“It is impossible to achieve independence with self-care when you are an acute spinal cord injured patient with a Stage IV sacral decubitus ulcer. These patients need to be fixed and should never be referred to nursing homes where their risk of sepsis and death become increasingly foreseeable,” states Greg Vigna, MD, JD.

Dr. Anthony Gelis, MD, Ph.D., describes the risk factors for spinal cord injured patients for developing decubitus ulcers during their acute hospitalization before rehabilitation in his article “Pressure ulcer risk factors in persons with SCI: part 1: acute and rehabilitation stages” published in Spinal Cord, 47, 99-107 (2009):

“The ER transfer time and the distance covered between the injury site and the ER, the use of a long spine board during the prehospitalization acute stage, are all associated with the onset of pressure ulcers. The incidence of pressure ulcers increases significantly beyond the 6 h”

Time spent in the neurosurgery ward is also a pressure ulcer-related risk factor, especially after 15 days.”

To read Dr. Gelis’ article: https://www.nature.com/articles/sc2008107

Dr. Greg Vigna, national decubitus ulcer attorney and retired spinal cord injury physician explains, “Dr. Gelis’ data shows that newly injured paraplegic patients need to get to the necessary trauma center quickly, and from there, they need to be transferred to Inpatient Rehabilitation Hospitals as soon as medically feasible. Inpatient Rehabilitation Hospitals have rehabilitation nurses and therapists who provide reliable repositioning for their patients when in bed or a wheelchair to prevent bedsores while at the same time teaching their patients to become independent with the necessary skills to prevent decubitus ulcers over their lifetime.”

Dr. Vigna explains, “We recently were retained by a newly paralyzed man with a Stage IV sacral decubitus ulcer identified during his initial hospitalization at an academic trauma center.”

Part 1: What should the academic trauma center do for a newly paralyzed man?

a. Refer him to a Long-Term Acute Care Hospital with a plastic surgeon on staff.
b. Refer him to a Nursing Home since all acute rehabilitation hospitals refused him due to the Stage IV sacral wound.
c. Prescribe a Clinton bed, plastic surgery consultation, and plan for flap when medically optimized.
d. A & C

Correct Answer: d

Dr. Vigna explains, “The Damioli study compared outcomes of paralyzed patients with deep Stage 3 or Stage 4 decubitus ulcer who were managed with reconstructive plastic surgery to those who were not, and the study revealed that those who were not managed with flap closure of their wound had a 17% risk of death at 1-year and a 44% risk of readmission due to complications related to osteomyelitis. He needs reconstructive surgery.”

Read the Damioli study: https://journals.sagepub.com/doi/full/10.1177/20499361231196664

Dr. Vigna ends, “Sadly, the academic trauma center referred him to a nursing home where he didn’t receive spinal cord injury care or rehabilitation and didn’t receive reconstructive surgery. Predictably, he developed a Stage IV hip decubitus ulcer and a Stage IV ischial decubitus ulcer to go with the Stage IV sacral decubitus ulcer. Where was the physician leadership? Where was the nursing advocacy?”

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 and nursing homes. 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.