Nursing Home Administration Expert Witness Advises on Neglected Patient’s Bedsores

ByMichael Morgenstern

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Updated onOctober 19, 2017

Nursing Home Administration Expert Witness Advises on Neglected Patient’s Bedsores

A nursing home administration expert witness advises on a case involving an elderly female patient who on August 14, 2014, fractured her pelvis. A pelvic x-ray revealed a left parasymphysis pubis fracture not involving the acetabulum. She was hospitalized as an inpatient on August 18, 2014. On August 22nd, she had her first physical therapy session in the Delaware hospital. During therapy she put little weight on her left lower extremity due to pain, yet she performed ankle pumps, hip abduction and adduction, long arc quads and marching for 5-10 repetitions. Physical therapy would consist of gait training, bed mobility, transfer training, balance training and therapeutic exercise.

The patient was significantly limited due to pain in her left groin and required minimum to moderate assistance for transfers with little ambulation due to painful weight bearing. The therapist felt the patient would benefit from continued physical therapy services and recommended rehabilitation at a skilled nursing facility prior to discharge home. On August 31st, the patient was transferred to a nursing home where she relied on staff for assistance with bed mobility, transfers, toilet use and personal hygiene. Shortly after admission, she described pain in her hips at 10/10 on the pain scale and was given Morphine Sulfate. While a resident at the nursing facility, she was often left in her bed for hours at a time in excruciating pain. At times, the sheets on her bed were tucked in at the edge of her bed so that her ankles and feet were pressed downward and inward for extended periods of time. The patient developed a sacral coccygeal decubitus ulcer and severe bilateral plantar flexion contractures.

Questions to the Geriatrics expert and their responses

Q1

Do you routinely treat patients similar to the one described in the case?

I have an active academic geriatric medicine and palliative medicine practice, and I see patients in inpatient, nursing home, and outpatient clinic settings. Patients with problems similar to the patient described in this case are not uncommon in my practice.

Q2

How/when do you determine if the necessary care and services include physical therapy and re-positioning?

In general, frail older patients with pelvic fractures who are appropriate for rehabilitation based on their care goals (which appears to have been the situation in this case) would typically undergo post-acute rehabilitation in a skilled nursing facility including physical and occupational therapy, along with re-positioning by facility staff as needed either for comfort or for impaired bed mobility. Patients who exhibit marked impairment of bed mobility and limited mobility due to pain would be at increased risk for complications of immobility and a failed course of rehabilitation and should be identified and case-managed accordingly.

About the expert

This highly qualified Gerontology and Geriatric Medicine expert is triple board certified and a Fellow of the American College of Physicians. He is Fellowship trained in Gerontology & Geriatric Medicine as well as Palliative Care. This expert is a Fellow if the American Geriatrics Society and a member of several professional organizations including the American Geriatrics Society. he has won countless awards throughout his career including the Pfizer/American Geriatrics Society Postdoctoral Fellowship Award. He is active in the research community with his projects attracting millions of dollars in funding. He has published 17 peer-reviewed journal articles and has authored 26 text books. He currently serves as Medical Director of the Palliative Care and Hospice Service at a major health care system in addition to his Professorship at a major university.

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About the author

Michael Morgenstern

Michael Morgenstern

Michael is Senior Vice President of Marketing at The Expert Institute. Michael oversees every aspect of The Expert Institute’s marketing strategy including SEO, PPC, marketing automation, email marketing, content development, analytics, and branding.

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