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Severe bedsores are never events that can be avoided with proper care

Prevention is the key in hospital and nursing home acquired pressure injuries

Pressure wounds (also called pressure sores, bedsores, or decubitus ulcers) are tissue injuries that are largely preventable. At the same time, though, they may develop quickly. Bedsores typically develop on parts of the body that have bony prominences, including the bottom (tailbone), hips, heels, and ankles.

Bedsore prevention and treatment report issues in a recent opinion entered by the Beaumont Court of Appeals styled Magnolia Place Health Care, L.L.C. v. Jackson, No. 09-20-00266-CV, In the Beaumont Court of Appeals. You can read the opinion here.

A dialysis patient had lived at Magnolia Place for over a year before he was transferred to Kingwood Medical Center because of critically low potassium levels after a dialysis session. Once he was admitted to the hospital, he was documented to have “an unstable decubitus ulcer measuring 7x8 cm on his backside, cellulitis of left AV fistula, and 2 punctured ulcers on his left AV fistula.” The infection tested positive for Staph aureus.

Having handled many bedsore cases, I frequently think about what a medical expert once said about treating bedsores in elderly patients. She explained that the best treatment is prevention. That’s because it’s very difficult and calorie-consuming to heal bedsores and severe pressure wounds.

Are bedsores preventable?

Hospitals, nursing homes, and assisted care facilities frequently defend bedsore cases by saying they are unavoidable even with good care.

I think there is a measure of truth to that when it comes to early-stage pressure injuries. Once they develop into Stage 3 or 4 pressure ulcers, though, the healthcare accrediting agency The Joint Commission classifies them as sentinel events that should never happen.

Later stage pressure sores often cause severe infections and sepsis, which are also difficult to treat, require lengthy hospital treatment, and can lead to death.

Case allegations

In the Jackson case, the plaintiffs filed a medical malpractice wrongful death lawsuit against Magnolia Place Health Care, alleging negligence for:

• Failing to prevent pressure ulcers

• Failing to assess, document and report a change in the patient’s condition

• Failing to institute appropriate nursing interventions to stabilize the patient and prevent complications

• Failing to properly train its staff

As a result of this negligence, the plaintiffs alleged that the patient develop sepsis that caused his death. They also alleged that the Magnolia facility was grossly negligent for “knowingly and intentionally allow[ing] the deceased to essentially rot in his own bed causing hi[m] to suffer huge, ulcerated bed sores that led to his death.”

The defense and appeal

Even in relatively clear cases such as this, Texas law requires medical malpractice plaintiffs to comply with the tort reform requirement of producing one or more medical expert reports early in litigation. In this case, the plaintiff timely produced a report from a physician with board certification in internal medicine, rheumatology, and geriatrics and experience in treating nursing home patients. The plaintiffs also timely produced an expert report from a registered nurse with clinical experience in wound care nursing.

The facility objected that the reports were insufficient because the experts were unqualified and their reports did not sufficiently detail the applicable standards of care, how Magnolia staff deviated from them, and how such conduct proximately caused the patient’s death.

Ultimately, the trial court denied the objections and motion to dismiss and the Beaumont Court of Appeals agreed with that decision.

Withholding medical records

One of the issues that caught my eye in this case is the fact that the medical expert noted in his report that Magnolia Place “thus far refused to produce the clinical records” and that he had “been forced to produce a chapter 74 report without this vital record.”

Incredibly, to me, the facility objected to the physician expert’s report on the ground that he admitted to never having received or reviewed the patient’s medical records from Magnolia Place and, thus, had no knowledge of events, the patient’s condition, or the facility’s conduct.

The squabble between the plaintiffs and the facility was apparently over Magnolia Place’s contention “that an authorization signed by a legally authorized representative of Robinson’s estate was required to obtain Robinson’s medical records from Magnolia.” Eventually, the plaintiffs open an estate in a probate court and produced an authorization signed by a court-appointed administrator.

I wonder if absent this litigation the family would’ve proceeded with opening a costly probate matter. Many estates wouldn’t need that.

When we encounter this argument from hospitals and health care facilities in medical malpractice wrongful death claims, will quickly remind them of how Texas law works, as an exception to the more routine HIPAA regulations.

Under Texas Civil Practice & Remedies Code Section 74.051 & 74.052, the statutory authorization form for release of protected health information, which must accompany a pre-suit notice of healthcare liability claim, may be signed by a parent, spouse, or adult child of the deceased person.

When there’s an initial resistance to producing medical records, or the facility is getting the runaround over who signed the authorization, my next step is invariably sending a notice of claim with the statutory authorization. That way, the facility has 45 days to turn over the records.

If you’ve been seriously injured because of poor hospital, nursing home, or other health care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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