Successful Strategies for Winning Pressure Injury Litigation against Health Care Providers

  • Talk about why they should be able to “Get to Zero!”
  • Use the facility’s “Pressure Ulcer Prevention Protocols” against them.
  • Use the NPUAP Staging System – the Plaintiff’s best friend

Remember, “Bedsores are a form of elder abuse” – and elder abuse is the way to avoid the caps on punitive damages!!!

EVERYONE is on the plaintiff’s side!

Pressure Ulcer “Prevention Protocols” Pave the Way to Litigation – use them!

  • Often inappropriately cast as rules or regulations
  • Often inappropriately absolute in their wording
    • Look for inflexible deadlines
    • Unnecessary mandates
  • Often inappropriately labeled as the “standard of care”
  • Best of all, they are called PREVENTION PROTOCOLS  which implies that all pressure ulcers should be preventable!


The NPUAP Staging System – the Plaintiff’s Best Friend!

  • They are now called INJURIES!
  • Inevitable & linear wound progression implied by
    • Term “staging” itself
    • Numeric nature of the staging system
  • Allows for erroneous & dangerous misperceptions
    • All pressure ulcers/injuries can be stopped at an early stage

The NPUAP Staging System is the Key to Winning Cases for the Plaintiff – Use it to your advantage!

  • A woman suffered a cervical fracture falling from her bed and lay paralyzed on the floor at home for unknown period of time (days).
  • In addition to new onset paralysis, she had acute respiratory failure.
  • She was malnourished at time of admission.
  • Patient successfully sued hospital for negligence, alleging that the pressure ulcers progressed as a result of failure to implement the “pressure ulcer prevention protocol”.
  • Not documented as being turned q 2 hrs, specialty mattress not provided immediately, other imperfections in care.
  • Bolstered by the progression of the ulcer from Stage 1 to Stage 4

Do NOT discuss the critical weaknesses of the NPUAP Staging System

  • Do not let on that there are at least 2 distinct mechanisms for pressure ulcer/injury formation – one of which is “inside out” and the other of which is “outside in.”
  • Do not allow discussion about why many don’t happen over a bony prominence and have an inexplicable tendency to follow the distribution of a named artery which may be mean arterial pressure matters.
  • Do not admit that incontinence associated skin breakdown is not supposed to be staged – allow the usual confusion to persist about the moisture-related issues that are common.

Most Important of All- Do not Discuss Real Evolution of a Stage 4

  • They start with a Deep Tissue Injury

which evolves into  .  . .

  • An unstageable lesion as the tissue necrosis works its way from the in side to the outside

and ultimately . .

  • A Stage 4 “pressure injury”

This can win the case for you

It gets better! Pressure Ulcers are also a CRIME!

“With the introduction of criminal prosecution for gross neglect, a new weapon against poor nursing care has appeared.“ American Journal of Forensic Medicine.

Go ahead, try to convince the jury . . .

    The plaintiff’s expert has been ON the NPUAP so they MUST be right!
  • The term stage does not mean “stage” in the way a normal person thinks it does.
  • Even though a person usually counts to 4 by starting at 1 – that’s not actually how you get to a Stage 4 pressure injury.
  • Pressure ulcers are NOT all the result of poor care – some are medically unpreventable.
  • About the term, “injury,” it doesn’t actually mean the clinicians INJURED anyone!