I am currently working on a case for a widow whose husband developed bed sores while in the hospital and those wounds caused him to develop two serious infections: sepsis and Clostridium difficile. The bed sores were so severe and the infections so strong that they persisted for more than a year and he ultimately died from a combination of cardio respiratory arrest and sepsis. The sad truth is that these bed sores should never have occurred. In fact, all bed sores are preventable and at worst, if one begins to develop, immediate action can lead to rapid healing with no damage.

Never let anyone tell you that bed sores are an accepted fact of life of long term care. They are not. The overwhelming number of long-term hospital and nursing home patients never develop bed sores thanks to the application of good standards of care, the use of modern technology and the diligent work of the medical staff.

The presence of bed sores, particularly advanced bed sores, is almost always an indicator that medical malpractice has occurred. Advanced bed sores are very painful, difficult to treat and can lead to life-threatening infections as they did in the man whose widow I now represent.

This article provides basic information on bed sores by explaining what they are, how they form, how to prevent bed sores, the four stages of bed sores and how they are treated. This information is not a substitute for medical or legal advice. If you need medical treatment, please see a medical doctor as soon as possible. If you need legal advice, you should consult an experienced medical malpractice attorney.

As a New York medical malpractice attorney, I help clients prosecute claims of medical malpractice. The medical malpractice lawsuit can help a person or family of a victim receive justice and compensation for their loss or damages. The medical malpractice lawsuit pressures providers into improving care so that future patients do not suffer similar abuse.

What are bed sores?

Bed sores, sometimes spelled as bedsores and sometimes known as pressure sores are decubitus ulcers. These pressure ulcers result from prolonged pressure on the skin, though repeated friction can cause bed sores as well. They may begin as a mild pink mark on the skin though they can develop into open and deep wounds that extend to or even through bones.

How do Bed Sores Occur?

A bed sore will develop when a person's skin becomes trapped between his or her bones and an external surface, such as a hospital bed or a wheelchair. If this condition persists, a lack of blood circulation will occur and the skin will decay. It is easy to understand how repeated friction can cause the skin to blister or tear.  Bed sores develop their name because they often occur during a prolonged hospital or nursing home stay when a person may lay in bed for hours or days on end with little or no movement.

Bed sores most often develop near bony areas of the body. For example, these skin ulcers will develop when a patient's skin becomes trapped between the hip bone and a nursing home mattress for an extended period of time. Other bones that frequently become involved with bed sores include the spine, tailbone, elbow, heel and foot.

The longer a person goes without moving, the more likely a bed sore will form and the longer it goes untreated and the pressure unalleviated, the worse the bed sore will become. Nursing homes with lax standards or inadequate staffing often produce conditions where patients develop bed sores.

Preventing Bed Sores

The best way to avoid bed sores is to ensure regular movement of the body and to keep the person well-hydrated and well nourished. The hydration and nourishment promote healthy skin and good blood flow. The regular movement ensures that no part of the skin becomes trapped for a prolonged period of time. Standard protocols in nursing home and extend hospital stays require moving a bed-ridden at least once every two hours.

Here is a list of standard ways to prevent bed sores:

1. Reposition a person at least once every two hours.
2. Position a person in bed to minimize pressure, including keeping the head flat and perhaps placing a pillow between the knees.
3. Use devices to reduce pressure on the body. Many hospitals and nursing homes now use gel mattresses or mattresses with air circulating through them. Patients who spend considerable time in a wheelchair can use seat cushions made of gel or foam to alleviate pressure.
4. Change sheets frequently to avoid the spread of infection.
5. Keep the skin dry and free of perspiration or fluids (e.g. fluids that drain from wounds) as these can promote bed sores.
6. Massage the skin to promote healthy blood flow
7. Inspect areas of the body that are likely to form bed sores for signs of redness. If redness does occur, take immediate action.

I cannot stress enough the importance of prevention. Given the available body of knowledge and experience, there is no reason for patent to develop a serious bed sore or decubitus ulcer. If a patient develops a Stage One bed sore (pink or red skin), rapid recognition and treatment will led to immediate healing and the prevention of a more serious condition.

Four Stages of Decubitus Ulcers or Bed Sores

Like other wounds, bed sores are categorized in four stages according to severity:

Stage One:Intact skin with redness. The treatment consists of identifying the source of the bed sore and alleviating pressure as well as covering and cushioning the affected area. Doctors will take steps to ensure an adequate diet and adequate hydration and may prescribe increased Vitamin C and zinc. Stage One bed sores may heal themselves and are readily treatable. The key is to identify the source of the wound and to prevent any worsening of the condition.

Stage Two:This stage involves blistering of the skin, though the blister may be either broken or unbroken. The most notable change from a Stage One wound is that the skin is now injured. In addition to the same steps taken to treat a Stage One wound (i.e., alleviating pressure), Stage Two wounds require wound dressings that not only protect the affected skin area, but also provide insulation and absorption of any fluids. Doctors may use skin lotions to hydrate the area and will monitor nutrition as well. It is critically important to aggressively treat a Stage Two bed sore to prevent any worsening. Stage Two wounds are readily treatable and any worsening only results from a lack of sufficient care.

Stage Three:This stage involves a clear break in the skin and the wound may extend through all layers of the skin. Infections are likely to occur, making a Stage Three wound particularly dangerous. The treatment of Stage Three wounds can be difficult and requires immediate efforts to alleviate pressure and to cover and protect the wounded area. Doctors may use antibiotics to treat infections that develop.

Stage Four:This stage involves an open wound that extends through the skin and affects underlying tissue such as muscles, tendons or ligaments. Stage Four wounds can affect bones and organs.  Stage Four wounds are very painful and can be life-threatening. Treatment usually requires the intervention of a wound specialist and may require surgery.

Treating the Serious Bed Sore

The best treatment is prevention as prevention is much easier than treating the serious skin ulcer.

All stages of bed sores require at least two forms of treatment:

1. Relieving the pressure that caused the bed sore.
2. Ensuring adequate hydration and nutrition. The diet should have a high protein content and adequate vitamins and minerals, particularly Vitamin C and zinc.

If the bed sore breaks the sin, then medical providers must take additional actions to protect the wound and facilitate healing. The medical staff should provide a dressing for the wound and may use a lotion to help the healing. If the bed sore is infected or oozing fluids, then the medical staff must keep the wound clean, usually by using a saline solution to help clean it. If dead skin develops, the doctors will remove the dead skin (known as debriding). Doctors may irrigate the wound to keep it clean.

The deepest bed sores are the most difficult to treat. Some doctors may use surgery to place a layer of skin over the wound. They will also use antibiotics to treat infections.

Patients with Bed Sores

It can be very difficult to learn that a loved one has developed bed sores. We may feel guilt for not preventing the wound, even though we did our best to ensure our loved ones receive good medical care. We may experience anger at the medical staff. The best thing we can do is to ensure that the medical provider acts aggressively to treat the bed sore and prevent further bed sores.

If you have questions about bed sores that you or a loved one has developed, you should seek the care of a good doctor, perhaps a wound care specialist. If you have legal questions regarding bed sores and medical malpractice, you may want to consult an experienced and successful medical malpractice attorney. I handle medical malpractice cases in New York and if you have a bed sore or medical malpractice question in New York, I will be glad to answer your questions and assist you. You can call me at 1-800-660-1466 or mailto:Carol@SchlittLaw.com?subject=Client%20Inquiry" email me.

This material is intended for informational uses only. It is not meant as legal advice. To receive legal advice, you should consult an attorney.