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Bed sores

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dlc56

Guest
My father-in-law was admitted to a hospital in early July to treat an infected wound in his foot caused by diabetes. He was in the hospital for a few days before they did a partial amputation of his foot. It did not heal and he had to have his leg amputated three weeks later. The care he received at this hospital was extremely lacking. He had a couple of good nurses but for the most part if we were not there to make sure things got done - they didn't. The wound from his amputated leg healed beautifully on its own within a few days and he was transferred to a rehabilitation/nursing facility. When he arrived there and we were helping to get him situated we noticed horrible bed sores on his back side. The rehab facility did what they could to help them heal but did not have much luck. Last night we had to take him back to a hospital (we chose another one). He has a staph infection in his blood apparently caused by these open wounds (one of them has tunneled). He is very sick and in intensive care. His blood pressure is very low; his heart rate very high; bleeding internally (not found where yet). They are aggressivaly tending to the wounds but were flabergastted when they saw them. My heart is breaking for this dear man who is suffering so much unnecessarily. He will be 80 in two weeks. During our first week at the rehab/nursing facility another patient was brought in from that same hospital with bed sores. We got excuses daily from the first hospital that they were understaffed and had "paperwork" to do; etc. etc. The lack of empathy and caring scared me. I pray I never have to go! This has got to stop somewhere. It was their lack of care and diligence that caused the bed sores. We have never considered sueing before but maybe it will make them change the way they care for their patients. If it saved one person from having to go through the unnecessary pain that my father-in-law is experiencing now it will be worth whatever aggravation it causes. Thank you in advance for your advice.
 
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tigger22472

Senior Member
Although I am one that knows that sometimes they are unavoidable and sometimes even with the proper care they continue to get worse I have a few suggestions for you. One is to call your state health department and report it. They are required then to go to the hospital and do a check and investigate. They can get access to his medical records and find out if it was being treated at all in the hospital. The down side to this for the hospital and I do say sometimes I have to sympathize is that if they WERE doing what was supposed to be done they could still get in trouble for it which IMO isn't necessarily right.

In the nursing home I work at we had a resident who developed 'a red spot' and it was reported and treated as it was to be yet no matter it continued to get worse (it had not tunneled). State was called and came in. The state rep continually asked our DON why the resident was allowed to get the sore. The DON showed records proving it was treated very very early on and it didn't satisfy them. I know of other residents that yes they do continue to tunnel with proper care but their skin is so fragile that it matters not.

My husband received a bed sore over 2 years ago while in traction(it was no where close to beginning to tunnel) when he broke his neck and although he's young (32) and move to get pressure off of the spot the spot is still noticable.
 
D

dlc56

Guest
Not treated

AL
Thank you for the information. The nursing facility treated them as best they could. The hospital where they developed did not. There were so many other obvious neglects that it doesn't surprise us. Everything I have read about them indicates that they are very preventable with diligent care which he obviously did not receive.
 

tigger22472

Senior Member
dlc56 said:
AL
Thank you for the information. The nursing facility treated them as best they could. The hospital where they developed did not. There were so many other obvious neglects that it doesn't surprise us. Everything I have read about them indicates that they are very preventable with diligent care which he obviously did not receive.
The big question is do you KNOW for certain that it wasn't treated in the hospital? I mean have you seen his records? Also despite what you have read sometimes even in diligent care they aren't always preventable and I suspect that due to the diabetes your FIL's skin is fragile and age definately plays a role in it also. The skin is much much much (did I stress much? lol) more fragile in older people. As I said I've seen it where it has been treated from the moment of a simple RED SPOT and still it progressed and continued to progress.
 

ellencee

Senior Member
Everything I have read about them indicates that they are very preventable with diligent care which he obviously did not receive.
Whoa, now! What a blessing it would be if that statement were only true!

Bedsores, which are called decubiti (a single 'sore'=decubitus), can develop and progress to the stages that you described in spite of the best of care.

I suggest that a representative for your father obtains his hospital records from the first hospital. Perhaps his physician could do that for you or the currently treating hospital could do that. Once you have the records, you need to have the records reviewed by an RN. You probably know an RN that you could ask to review the records. Don't ask an LPN, a CNA, an MD, and don't try and do it yourself. Only an RN can tell you if proper nursing care was implemented.

To have a medmal suit, your father-in-law would have to have suffered significant damages that would not otherwise have occurred and the damages must have been foreseeable--in other words--for your father-in-law to have a claim, it would have to be proven that more likely than not, he would not have developed stage III decubiti and would not have developed a systemic infection secondary to the decubiti without the negligent care rendered by the nursing staff and the MD.

Here's what you are up against:
age (80 years old),
diabetes (very poor peripheral circulation/nerve function which leads to skin breakdown despite adequate care; predisposition to developing systemic infection),
inadequate nutrition and hydration (because healing his surgical site placed abnormal demands on nutrients and fluids),
immobility without alternative positioning except to turn from side to side which never allows the entire back and buttocks to be free of pressure).

Even if you prove the hospital did absolutely nothing to prevent or treat the decubiti and is guilty of the grossest of gross negligence, it will be a challenge to prove that the outcome would not have been the same.

I sincerely hope that you are able to find the answers and the remedies that are needed. I absolutely abhor sorry nursing care. I can not and will not make excuses for any nursing care that does not include maintaining the integrity of the skin through judicious repositioning, massage, and keeping the areas clean and dry. I simply caution you about not to believe with absolute certainty that negligence equals money.

If your father-in-law can not file a medmal suit, JCAHO and any other accrediting or licensing organization will respond to the complaints and any board of nursing will take disciplinary action against any CNA, LPN, or RN who fails to provide necessary skin care and results in stage III decubiti.

EC
 

tigger22472

Senior Member
Ellencee... You'll like this. State came in to our facility and saw the records of a resident that had a bed sore and saw that the facility had reported on this spot No less then daily and often each and every shift and it was charted what was being done... as I said it started as a red spot. The person from state kept repeating...."Why did you let her get it?" Our DON repeatedly showed this person the records. She said the state lady just kept asking that same question OVER AND OVER. It's just another example of the people in charge HAVING NO CLUE!!

You are SO right too about the circulation and the skin. I too despise neglect when it comes to nursing care but I also have seen MANY situations where these things have a life of their own and one treatment might work for one person but not for someone else. That alone would rule out malpractice if they tried something and it didn't work as it delayed care.
 

ellencee

Senior Member
dlc56
You can do one thing very quickly and it may help get your plans in order.
tigger22472 will have to help me out on the name of the form, but when someone is admitted to a nursing home, an FL2 or FL72 or some kind of FL has to be completed by the MD prior to the patient's discharge from the hospital and prior to the admission to the nursing home. Get that form and see if decubiti are listed as a problem and if so, what are the measurements, grade (I, II, III, IV), and what treatment is ordered.

A nursing home or any longterm care facility should refuse to admit a patient with stage III decubiti. (I think it is a licensing standard, but I am not sure.) If the FL? lists stage II and the patient arrives with a stage III (which can happen overnight), the patient should be turned around and sent to the hospital. Unfortunately for your father-in-law's facility, once they admitted him, they accepted liability for the decubiti and the development of the systemic infection.

The hospital would probably defend with the nursing home's negligence of admitting a patient who did not meet admission standards (stage III decubiti or an increase in decubiti measurement after the completion of the FL?).

I don't think your father-in-law would be able to sue the hospital without also suing the nursing home.

EC
 

tigger22472

Senior Member
I'd help if I could but I don't know the forum # either..LOL

But you are correct... I guess a good question too is to know if the patient was in the nursing home before the hospital also.

OP Ellencee also made a good point on how you would have to prove that he wouldn't of gotten this regardless before have a malpractice suit. You have to consider his condition, his problems.. ETC...

For example, in my husbands case it was likely VERY unpreventable. He was FLAT on his back in traction (basically screws in his head hold his head still and held down by weights) for 6 days... put on top of that the fact that his condition didn't have him eating well which can affect the skin condition as well as circulation. Once surgery was over he could be moved from side to side to remove pressure but by doing this you're also risking somewhere else getting a sore depending on the skin. And again 2 years later you can still see where the spot was and all it looked like was a broken blister... no tunneling.

We are not saying that there wasn't neglect we are just saying you need to make sure of this before pursuing it. Without being certain or having it reviewed you are looking at spending a lot of money for something that you won't win at.
 
D

dlc56

Guest
I appreciate the information

Thank you for all the good information. My father in law was independent and living alone when he was first taken to the hospital. We are not looking for money unless it would be to supplement the extra rehab that might not get covered by Medicare. What we would like is a solution and for it not to happen to anyone else. Yes, we know for a fact that they were not attended to. We witnessed, we asked, we reported, etc. That is interesting about the rehab should not have admitted him though. Right now we just want him to live, he is in ICU with septic shock and in extreme pain because they can't give him any pain medication due to the low blood pressure. No one should have to endure this. Maybe bed sores are inevitable but when they are present and not treated there is a problem and someone needs to answer to it and correct it. If they are in fact under staffed then stop accepting patients if you can't care for them.
 
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