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!

Dr. Fife sees patients at the CHI St. Luke's Hospital Wound Clinic in The Woodlands, Texas. For an appointment call (936) 266-2150.

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