Author Archives: Adam Peck

Pressure ulcer litigation is a growing concern for nursing homes. The incidence of a pressure ulcer alone is used as defacto evidence of neglect on the part of a nursing home. These cases rely on disparate medical records from all treating facilities, testimony of employees of record (when available), and the interpretation of events by expert witnesses. A neat linear format is created by this attenuated reconstruction of events. However, a confluence of factors can lead to the occurrence of a pressure ulcer. Additionally, limited evidence is available regarding the effectiveness of specific prevention strategies. Knowing the outcome in a case being litigated, plus the limitations described above, weakens one’s ability to objectively judge whether reasonable prevention strategies were employed in a timely manner or even whether prevention was possible.

Pressure ulcers are a phenomenon, not a disease or even a discrete medical condition. Pressure ulcers – skin breakdown that occurs entirely as a result of exposure to a toxic combination of physical forces, such as pressure and shear – are more accurately described as an injury as used by the Institute of Medicine (IOM). Experienced clinicians know that this type of pressure ulcer is the exception rather than the rule. Instead, the incidence of pressure ulcers in nursing homes is more accurately described as an event, often associated with medically complicated residents who usually are frail and immobilized. Clinicians must continue efforts to understand pressure ulcers, learn which can be avoided, and find better ways to treat them. Criminalizing this event will never provide an environment that encourages funding of the basic research needed to comprehensively understand their natural history nor will it help people at risk for developing pressure ulcers or those responsible for patient care.

The Current Nursing Homes Oversight Environment

The nursing home industry ranks high on the list of the most regulated industries by both state and federal oversight agencies. The federal government is a major stakeholder in the nursing home industry. In the year 2000, the federal government paid nursing homes an estimated $39 billion. Through the Centers for Medicare and Medicaid Services (CMS), the federal government performs an increasingly coordinated oversight role.

Septic sores, or infections involving a loved one in a nursing home.

Any occurrence involving broken bones, especially a fractured hip, a broken arm, or broken leg.

Any type injury or death occurring during or shortly after an occurrence of wandering (including outside the facility) when the staff is not aware that the resident is missing for some period of time

Resident is frequently ill, and the illnesses are not promptly reported to the physician, and or the family

Serious injuries requiring emergency treatment or hospitalization of a loved one

Rapid weight loss, or weight gain without physician or family notification, and a change in treatment being provided

Unexplained or unexpected death of the resident

One nursing home resident injures another resident

Heavy medication or sedation of a parent or a loved one in a nursing home

Nursing home patients have been dragged down hallways, doused with ice water, sexually assaulted and beaten in their beds, yet few prosecutions result says Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Many physical and sexual abuse cases in nursing homes are not treated the same as similar crimes elsewhere, Peck states.

Recently, a case of abuse and sexual assault was described as choking, breaking the elder’s neck, and her wrist bones and her hand.

This elder unfortunately died two days later from the trauma. The Facility staff member eventually pleaded no-contest and served a year in prison. The incident was not reported to a state official who was in the nursing home at the time of the beating, he said.

This particular investigation found that nursing homes rarely call police for attacks that would bring an instant response if they occurred elsewhere says California Elder Law Attorney Steven Peck.

Over two million Americans are cared for in 20,000 nursing homes. The homes received $100 billion in reimbursements from Medicare and Medicaid in 2010.