Bed Sores, Pressure Sores, Decubitus Ulcers

All too often, Rueb and Motta have helped clients in their twilight years who have suffered from bed/pressure sores, also called decubitus ulcers.  The ulcers are measured in grades, and they can lead to serious illness, sepsis and death. In cases where our clients have suffered ulcers, the facilities or caregivers were simply ill-equipped to deliver the scope of services necessary either due to the lack of physician skill or support or the lack of coordination of care by health providers.  Once detected, coordinated and intensive multidisciplinary care is necessary to avoid any further complications. 

The medical issues are more often than not significant since patients with deep Grade III or IV decubitus ulcers are typically chronically ill and immobile. Nutrition is also a big concern; malnourished patients will not heal. Infectious diseases are significant issues and these patients are often infected with very dangerous and resistant bacteria.  IV antibiotics must be used. Orthopedic surgeons may be required to assist with the plastic surgeon during surgery to provide more aggressive intraoperative care which may include removal of dead bone, placement of antibiotic beads into adjacent bone, and removal of infected underlying hardware. General surgeons may be needed for the more complex cases.  Physiatrists are often instrumental in the care of these patients because they are trained in determining psychosocial aspects of the patient that led to the ulcer, trained in the preoperative and postoperative care of these patients, and trained in managing patients with disabilities.  There are numerous other professionals that need to help care for the clients with decubitus ulcers.   They include dieticians, nurses knowledgeable in post-operative care who are familiar with the specialty beds necessary for the management of wound patients and the indications when an air mattress is appropriate and the use of a clinitron bed is necessary. Physical therapists and occupational therapists are also essential for a client’s success and ongoing health maintenance.

It has been our experience that clients have often been thru futile attempts of conservative, unsuccessful efforts over a period of months.  These patients had undergone numerous hospitalizations; they had been on prolonged bed rest which has led to depression,  malnutrition, and chronic infections. These patients have often been in multiple facilities that did not have the capability to manage or care for the ulcers. By the time they made it to Rueb and Motta, they were infected with difficult to treat bacteria that required toxic antibiotics and required more extensive invasive surgery, and some of them died.

To maximize recovery, Rueb and Motta demands recovery all medically necessary and appropriate care that will prevent complications, improve outcomes, and improve the psychosocial aspects of a catastrophic patient’s life. A client’s recovery must account for future therapy, wheel chairs and their replacement, routine medical treatments such as spasticity management, and aggressive medical treatments that are required in the future. We will demand all medical care, equipment, aid and attendant needs of a patient, and we employ experts who accurately predict changes in these needs as a patient ages; all of which is designed to prevent complications such as decubitus ulcers.

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It is simply unacceptable for a client to develop a decubitus ulcer while under the care of a health care provider. In fact the National Quality Forum of the United States has identified Grade III and Grade IV Decubitus Ulcers as 'never events which are inexcusable actions in a health care setting, the "kind of mistake that should never happen"'. With this strong policy statement by the government, a bed sore is ample evidence for an attorney to prove a breach in the standard of care that would support money damages for past medical costs related to treatment of the decubitus ulcer, costs related to prevention of reoccurrence, damages for pain, suffering and disfigurement, and this would support a cause of action for, elder neglect, dependent care neglect, and wrongful death.

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