Bedsores: Usually A Case of Negligence

By Cian O'Carroll, Thursday, 12th February 2015 | 0 comments
Filed under: Medical Negligence, Hospital Acquired Infections, Personal Injuries.

Bedsores, more properly known as pressure ulcers or pressure sores, are a type of injury that affects areas of the skin and underlying tissue. They are caused when the affected area of skin is placed under too much pressure.

Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle.

Pressure ulcers develop when a large amount of pressure is applied to an area of skin over a short period of time. Or, they can occur when less force is applied but over a longer period of time.

The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected area of skin becomes starved of oxygen and nutrients. It begins to break down, leading to the formation of an ulcer.

Healthy people do not get pressure ulcers because they are continuously and subconsciously adjusting their posture and position so that no part of their body is subjected to excessive pressure.

However, people with health conditions that make it difficult for them to move their body are at high risk of developing pressure ulcers. In addition, conditions that can affect the flow of blood through the body, such as type 2 diabetes, can make a person more vulnerable to pressure ulcers.

According to the HSE, around 1 in 20 people who are admitted to hospital with an acute (sudden) illness will develop a pressure ulcer. They also note that people over 70 years old are particularly vulnerable to pressure ulcers due to a combination of factors, such as: reduced blood supply, ageing of the skin and the likelihood of older people having a higher rate of mobility problems noting that two out of every three cases of pressure ulcers develop in people who are 70 years old or more.

While the HSE notes that pressure ulcers can be prevented by regularly changing a person's position  and using equipment, such as specially designed mattresses and cushions, to protect vulnerable parts of the body they also claim that “Unfortunately, even with the highest standards of clinical care, it is not always possible to prevent pressure ulcers in particularly vulnerable people.”

But is that correct? Is the HSE, in its website information not being a little self-serving here? My experience would tend to the view that where a patient has developed a pressure ulcer while in the care of a health provider and that ulcer has caused them significant injury, they will most probably have a good case in negligence against that healthcare provider. This is because any patient who is at high risk of developing a pressure ulcer ought to be identified by the nursing staff and in particularly by a specialist nurse usually called a tissue viability nurse whose job it is to both identify those patients at risk and to devise a care plan that will prevent the development of the condition.

Where things are predictable, the law places a much greater onus on the health service to act positively to prevent such an occurrence. For that reason, once a patient is noted to have a low level of mobility or to have other risk factors that would tend to make the development of pressure ulcers more likely, such patients must be monitored very carefully. While pressure ulcers can develop over a relatively short period of time, as short as a few hours for the more vulnerable patient, the nursing staff are trained and expected to inspect the high risk areas of skin quite regularly are thereby identify pressure areas and act to alleviate the pressure before harm is caused to the patient.

For some people, pressure ulcers are a minor inconvenience requiring only some nursing care. For others, they are a very serious type of injury that can lead to life-threatening complications, such as blood poisoning or gangrene (a condition where the body's tissue begins to decay and die). It is usually to this more serious type of injury that legal actions arise though in law there is no reason why less serious pressure sore injuries could not similarly result in legal action.

In our medical negligence practice, the pressure sore cases we have acted in each arose from situations where our clients were confined to bed for an extended period, typically in a hospital, and developed pressure sores at the usual pressure points such as the heels, buttocks, back, shoulder blades and the back of the scalp. Some of these sores have proved to be very deep and very slow to heal. One case resulted in osteomyelitis which is an infection of the bone and required multiple operations to remove the infected areas of bone. Operations to remove the ulcerated tissue are common features of such cases where the surgeon will be required to debride or cut away the affected tissue around the area of the ulcer and special mechanical dressings are then required to maintain a vacuum around the affected area to aid healing.

It is also a common feature of such cases that the patient is not given any indication that the development of such pressure ulcers is an occasion of a poor standard of care though unfortunately that lack of candor is common to most occasions of poor care in our health services. I note that this week Minister for Health Leo Varadker has indicated his intention to introduce legislation making such admissions of harm a legal requirement in the provision of healthcare. That is perhaps a topic for a future column.

Given the serious nature of many pressure sore injuries and the high probability that such an injury has been caused by negligent care, it may well be appropriate to consider legal advice on the options available to an affected patient either to report the issue or in appropriate cases, seek redress.

If you have a query regarding this article you can contact Cian O’Carroll Solicitors on Freephone 1-800 60-70-80 or visit

Cian O’Carroll Solicitors, A Medical Negligence & Personal Injury Law Firm

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