of bedsores include tenderness, swelling, discolored skin, abnormally textured skin, and a pus-like discharge from the affected area.

If left untreated, bedsores can worsen and cause serious health problems. What starts as a condition only affecting the outer layers of skin can move deeper and deeper into the body, as far as the bones, and ultimately may cause infection and become untreatable. Infections caused by bedsores are a cause of death for many nursing home and long-term care facility residents. The risk of death notwithstanding, untreated bedsores are a source of extreme discomfort and can make your loved ones’ lives very difficult.

Nursing Home Rating System Masks Problems in Maryland Nursing Homes

March 18, 2021 | Lebowitz & Mzhen

The U.S. Nursing Home rating system was introduced twelve years ago, providing for ratings from one to five stars. It was meant to provide a way for people to evaluate and compare nursing homes for their loved ones. However, an investigation by the New York Times recently revealed that the rating system is not an accurate reflection of the quality of care given at a nursing home. The investigation found that many nursing homes have manipulated the system to improve their ratings and hide problems, raising serious concerns for Maryland nursing home residents.

The rating system is based on a combination of self-reported information and on-site inspections. The investigation found that the information submitted to the Centers for Medicare & Medicaid Services (C.M.S.) is often wrong, making facilities appear cleaner and safer, and that the government rarely audits the data provided through self-reporting. Accidents and health issues are often unreported, it also found. Abuse and neglect were discovered through inspections at five-star facilities, but the inspectors rarely found the infractions serious enough to lower the ratings. A previously conducted study from the University of Chicago found that nursing homes did not report about 40 percent of residents who were hospitalized after serious falls.

It also found that the nursing homes were not prepared for the pandemic in part because the rating system allowed them to ignore staffing requirements and infection-control deficiencies. Over 13,000 nursing home residents have died due to COVID-19. The Times found that residents at five-star facilities were about as likely to die due to COVID as residents at one-star facilities. At some nursing homes with five-star ratings, “residents developed bed sores so severe that their bones were exposed.” The son of a resident at a five-star facility on Long Island who died from COVID-19 in the spring believed that the facility was short-staffed or overcrowded because before contracting COVID-19, his mother was moved from a private room into one with other residents.

Court Finds Medical Malpractice Affidavit Is Defective in Bed Sore Case

June 14, 2017 | Lebowitz & Mzhen

Last month, an appellate court in Georgia issued a written opinion in a case brought against a hospital involving allegations that the hospital was negligent in allowing the plaintiff to develop a stage IV bed sore. Ultimately, however, the court rejected the plaintiff’s case because the required expert affidavit that was filed along with the case failed to comply with state-law requirements.

The Facts of the Case

The plaintiff was admitted to the defendant hospital while he was unconscious. While he was being treated by the hospital, he developed a stage IV pressure ulcer near the base of his back. The plaintiff filed a personal injury lawsuit against the hospital, claiming that the hospital staff was negligent in failing to assess and treat the pressure ulcer and to properly care for him while he was unconscious.

As is the case in Maryland, under Georgia state law, medical malpractice plaintiffs must submit an affidavit in support of their claim. Essentially, the affidavit must come from a medical profession in a relevant field, and it must “set forth specifically at least one negligent act or omission claimed to exist and the factual basis for each such claim.”

Nursing Home Resident Dies After Developing Gangrene from Untreated Bedsores

October 7, 2016 | Lebowitz & Mzhen

A recently published news report discusses the tragic story of an 88-year-old man who passed away in August 2015 after developing gangrene in two improperly untreated pressure wounds, or bedsores, that significantly worsened while he was living at a nursing home. According to the report, the deceased man’s daughter-in-law discovered the wounds while visiting her father at the nursing facility and requested that he be taken by ambulance to a hospital for immediate treatment. Despite the request, the nursing home staff refused, insisting the wounds were minor and manageable. Against the advice of the nurses and employees at the nursing home, the resident’s daughter took him to the hospital herself.

The Man Was Not Hospitalized Soon Enough and Succumbed to a Gangrene Infection

Although his daughter took matters into her own hands and hospitalized the man after she discovered what appeared to be severely infected pressure wounds, the action was not taken soon enough to save his life. By the time the man arrived to the hospital, the infection had taken over, and his organs were shutting down. He passed away shortly after he was admitted. Seeking answers and compensation for the apparent negligence of the nursing home, the man’s daughter pursued elder abuse and nursing home neglect claims against the nursing facility. According to the report, the daughter alleged that the medical professionals and support staff at the nursing home failed to properly prevent, diagnose, or treat his condition, ultimately resulting in his death.

Deceased Woman’s Family Files Wrongful Death Claim Against Nursing Facility

September 9, 2016 | Lebowitz & Mzhen

The executor of a deceased former resident’s estate has filed a wrongful death claim against a Chicago area nursing home on behalf of the woman’s surviving family members. According to a local news source, the family is seeking damages for the woman’s wrongful death, which was allegedly caused by the negligence of the employees and management of the nursing facility where she died. The lawsuit was filed on August 10 in Illinois state court and is seeking over $50,000 in damages, according to the news source.

The Plaintiffs Allege that the Defendants Failed to Adequately Supervise the Condition of the Deceased Resident

The plaintiffs in the case of Rodriguez v. Aperion Care International are the surviving family members of a woman who died earlier this year while living at a nursing home facility operated by the defendants. According to the allegations discussed in the news article, the woman died after suffering from skin breakdown and pressure ulcers that she developed while bedridden at the defendant’s facility. These conditions, which allegedly led to her death, are commonly known as bedsores and are generally preventable if residents are cared for properly.

University of Maryland Study Shows Correlation Between Patient Turnover and Poor Nursing Home Quality

February 17, 2014 | Lebowitz & Mzhen

Earlier this month, two studies came out of the University of Maryland that examined why many nursing homes are providing inadequate care to their residents. The answer will probably not surprise many who have stayed in a nursing home themselves or had a loved one stay in a nursing home: The studies show that high turnover rates among staff members have a detrimental effect on overall nursing home quality, as well as the quality of care offered by the nursing home.

A recent article by Infection Control Today details a few of the studies’ findings, including one that suggests high Certified Nurse Assistant (CNA) turnover results in an increase chance that a patient will suffer from a pressure ulcers, pain, or a urinary tract infection. The basis conclusion of both studies is that preventing nursing home staff turnover should be a higher priority for nursing home management.

Nursing Home Management in Maryland

While these studies indicate that an increase in CNA turnover increases the odds of health problems in nursing home patients, the fault does not all lie with the individual CNAs. Nursing home management is charged with making many of the staffing decisions that lead to the high turnover in the first place. If nursing home management does not create a healthy, pleasant working environment, high turnover is inevitable.

Maryland Attorney General Announces $48 Million Settlement over Unapproved Bed Sore Ointment

March 13, 2013 | Lebowitz & Mzhen

The Maryland Attorney General announced last month Maryland has reached an agreement with

with Healthpoint and DFB Pharmaceuticals, its partner. The settlement, to which fifteen additional states and the federal government are also plaintiffs, is a result of allegations that Healthpoint was responsible for causing false claims to be submitted to the Maryland Medicaid programs for one of its products called Xenaderm. Xenaderm is a skin ointment that was prescribed to many nursing home, and potentially other, patients for the treatment of bed sores. However, the drug has not received the required approval from the Food and Drug Administration (FDA).

The various complaints related to the settlement alleged that Healthpoint unlawfully marketed Xenaderm without FDA approval. The allegations further claimed that this marketing was modeled upon a drug created some time before 1962, which itself had received review from the FDA. The FDA ruled in the1970s that the principal ingredient in Xenaderm was “less than effective” for treating bed sores, its intended use. The defendant(s) allegedly misrepresented the drug’s regulatory status repeatedly in reports that it submitted to both federal and state agencies.

Subject to terms of the $48 million settlement, which is to be awarded to 47 states and the federal government, defendants Healthpoint and DFB Pharmaceuticals will have to pay roughly $33 million to settle Medicaid-based claims nationally. Maryland itself will receive nearly $350,000 in refunds to the state’s Medicaid program, which accounts for the improper payments on behalf of both the state and federal governments.

Federal Law Protects Nursing Home Residents from Bed Sores

February 19, 2013 | Lebowitz & Mzhen

Pressure sores or ulcers, which are commonly referred to as bed sores, are probably among themost common sort of potential new injury incurred by nursing home patients who are incapable of moving about freely. While they can be annoying or painful, they can also become infected and lead to a vast array of additional complications for nursing home residents. Perhaps most importantly, they can be prevented.

It’s for this reason that federal law makers have passed regulations for nursing home facilities which address this problematic complication.

42 CFR § 483.20 entitled “Resident Assessment” requires a comprehensive assessment of the resident. While this blog post focuses on the skin care assessment and bed sore prevention, the facility is required to assess 17 other factors, all related to the patient’s condition upon entering the facility. The facility has 14 days from the person’s arrival to complete this assessment, and it then has 7 days from the completion of the assessment to develop a care plan addressing the patient’s various needs.

42 CFR § 483.25 Quality of Care, explicitly addresses what must be done in regards to bed sores specifically. It states that based upon the comprehensive assessment, the facility must ensure that:

A resident who enters the facility without bed sores does not develop them (unless the person’s individual medical condition makes them unavoidable); and
A resident who does have bed sores must receive proper treatment and/or services to promote the healing process, prevent infections from developing, and prevent new sores from happening.