By: Kenneth C. McCawley, RN         October 5, 2016


Avoidable pressure ulcer development continues to lead negative health outcomes in skilled nursing facilities. Many of these negative health outcomes can be attributed to medical negligence.  The following statistics are in relation to pressure ulcer development:

  • Number Affected: 2.5 million patients per year.
  • Cost: Pressure ulcers cost $9.1-$11.6 billion per year in the U.S. Cost of individual patient care ranges from $20,900-$151,700 per pressure ulcer. CMS estimated in 2007 that each pressure ulcer added $43,180 in costs to a hospital stay.
  • Lawsuits: More than 17,000 lawsuits are related to pressure ulcers annually. It is the second most common claim after wrongful death and greater than falls or emotional distress.
  • Death: About 60,000 patients die as a direct result of a pressure ulcer each year.


According to Centers for Medicare/Medicaid Services (CMS):


Neglect is “failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.”[1]


Avoidable meaning the resident developed a pressure ulcer and that the facility did not do one or more of the following:

    • evaluate the resident’s clinical condition and pressure ulcer risk factors;
    • define and implement interventions that are consistent with resident needs, resident goals, and recognized standards of practice;
    • monitor and evaluate the impact of the interventions; or
    • revise the interventions as appropriate.[2]

Pressure Ulcer Development:

Pressure ulcer development continues to be one of the indicators for quality of care in skilled nursing facilities. Some negative outcomes with pressure ulcer development include:

  • Pain
  • Loss of Mobility
  • Risk of Development of Infection
  • Decreased Dignity
  • Unnecessary Surgical Procedures
  • Prolonged Hospitalizations
  • Death


Skilled nursing facilities are directed to provide the highest quality of care to all residents and to avoid negative health outcomes as warranted. Avoidable pressure ulcers can develop from improper fitting footwear, limited repositioning while in a bed/wheelchair, no pressure reducing surfaces issued to the respective resident upon admission/change in health condition, poor hydration/nutrition, bowel/bladder incontinence issues and decrease in activities of daily living.  These risk factors can also be “tied” to neglect as defined above.


Successful litigation has and is continuing in courts for avoidable pressure ulcer prevention with staggering financial amounts being awarded. According to Corstrata, “83% of wound related litigation is settled in patient’s favor . . . individual judgements as high as $312 million.”[3]

Pressure Ulcer Settlements for Residents:

The following provides examples of pressure ulcer settlements reached on behalf of nursing home residents:

  • In Delaware, an 88-year-old woman developed pressure ulcers which progressed to become severely infected. Her family filed a lawsuit against the nursing facility on her behalf. The resident and her family were awarded a $2.3 million settlement.
  • A quadriplegic nursing home resident developed pressure ulcers during his residency in an Illinois nursing home. Despite treatment, the pressure ulcers did not heal for more than a year. His family members filed a lawsuit on his behalf, and the client was awarded a $1 million settlement.
  • An 88-year-old nursing home resident developed severely infected pressure ulcers. In order to treat the condition, the resident underwent hospitalization with subsequent surgeries for comprehensive wound care management. The resident and family were awarded a $1 million settlement.


Pressure Ulcer Death Settlements for Family Members:

The following provides examples of pressure ulcer settlements reached on behalf of nursing home residents who died as a result of sustained pressure ulcers:

  • In Texas, an 82-year-old woman developed severe pressure ulcers that infected the underlying bone. As a result, the resident died. Her family filed a pressure ulcer lawsuit on her behalf and was awarded a $1.2 million settlement.
  • A similar infection case occurred with the family of an 87-year-old woman in a Washington nursing home. She died of Stage IV pressure ulcers. The resident’s family was awarded a $900,000 settlement.
  • In Illinois, an 80-year-old woman developed multiple Stage IV pressure ulcers. The infection of these pressure ulcers led to her demise. Her family filed lawsuits against the nursing home and received a $1 million settlement.


There are millions of patients each year in nursing homes affected by the avoidable development of pressure ulcers. The cost to the health care system is billions of dollars annually and the number of lawsuits is currently in the thousands.   Once avoidable pressure ulcer development is proven, litigation and jury awards in favor of the plaintiff are likely with settlements worth millions of dollars for the plaintiff.

About the Author:

Kenneth C. McCawley, RN has 24 years of clinical practice in critical care nursing as well as over 16 years of Director of Nursing Services at various skilled nursing facilities. Kenneth is also the co-owner of Med Legal Pro, LLC.  Kenneth can be reached at or 570-445-1453.

[1]  42CFR Part 488.301

[2] 483.25c/TagF314