Dr. Greg Vigna and attorney Ben Martin discuss how bed sores—also called pressure injuries—are preventable but often caused by poor nursing care and hospital neglect. They explain how profit-driven hospital systems discharge patients with untreated wounds and stress that these injuries are “never events” indicating serious failures in patient care.
If your family member developed a severe bed sore while under medical care, you may have legal rights. Early intervention can prevent infection, sepsis, amputation, or wrongful death.
📞 If your loved one has suffered from untreated or severe bed sores, visit VignaLawGroup.com for more information. FREE CASE REVIEWS at https://vignalawgroup.com/contact/
TRANSCRIPT:
B: I want to get a little bit even more granular, right. So what is a bed sore?
V: A bed sore is a area of dead tissue caused by pressure. So the muscle dies first. If a person is not reliably turned. If the muscle dies, then the skin will die because it loses its its blood supply, which comes from the muscle. And over 2 to 4 weeks time, that skin will become dead. And eventually you could put your fist and or two fingers into the wound because it's a serious injury.
V: Good morning. I'm a doctor. Vigna I'm here with Ben Martin, and we're going to talk about bed sores. So, Ben, you've sued on pretty much any type of serious personal injury. Pharmaceutical injury, medical malpractice, 18 Wheeler injuries, paraplegia. What is it about bed sores? You know, you you have a lot of bed sore clients. So tell us why you're in this litigation.
B: I've represented people for many, many years, decades who have had experience with a bed sore. Right. But at some point it was happening so often that it just to me, was becoming an epidemic. And so then I looked at the specifics of why is this happening? You know, so we we got involved together and looking at bed sore cases, in you from the medical aspect of it and both of it from the legal aspect of it. And, and it really did seem to me that it was becoming an epidemic. I hadn't remember bedsores being such a problem 20 years ago, 30 years ago. Why is it becoming such a problem now? Tons of people, many people are getting these these bed sores in hospitals, in nursing homes.
V: They're supposed to be safe places.
B: It makes no sense to me.
V: All bed sores are bad injuries. And stage three, stage four, they're all preventable. And someone is making a profit on providing bad care.
B: Right
V: What's your thoughts on hospital acquired bedsores?
B: Okay. So that's that's really what got me back into looking at bed sores in bedsore cases across the country, because I was really shocked that hospitals were over and over again causing these bed sores.
V: Tell us about Never events and what that means to a lawyer and prosecuting a case.
B: So there's a specific meaning for the term never event and never event. And you can you can correct me on this, Greg, because you're, you're as much of an expert or more than I am.
V: I'm more of an expert than you are.
B: I see never event is something that that, Medicare and the federal government say, oh, we're not going to pay for anything related to a bed sore once. Once you create a bed sore your hospital, you create a bed sore. We ain't paying for it because it's a never event. It should never happen.
V: And am I right? Yeah, exactly. And they go one step farther that it tends to indicate that the quality of care is bad. And if a hospital causes a bed sore, whatever care that bed sore required in that hospital going forward, they would be responsible for that cost. But that doesn't prevent a hospital to simply discharge that person who they seriously injured to a nursing home or another hospital, and they won't get billed with it. So what's your thoughts on that?
B: So that's that's another tragedy that we've seen that occurs is that a hospital will create this never event. Right. It's never supposed to happen. You're never supposed to a patient should never have a bed sore, should never develop a bed sore in a hospital. In the reason is that they're always preventable. So I'm going to interrupt.
V: Theres one tiny little sliver that may contribute substantially to bed sores, but I have never seen seen that one has eyes. If a person has septic shock and have profound hypertension, that that they can't support their own blood pressure, their can be the development of pressure because the person just can't supply their their tissues. When I've been in that situation that patients are profoundly sick and they can't be turned, and, you know, I put them on a clinic trolley and I've never seen this entity. But but it's described in the literature and, and it there's sustained and ongoing hypertension that may be causative. And and you know, that's why we have experts involved in each case to understand how this occurred.
B: So I'm understanding. So I'm understanding from your perspective, Greg, as a doctor. And by the way, you've treated what hundreds of patients who are, who are in a hospital setting that have developed bedsores.
V: Where they were transferred to my hospital to fix the bed sore because I created a program, a flat program. And so we were getting patients from 500 miles away from hospitals, nursing homes, home health who had serious bedsores and they were either going to be at high risk of death from sepsis or make it to my hospital for closure.
B: Back to the question of the bed sores in hospital related bed sores. I would say rare situation where you've got hypertension that's, in this case, massively low blood pressure that occurs as a result of sepsis. That may be something that could be argued isn't preventable. Right. But in the vast majority of cases, a bed sore a decubitus ulcer it's also a pressure wound is completely preventable. And it's preventable through good care, through the standard of care in a hospital. And that's turning people right. Can you can you explain that, how that all occurs? How are bedsores prevented?
V: Prevention of any patient who is dependent on others because of illness or injury require manual repositioning to change their side. If they're laying on their back after two hours before two hours, they need to be turned on the side. Two hours later, they could be turned back on their back or the other hip. And that skin observed, it's just routine nursing care, okay, that that all nurses are taught every hospital will have ongoing should have ongoing education of nursing. Every hospital should be monitored turning, monitoring their occurrence of bed sores, ongoing education. But we're seeing hospitals now and we're seeing nursing homes being bought by private equity. We're hospitals are hedge funds, hedge funds, hedge funds. Yeah. Private equity is buying community hospitals for profit. They are taking the profit instead of reinvesting in the education of nurses and nurses aides and people are getting bedsores. And it's what they consider the price of business. So so we're suing a lot of hospitals that are owned by private equity. Now.
B: Here's my question. How does a bed store develop and why does it develop and get into the minutia if you need to of of of how it affects the circulation and how pressure affects. Did you explain all that stuff?
V: Yeah, I got it. So say you are lying on your back and you are not moving, okay? Because you're sedated on a ventilator and you're laying on your back. So you have your sacral bone and the skin compressing because of gravity and pressure from the bed. The muscle, the muscle is under the skin in between the bone and the muscle gets pressed. When the muscle is getting pressed or pressure on that muscle, it prevents blood flow. And if you if it prevents blood flow for too long, the cells lose their oxygen supply and that cell on an individual basis will die. And if there's a lot of cells, then you are losing tissue. You're losing muscle. And over 2 to 4 weeks that muscle will die, liquefy, and there will be an appearance of a dead tissue on the skin where all the skin will turn black. The the muscles get underneath it and it goes all the way to bone. That is a bed sore. That's a stage four bed sores and that's a serious injury. So we have clients who develop up these dead areas of their skin, big areas on their sacrum, which is on top of the buttock or on their hip or on their heels. And the hospitals are just simply discharging them to a nursing home without a formal plan for getting them to cure.
B: Okay. So and that's what I still don't understand. What is the motivation of a hospital? Having a patient with a bed sore, probably created by the hospital and then discharging the patient to a nursing home without any plan of care. And I'm talking about a patient that may or may not have even been to a nursing home patient in the first place. In other words, someone who walks into the hospital, it lives it home, lives in assisted care and and then all of a sudden develops, bed sores and a hospital then is sent to a nursing home. How does that happen?
V: The conduct is is appalling and unconscionable that hospitals are sending people to a lower level of care where there is not a pathway to cure. They're getting the patient who they injure off their books because because insurance companies will force them to pay for that cost if that patient stays at their hospital and gets care. So these hospitals, hospitals have a lot of different doctors. They have plastic surgeons, they have general surgeons, they have infectious disease doctors, they have internal medicine. Doctors have orthopedic doctors, all of which are sometimes needed to treat a complex wound. And they're discharging patients to other hospitals that might not have the staff do not have the program to to fix these wounds, or they're sending them to a nursing home where they rarely will even see a doctor with a dead piece of flesh on their body to get infected, to develop septic shock. It's unconscionable. There's no other explanation.
B: So what's the I mean, when a hospital sends a patient to a lower level of care, they've got an ongoing bed sore, so it hasn't been fixed. What is expected to happen to the patient?
V: It's miserable. Okay. These these patients are miserable. They have big wounds. They're confined to bed now because they can't see if you have a bed sore on your butt, it's hard to sit on your butt. Okay. And so you're basically in bed turning side to side. And you're getting wound care with hopes that the wound will, over time, grow in. For that to happen, a lot of good things have to happen 44% of the time. When you have a stage four bed sores or down to bone that's infected, that patient is going to be admitted back to the acute care hospital with sepsis.
B: 44%
V: 17% of those people who are discharged without a flap die. All conservative care, whatever it is, is associated with a 17% risk of death compared to flap surgery. Flap surgery. Every plastic surgeon in their residency knows how to do flap surgery. It's not that it's not that hard. It would be hard for me to do. But plastic surgeons, that's what they do. That's what they're trained to do. And hospitals are discharging patients that they could fix that they caused injury to a lower level of care.
B: Explain what a flap surgery is.
V: Yeah. So the way you treat a bed sore when you have a big, big area of dead tissue on a person's, but that is black, you have to get the dead tissue off. Okay. You have, that dead tissue is going to start getting infected. It will get, malodorous. And what does that mean, malodorous? Just a nasty smell. Okay. It's horrible. Okay, well.
B: What causes a bed sore of to bring forth a nasty smell? I hate to give you a specific.
V: But it's infected with staph. It's infected with gram negative bacteria. So these wounds have to be the treated. You have to have reliable pressure relief. You could, put them on a $60,000, clinic bed. That will make it so that there's absolutely no ongoing pressure that that person will suffer from.
B: If they if that occurs, if all of that occurs, can a person get better?
V: Yes. If a person has reliable pressure relief and the wound is cleaned out, debris and there's no infection and there's adequate nutrition, wounds can grow in over time. Okay. But that could take months. And sometimes over a year. And you have to have perfect care and not get infected during that time. So the standard of care ever since I've been practicing has been to flap these patients. And that is you bring in a plastic surgeon, they move muscle that's next to the wound over that. There's redundant skin and that wound becomes closed. You have a drain there that you keep in place for, a couple of weeks and that wound becomes healed. So in four weeks after a flap, these patients are generally up in the chair involved in rehab. Okay. Trying to get better now. So I'm a spinal cord injury doctor. Okay. So I've taken care of spinal cord patients my whole life, and I'm in this, I'm in this small rural hospital, that I developed the flap program in northern Louisiana, and I was referred a bed sore case from a New Orleans, a major teaching hospital in New Orleans on a African American who developed a pressure ulcer right after injury. And they were trying to rehab him. You know, they had him going through rehab with the bed sores on his butt, that's impossible if you don't have legs and can't walk and you have a big old sore on your butt, how are you supposed to learn how to transfer from bed to chair, chair to toilet? If if you have a dressing on your butt and you have to do pressure relief, it's a it's a set up for failure. So this patient got referred to me, my hospital, and they wasted 4 to 6 weeks doing rehab on a spinal cord. Patient who couldn't be rehabbed. And so he comes to my hospital and and he's expecting wound care. And I'm like, you know, I recommend that that we close this wound. Okay. We fix this wound and then rehab. You okay? Because he needed more rehab to get what happened, and, well, we fixed him and he left the hospital as an independent, paraplegic man who able to take care of himself without a wound. He didn't have to go home with home health, go side to side. It's kind of common sense, isn't it? You fix the wound and that's the standard of care. It's been the standard of care. And now since 2023, the national guidelines say that these wounds should be closed to finally.
B: Okay, I want to get a little bit even more granular. Right. So what is a bed sore?
V: A bed sore is a area of dead tissue caused by pressure. So the muscle dies first. If a person is not reliably turned, if the muscle dies, then the skin will die because it loses its its blood supply, which comes from the muscle. And over 2 to 4 weeks time, that skin will become dead. And eventually you could put your fist and or two fingers into the wound because it's a serious injury.
B: Are there different names that, medicine uses for a bed sores?
V: Well, bed sores are called bed sores, decubitus ulcer pressure injuries. They're all the same thing. Pressure. Yeah. They're all and and we call them never events okay. And and it indicates that nursing care was bad. If there's bad bedside care, then there's other problems in that hospital that are likely. Because what happens at bedside is by far the most important thing that occurs with a patient. Because if a patient's not being turned, that means that nurses are not going in there to assess the patient. If they're not being assessed, then doctors aren't being notified of medical changes. So that's it. It's usually the tip of the iceberg.
B: What type of patient would be subject to development of a bed sore? Like, let me ask you this question. Someone who walk into a hospital and they're there for a surgery, that they're a young, healthy person, they're going to be in the hospital for, a couple of days and be released. Are you expecting that that patient might become subject to a bed sore?
V: Any patient who, because of illness or injury, has a period of time. Generally, it could be as little as a day that they can't provide their own turns. They need to be turned because bed sores can can occur. We have serious bed sores on patients who go in for elective knee surgery, for knee replacements, surgery, okay that they walk into the hospital, they have knee replacement surgery, they have a difficult rehab. And and because of pain, because of other complicating factors aren't able to turn and we have a wrongful death in Texas on on a knee replacement, a patient and an elderly person who got a bed sore, you know, so this happens to anyone because of illness or injury who cannot turn themselves. So I'm a rehab doctor. I take care of spinal cord patients. I take care of brain injured patients. I take care of people with amputations, catastrophic orthopedic injuries, people who have heart attack strokes. My whole population was at risk for bedsores. So in terms of prevention monitoring, we were on okay. So during my clinical practice, there were two patients of mine who developed bedsores that required surgery and surgical intervention to cure. And in both of those those patients, I did not allow them to be discharged until I figured out a path to get them fixed. And I found a surgeon in the community to help me. And I kept that patient in my hospital, and I had them fixed and then ultimately developed flat programs after that so they can occur. It's usually it happens when nurses aren't doing their jobs and, you know, but certainly in those situations, people were held accountable for their failures.
B: What about physician liability? Just just meaning so so when I say liability, I'm asking, what about a physician's responsibility for a bed store or the physician's ever responsible.
V: Yes. So in terms of there's there's two parts. So in terms of causing a bed sore, you know, generally that's in the indicative of nursing care because that's the doctors aren't they're turning a patient. Okay. But we are seeing hospitals and in nursing homes where a person is developing a bed sore and a doctor is notified, and the doctor never actually looks at the wound and is deferring treatment to the nursing staff. If you are the attending doctor, you need to look at that wound, you need to stage that wound, and you need to make sure that patient is safe. We're seeing hospitals who now own or employ hospitalist, you know, so a hospital causes a bed sore. They're hospitalist who they employ doesn't assess the wound. They provide ineffective care. And then that hospitalist signs the discharge order, having them go to a lower level of care. We're suing those doctors, their employer, which is the hospital, the nurses in the hospital. So there's failure to prevent and the failure to treat. And then there's the unsafe discharge. Brutal story end.
B: Brutal.
V: So if you've suffered a bed sore, you know, we we are prosecuting these cases across the country. But we have experts, you know, plastic surgeons, general surgeons, orthopedic surgeons, nursing home administrators, hospital administrators, infectious disease doctors, nurses and nursing experts. And and so we're prosecuting these cases across the country.
