Bedsore and Pressure Ulcer Lawsuits — Legal Rights When Sores Develop in a Care Facility

## Bedsores — When a Preventable Wound Becomes a Legal Claim

Pressure ulcers (bedsores) are injuries to the skin and underlying tissue caused by prolonged pressure, typically occurring over bony prominences in patients who are not regularly repositioned. In nursing home settings, severe pressure ulcers — Stage III and Stage IV — are recognized as indicators of inadequate care because proper nursing protocols (regular repositioning, pressure-relieving mattresses, nutrition management) prevent their development in most patients. When severe bedsores develop in a nursing home resident, it frequently constitutes negligence.

Medicare has classified Stage III and Stage IV hospital-acquired pressure ulcers as "never events" — conditions so preventable that their occurrence is considered prima facie evidence of inadequate care. This classification directly supports negligence claims when these injuries develop in nursing home settings.

The Pressure Ulcer Staging System and Legal Significance

**Stage I:** Non-blanchable redness of intact skin. Not necessarily neglect — can occur even with good care in severely ill patients.
**Stage II:** Partial thickness skin loss — a shallow open wound or blister. More concerning; may indicate inadequate repositioning.
**Stage III:** Full thickness skin loss through the subcutaneous tissue. Muscle or bone not visible but may be present at depth. Strong indicator of significant care failure.
**Stage IV:** Full thickness tissue loss exposing muscle, bone, or tendon. Life-threatening if infected. In most cases, this injury level in a nursing home resident indicates sustained neglect over weeks.
**Unstageable:** Full-thickness tissue loss whose base is covered by eschar or slough — cannot be staged until debrided.

Key Evidence in Pressure Ulcer Lawsuits

Wound care records: nursing documentation of wound assessments, measurements, and treatment should be consistent and reflect appropriate wound care protocols
Turning and positioning records: facilities are required to document repositioning every two hours for at-risk patients — gaps in this record are critical evidence
Nutritional records: malnutrition and dehydration dramatically accelerate pressure injury development and are independently evidence of care failure
Staffing records: inadequate staffing on the dates the wound developed is systemic cause evidence
Prior survey and inspection reports: prior citations for pressure ulcer prevention deficiencies establish the facility's known problem

A wound care specialist or certified wound care nurse can review the medical records and testify about whether the development and severity of the pressure ulcers is consistent with appropriate care or indicative of neglect. This expert testimony is typically essential to the case.