How Are Pressure Ulcer (Bedsore) Cases Proven in Court?

Your mother went into a nursing home in February to recover from a broken hip. The admission nurse scored her pressure ulcer risk that first afternoon, and the number put her in the high-risk group.

Five weeks later, a hospital doctor tells you that the wound on her left heel has reached the bone. The facility’s answer is that she was diabetic, her circulation was poor, and nobody could have prevented it.

Whether that answer holds up depends on paperwork most families never get to see. In decubitus ulcer litigation, most of the fight is over whether the wound could have been prevented. If the medical terms are new, the guide’s overview of bedsores in nursing homes covers the basics. Here’s how families and their lawyers prove pressure ulcer cases, from the first risk score to the expert witness.

The Braden Score Shows What the Staff Knew

Many nursing homes measure pressure ulcer risk with the Braden Scale, a nursing tool that scores six areas:

• Sensory perception
• Moisture
• Activity
• Mobility
• Nutrition
• Friction

Totals on the scale run from 6 to 23, and a lower score means a higher risk. According to the Agency for Healthcare Research and Quality, a score of 18 or below generally marks a patient as at risk. The agency says the care plan should address the specific weak spots where the score turns up.

Let’s say your mother scored a 12. She couldn’t roll over on her own after the surgery. The nurse’s Braden Scale assessment went into her chart that first afternoon, where the rest of the staff could see it.

Federal guidelines treat a pressure ulcer as unavoidable only if:

• The facility evaluated the resident’s risk
• Put interventions in place that fit her needs and professional standards
• Watched whether they worked
• Changed them when they didn’t

Lawyers on both sides start the argument over avoidable versus unavoidable pressure ulcers with that test, because it spells out what a careful facility does with a high-risk resident.

So, the first question in her case is whether the care plan answered the 12 on the Braden Scale. Look for a pressure-relieving mattress, a turning schedule, her heels floated off the bed, and a note from the dietitian.

Wound Notes Turn the Chart Into a Timeline

Once a wound shows up, nurses stage it and then record its length, width, and depth. Lined up by date, those entries become the wound staging evidence a case is built on, because they show how fast the wound grew and what the staff did at each step. The physician’s notes add when the doctor was told and what treatment was ordered.

Let’s say the chart shows a weekly skin check on March 3 that reads “skin intact.” Then a wound note on March 10 describes a heel covered in black, dead tissue. An expert will want to know how a heel went from intact to that in seven days and whether anyone looked at it in between.

You can add to the bedsore lawsuit evidence on your own, with dated photos from your visits and a written note of when someone first told you about the wound and what they said.

Turning Logs and Staffing Sheets Cover the Nights

The turning and repositioning records show whether anyone on the nursing home staff carried out that care plan, shift by shift. That’s important, because a resident who isn’t eating or drinking enough also heals slower.

Then there are the nursing home staffing logs. Federal rules require a facility to post how many nurses and aides are on duty for every shift and to keep those daily postings for at least 18 months. These logs have to hang where residents and visitors can see them. Let’s say the turning log shows your mother repositioned every two hours on March 8.

The posted staffing for that night shows one aide for her entire hall. The jury’s question is whether one person could have done all of it, which is a question about the schedule the facility set, not the aide.

Experts Connect the Chart to the Wound

Bedsore cases almost always need medical expert testimony from a wound care physician, an experienced nurse, or both. The expert explains the standard of care for pressure sores and says whether the missed care caused the wound.

The facility will bring its own expert, who usually argues that the resident’s body made the wound unavoidable. In your mother’s case, that means her diabetes and poor circulation. Diabetes does raise the risk. Her expert will point out that the admission nurse knew about both conditions and then will ask what the care plan did for her heels because of them.

In some states, a bedsore claim against a nursing home goes through the same rules as a medical malpractice case, and Texas law, for example, treats a nursing home claim as a health care liability claim. The family has to serve an expert’s written report within 120 days after each facility files its answer, or the claim can be dismissed.

In a state like that, proving medical malpractice for bedsores starts with a wound care expert reading the chart months before trial.

What Families Can Do While the Records Still Exist

A high-risk score on day one and a wound to the bone five weeks later leave questions only the chart and an expert can answer. My Nursing Home Abuse Guide covers bedsores, records and nursing home negligence claims for families trying to understand what happened.

Ask the facility for your mother’s records, starting with the admission assessment, the wound notes, and the turning logs. Then bring them to a nursing home abuse attorney in your state, who can tell you whether the facts support a case.