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How to Prove a Pressure Ulcer Is Due to Neglect

February 1, 2024 Nursing Home Info

Our attorneys have handled numerous cases involving pressure ulcers.  A pressure ulcer, also commonly referred to as a “bedsore”, is an injury to skin and underlying tissue resulting from prolonged pressure on the skin. In many instances, a pressure ulcer is due to neglect.  But how does a lawyer prove it?

In this blog post, we will explain everything you need to know about pressure ulcers.  We will also explain how we go about the process of proving a pressure ulcer is due to neglect.

Understanding the Basics of Pressure Ulcers

Pressure ulcers usually occur in patients who are hospitalized or in nursing homes.  For a pressure ulcer to occur, the patient must be somewhat immobile.  Healthy people can reposition themselves at any time, but sick and feeble people can have mobility deficits. This presents the risk of prolonged pressure to one small area of the body.

In regard to the areas of the body that are most commonly affected, the tailbone or sacrum area is the most prevalent, followed by the heels. Many patients in nursing home beds are left in the “fowler’s’ or “semi-fowler’s” positions, both of which cause pressure on the tailbone and the heels. Below is photo from showing the fowler’s position:


When a patient is in the semi-fowler’s or fowler’s position for too long, pressure on the tailbone and the heels causes loss of blood supply to those areas.  As a result, oxygen does not reach the skin and tissue in these areas. Once that occurs, cellular death begins, leading to a pressure ulcer. It only takes 2-3 hours of prolonged pressure for the cellular death process in skin/tissue to begin.

Different Stages of Pressure Ulcers

Pressure ulcers are categorized by medical professionals into four stages, from least severe to most severe. Johns Hopkins Bedsores Guide sets forth these four stages:

  • Stage 1. The area looks red and feels warm to the touch. With darker skin, the area may have a blue or purple tint. The person may also complain that it burns, hurts, or itches.
  • Stage 2. The area looks more damaged and may have an open sore, scrape, or blister. The person complains of significant pain and the skin around the wound may be discolored.
  • Stage 3. The area has a crater-like appearance due to damage below the skin’s surface.
  • Stage 4. The area is severely damaged and a large wound is present. Muscles, tendons, bones, and joints can be involved. Infection is a significant risk at this stage.

We will not provide pictures because of the graphic nature of pressure ulcers. However, feel free to Google this if you have concerns your loved one is developing a pressure ulcer.

Life-Threatening Complications from Pressure Ulcers

Pressure ulcers can be fatal.  The primary concern is the risk for infection.  If a pressure ulcer becomes infected and is not quickly diagnosed, it can lead to sepsis. The Mayo Clinic defines sepsis as:

Sepsis is a serious condition in which the body responds improperly to an infection. The infection-fighting processes turn on the body, causing the organs to work poorly. Sepsis may progress to septic shock. This is a dramatic drop in blood pressure that can damage the lungs, kidneys, liver and other organs. When the damage is severe, it can lead to death.

In addition to sepsis, an infected pressure ulcer near the tailbone frequently causes osteomyelitis, which is infection of the tailbone and spine. This can lead to osteonecrosis (bone death) and/or septic arthritis.

How to Prove a Pressure Ulcer is Due to Neglect

If a healthcare provider fails to abide by the “standard of care” and causes injury or death, then the healthcare provider can be sued for:

In all of these types of cases, the burden of proof is on the plaintiff to show by substantial evidence that the pressure ulcer resulted due to a failure by a healthcare provider to abide by the standard of care.  But what is the standard of care?

Each state defines it differently, but in Alabama, the standard of care is defined as:

The standard of care is that level of such reasonable care, skill, and diligence as other similarly situated health care providers in the same general line of practice, ordinarily have and exercise in like cases. Ala. Code 6-5-542

In almost all situations, the standard of care requires nursing staff to reposition an immobile patient every two hours. This is because the studies are clear that cellular death can begin within 2-3 hours of prolonged pressure on the tailbone or the heels.

When we are reviewing a case involving a pressure ulcer, we always review the medical records in detail to determine whether the patient was actually repositioned every two hours.  If the patient was not repositioned and was left in the semi-fowlers position for a lengthy period of time, then it is likely neglect occurred.

The Expert Witness Requirement

The Alabama Medical Liability Act requires the plaintiff to offer expert witness testimony that the defendant failed to abide by the standard of care.  This expert witness must be “similarly situated” to the defendant.  A similarly situated expert is defined by Ala. Code 6-5-548 as someone who is:

  1. Is licensed by the appropriate regulatory board or agency of this or some other state.
  2. Is trained and experienced in the same discipline or school of practice.
  3. Has practiced in the same discipline or school of practice during the year preceding the date that the alleged breach of the standard of care occurred.

For example, in a case against a nursing home, we would have to retain an expert witness who is a licensed nurse that has training and experience working in nursing homes, and has worked in a nursing home in the year prior to the alleged negligence.

If the plaintiff does not have testimony from a similarly situated expert witness, the plaintiff’s case could be dismissed regardless of the merit of the case.

Suspect Your Loved One Suffered a Pressure Ulcer Due to Neglect?

If you think your family member has suffered a pressure ulcer due to neglect, let us review the case at no charge. We will be responsible for investigating the case, retaining an expert witness, and litigating the case. We are only paid if we win.

Our lawyers have decades of experience in handling cases involving pressure ulcers.  Let us get to work for you and your family now.