“List of Serious Reportable Events (aka ” Never Events” ) … 4F. Any Stage III, Stage IV, and unstageable pressure ulcer acquired after admission/presentation to a healthcare setting … 5D. Patient death or serious injury associated with the use of physical restraints or bedrails while being cared for in a healthcare setting,” according to the National Quality Forum, List of Serious Reportable Events.
Read the National Quality Forum List of Serious Reportable Events: https://www.qualityforum.org/Topics/SREs/List_of_SREs.aspx
Dr. Greg Vigna, national malpractice attorney and wound care expert, “Stage III or Stage IV decubitus ulcers acquired in a hospital is a massive red flag for patients because it indicates that the bedside care is broken, which is the most important point of care in every hospital. The roots of broken bedside care can be traced back to decisions and priorities of the hospital’s administration and governing boards.”
Dr. Vigna explains, “Stage III and Stage IV decubitus ulcers are preventable bedsores. It starts with a simple bedside assessment by nurses and doctors to identify patients who are at risk for this type of ‘Never Event’. Then, a simple treatment plan that provides scheduled repositioning by nurses and nurse aids every two hours, keeping the head of the bed less than 30 degrees, and utilizing an alternating air mattress should be executed. Adequate staffing levels for nurses and nurse aids is also essential, there must be ongoing education and training for the staff, and there must be accountability for nurses and doctors who do not perform their jobs.”
Dr. Vigna states, “Our allegations are consistent with a broken hospital”:
27. On November 17, 2020, Dr. Qurratulain Hayat, internal medicine, noted “Nursing complaining of lack of staff to appropriately redirect Mr. Campbell for multiple hours a day. Due to staffing shortages, restraints will be re-initiated. The patient does not require restraints medically, but for his safety and the safety of others, the patient cannot be allowed to wander the halls in the hospital.”
30. Prior to the first noted decubitus or pressure ulcer on December 11, 2020, Mr. Campbell was documented to have been in restraints, either bilateral wrist restraints, vest/jacket restraints, vest/jacket and wrist restraints, or all side rails up from October 18, 2020, to December 3, 2020. During this period the records indicate there were “no signs” of circulation/skin “injury.”
32. On December 11, 2020, at 18:50 on December 11, 2020, the records from SJC document that Mr. Campbell had an “unstageable” pressure ulcer on his sacrum and there was no preexisting wound.
(Case Number: CV001126, State of Wisconsin, Circuit Court Civil Division, Milwaukee County)
Dr. Vigna concludes, “Patients generally don’t get bedsores when they have mobility. Our client had mobility and then restraints were applied to keep him in bed. This was a bedsore caused by a restraint. This is an injury caused by a restraint. This is a ‘Never Event x 2’ lawsuit.”
Greg Vigna, MD, JD, is a national malpractice attorney and an expert in wound care. He is available for legal consultation for families and patients who have suffered decubitus ulcers due to poor nursing care at hospitals, nursing homes, or assisted living facilities. The Vigna Law Group, along with Ben C. Martin, Esq., of the Martin Law Group, a Dallas Texas national pharmaceutical injury law firm, jointly prosecute hospital and nursing home neglect cases that result in bedsores nationwide.
To learn more, visit the Decubitus Ulcer Help Desk.
Case Number: CV001126
State of Wisconsin, Circuit Court Civil Division, Milwaukee County
