Dr. Vigna explains the difference between true end-of-life skin changes and neglect-related bedsores, exposing how facilities falsely label serious wounds as “Kennedy ulcers” to avoid accountability and legal responsibility. He also discusses restraint-related bedsores, unsafe hospital discharges, and the standard of care required for treating stage 3 and 4 pressure injuries, emphasizing that these wounds are preventable, treatable, and never a natural part of dying.

For listeners who have a loved one suffering from bedsores, contact Dr. Greg Vigna at (817) 809-9023 or visit vignalawgroup.com.

TRANSCRIPT:

Welcome to justice with doctor V. I am a doctor and a lawyer. I have a national litigation practice and represent those who have suffered catastrophic injuries. Today's episode we're going to be talking about:

Kennedy ulcers, a major point of confusion in patient care. The difference between a true end of life skin change and a preventable pressure injury that gets mislabeled as a Kennedy ulcer. We talk about how facilities use this label to avoid accountability. What actually causes these wounds, and how families can understand when it's a natural part of dying versus when it's the result of neglect. 

I've been in this litigation for over a decade, and these are serious injuries.

Before we go into the term, Kennedy ulcer, could you give me a backstory on what a bedsore generally is? 

We have bedsores caused by nursing, not turning people. But there is also something called the restraint related bedsores that we have clients who were agitated and were restrained into the bed so that they could not walk because they might fall or cause problems down the hallway, that they were restrained and develop the bedsores. That's a bad injury because the government causes injuries from a restraint and never event bedsores.

Stage three and stage four is never event. So in other words, we have clients who we represent who have two never events serious injury caused by restraint and a bedsores because the restraint was preventing these our clients from moving. So the restraint was basically pinning them down, developing the saw on there. That's a serious injury. And talk about the distress that our client would have to endure while he's being strapped to a surface. And that drainage is causing the pressure. 

And how severe can bedsores like this be? 

Yeah. We represent clients who have lost limbs because of restraint. We represent a client who we allege had a wrist restraint and lost blood flow to the hand and lost their arm. We have clients who have been restrained and into bed and develop a heel sore because they're trying to move, but they're restrain. They press their heel against the bed and and develop a pressure ulcer to the heel. 

How is this preventable or what is the treatment plan for when stuff like this does happen? 

A doctor's role in in bed sore management? First of all, if you're in a hospital and you're a doctor and you're the attending and you get notified that there is a bed sore at the hospital, cause you need to examine that bed sore and and make sure that patient is safe from further injury. If it's a serious bed sore where there's dead tissue that attending doctor should console plastic surgeon or general surgeon if there's area of dead tissue that may needed debridement.

We have clients who develop dead areas on their body and they get sent to a nursing home before the dead tissue is cut off and that becomes infected, smelly, chronic infection in the bone. And that hospital just discharge that patient to a nursing home. That's an unsafe discharge. The standard of care is pretty well decided that people who developed serious bedsores, they should have access to a doctor who can direct them to surgical management versus conservative management.

If you have a serious injury, you need a doctor who can have access both treatments and discuss risks versus benefits of both. If you don't have the capable of operating on that person for cure, these things go bad often with people who have serious bedsores, and you hope that wound care will slowly allow the body to heal in. That could take a year, year and a half, and during this time, these patients become malnourished, they become septic, they get admitted with septic shock. We know that 17% of people who have a stage four bed sore with a bone infection, they die at one year. 44% are readmitted. If there's a hospital cause bed sore, that patient needs access to a doctor who can help.

We are suing hospitals for failure to prevent and failure to treat. If they discharge that person to a nursing home that does not have the capabilities for a plastic surgeon, that's an unsafe discharge. We're suing doctors and hospitals for at these harms. 

If a patient does receive a stage four bedsores, what are the next steps in treatment? 

So again, I ran a flat program when I practice medicine. And a person who was admitted with a stage four bed sore with osteomyelitis, we would put them on a clinic run bed. Maybe that we would order labs to see what their nutrition is. If they're malnourished, we might have to include a feeding tube, allow for proper nutrition to allow for wound healing.

Treatment is very easy for these bed sores. It doesn't take Harvard plastic surgeon. It's reliable pressure relief either on a clinic run bed or with nurses providing reliable pressure relief, nutritional support, surgical debridement of the dead tissue, wound care and when that wound sufficiently is closing in and you see the body healing, you can provide a flap with the plastic surgeon to rotate muscle over that hole. The redundancy skin. You close these wounds with I.V. antibiotics, secure that underlying infection that's generally always present, and you flap these patient patients who don't want to flap, which is not unusual in the elderly population. You tell them the risk of non flap versus conservative measures. And you then provided conservative measures wound care nutritional support. But what you don't do is send that person to a nursing home that doesn't have access to a plastic surgeon.

You need you need to be refer people, people who are injured with stage A deep stage three. Stage four. Bedsores really just needs a doctor who has the capabilities to fix these wounds surgically with flaps, or provide conservative wound care because the patient really doesn't want a flap. Surgical flap closure of of serious bed sores is really the standard of care. 

Now that you've given some background, why do facilities like nursing homes use the term Kennedy ulcer connected it to bed sores? 

It's unfortunate, even today, that nursing homes are telling patients families that their loved one has developed. The Kennedy and Kennedy ulcers means that there is imminent death ahead because of the presence of a sore, and that sore is a hallmark sign that a person is nearing their death. Kennedy. Ulcers don't really exist, that pressure ulcers are pressure ulcers.

The reason why they're calling it a Kennedy ulcer is that bed sores caused death, and they're saying this is a Kennedy ulcer, that it appeared because the person is supposed to. It is a myth, this nursing home where there was a nurse named Kennedy, she reported all of these patients who develop these sores near their death, and they wrote it up. Those patients would become patients at my rehab hospital. And I would then save those patients. If we got a lot of people with stage three, stage four bedsores from nursing homes, if they didn't get to my hospital where we had plastic surgeons to fix them. Yes, that bedsores would kill that person going forward. And there are still nursing homes that are telling patients, families that there's a Kennedy Olson, and we need to bring in hospice.

Where did the term Kennedy ulcer come into play? 

Yeah, Kennedy ulcers in the late 1990s, is a term that indicates a serious ulceration in the skin that looks just like a pressure ulcer that occurs spontaneously just prior to death. That was described in a nursing home. And they describe dozens of patients who this developed in what that nursing home was, was a unsafe nursing home that wasn't providing reliable pressure relief.

And these patients develop bedsores and then they die. That term is still alive. I don't know how it's alive because they can't offer any kind of reliable mechanism on how that would occur. And it's mythical and it's a lie. They'll have a nurse expert and a defense expert testify to that, and we will cross them very hard that then died. They believe that those sores that looked just like bed sores occurred spontaneously.

For families that do have members that are in these nursing homes, what do they need to know about Kennedy Ulcers?

First, if you've been told that your loved one has a Kennedy ulcer and are near death, that means that your loved one is not safe, that your loved one needs to be in a hospital. Number two, I hope you give me a call because we cross that nursing home hard and find out who and that nursing home is pushing for this diagnosis to be told to families of injured people. We're going to do discovery and we are, if punitive, are allowed by law, we're going to be after punitive damages. Kennedy ulcer is a mythical term, and we will, cross whoever brings that diagnosis.

So how is the term Kennedy ulcer used to avoid responsibility in these facilities?

Well, I think nursing homes use this term Kennedy ulcer, hoping that the family will go online to learn what they are or understand the seriousness of pressure ulcers. That's how they try and avoid a lawsuit, because they don't want to tell the families that they didn't turn their loved one, and now their loved one has a dead piece of flesh on their body that needs surgical debridement and can cause chronic infections and lead to septic shock. And they're trying to push this patient who they injured to hospice.