I’m Wendy York from the York Law Firm in Sacramento.
There are a lot of types of skin traumas that indicate neglect or abuse, but pressure sores are almost always a clear indicator of neglect or abuse because they always result from a patient being left in one position for prolonged periods of time.
We all of us have bony prominences, and there are certain areas of our bodies where we would be at risk of developing pressure sores. How do you prevent them? When a resident is first admitted, be it a nursing home or a skilled nursing facility, that institution has a duty to assess the resident from head to toe. And when they do that nursing assessment, this is a regulatory requirement, they must do a full assessment that includes doing what’s called a skin assessment. In most skilled nursing facilities they call it a Braden Scale.
When a facility does a Braden scale assessment, a nurse must determine if a resident is at risk of developing pressure sores. And if the resident is at risk, the skilled nursing facility must, per the federal regulations, develop a care plan to prevent the development of pressure sores. Also, both federal and state regulations explicitly assert that if someone comes into a skilled nursing facility without a pressure sore, and then they develop it, that facility is in trouble. Skilled nursing facilities have a legal duty to provide all available care and services to prevent a pressure sore from forming.
The reason this is important for the government is because pressure sores are considered a “never event.” A “never event” is a term coined by Dr. Ken Kizer in 2001 that refers to medical errors that should never happen – such as performing surgery on the wrong body part, or performing surgery on the wrong patient. These are events are fatal and should never happen, but still, they do.
Some years ago the federal government realized that it was spending a lot of federal taxpayer dollars on “never events” for medical care, pressure sores being one of them, and the federal government said if these hospitals and facilities are creating this problem they won’t get reimbursed for treatment. Essentially, the government said ‘No, no, no, no, you facility or hospital. If this event happens on your watch, you are not going to get reimbursed for all the care and treatment that is necessary to heal that never event.’
It would be wrong to say that pressure sores are usually not intentional. Pressure sores are always the product of neglect from people not providing care and services, and neglect is a form of abuse. When I see pressure sores, that raises a red flag for me as an attorney that there’s probably issues of neglect or of failure to provide care and services.