Decubitus ulcers are rarely unavoidable and for that reason are classified as ‘Never Events’ by the Centers for Medicare & Medicaid Services because they are preventable by basic nursing care that can be provided with adequate resource allocation at hospitals and nursing homes”, says Greg Vigna, MD, JD, national malpractice attorney and wound care expert.
Dr. Vigna adds, “Unfortunately, patients who suffer deep Grade III and IV decubitus ulcers rarely get to a medical facility that offers the scope of services necessary to manage their complex problems. It is not uncommon for medical providers to tell families that ‘this is part of the dying process’. That is simply not true, and many elderly patients are in fact salvageable with state-of-the-art medical care. I have managed hundreds of these patients referred to my center from hundreds of miles away and it is true that their medical conditions are exceptionally complex but many times these patients are salvageable and can have a reasonable quality of life that is determined to be acceptable by the patient and their families.”
Dr. Vigna continues, “I have been referred patients with chronic wounds that have been hospitalized multiple times, treated with conservative wound care, received weeks of IV antibiotics, only to have ongoing wounds that now are infected by multidrug resistant organism. Treatments are complex in these patients but are grounded on the basic tenants of wound care and once medically optimized, surgical closure is definitive care. Deep grade III and Grade IV decubitus ulcers are not compatible with life and certainly not compatible with any reasonable quality of life.”
Dr. Vigna’s tenants for management of deep Grade III and Grade IV decubitus ulcers:
- Complete and reliable pressure relief of the wound
- Nutritional support
- Treatment of infection, if present, and physical removal of necrotic tissue
- Treatment of anemia
- Local wound care with wet or moist to dry dressing changes, frequency of changes depending on drainage
- Surgical closure, if patient and family, consent to the risks versus benefits of surgical management and the patient is medically optimized
“I’m well aware of the barriers to effective wound care that must include a facility that offers the option for patients to provide musculocutaneous flaps of a deep Grade III & Grade IV decubitus ulcer” — Greg Vigna, MD, JD
Dr. Vigna concludes, “It is not our roll to be part of any healthcare decision as to treatments. I do believe, our clients and the families of our clients, truly understand the barriers to care and know what questions must be asked of medical providers as they negotiate the complex path to the care they choose. All we can do is hold nursing homes and hospitals accountable for the complications they cause as decubitus ulcers are preventable and should never occur if hospitals and nursing homes do their job of training their nurses and healthcare aids and staffing their facilities at safe levels.”
Dr. Vigna is a California and Washington DC lawyer who focuses on catastrophic injuries including spinal cord injuries, traumatic brain injury, birth injury, vaginal mesh neurological injuries, and hospital and physician malpractice, and nursing home decubitus ulcers. 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 malpractice and nursing home neglect cases, nationwide.
Resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815366/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1382548/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634357/
Greg Vigna, MD, JD
Vigna Law Group
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