October 31, 2004

Bedsores and medical fault

The late Christopher Reeve did more for medicine than promote spinal cord research; he shed new light on a problem than many suffer from. As CNN.com put it, “In the last week, Reeve had developed a serious systemic infection from a pressure wound, a common complication for people living with paralysis.”

I am well aware that pressure wounds develop in people who lack sufficient mobility, and yet suing medical professionals for not preventing pressure wounds is a growing source of income for trial lawyers. I have suffered through many a lecture from representatives of the legal industry who insist that pressure wounds are due to neglect.

Mr. Reeve’s death sheds light on the fact that fatal pressure wounds can develop in people with insufficient mobility, regardless of the attention and resources dedicated to the patient. One hopes this revelation will inhibit trial lawyers from devastating medical professionals who care for the vast number of immobile patients who develop serious and sometimes fatal pressure wounds. -- Dr. Steve Farmer, Upper Sandusky, Ohio

"Pressure wounds" is the medical term for what lay persons often call bedsores. USA Today, Oct. 24, has more on this issue -- W.O.

Posted by Walter Olson at October 31, 2004 11:01 PM

Being a quadraplegic, I can say pressure sores are due solely to neglect. Who is responsible depends on the circumstances. Mr. Reeve's were due to his own nelect since he is competent to instruct caregivers to prevent pressure sores.

Posted by: Philip Dunham at October 31, 2004 11:58 PM

Being a physician who cares for many who cannot care for themselves, I assure you you are mistaken. In your specific situation, your pressure sores may be linked to your own vigilance, but you have yet to run the full course of the aging and disease process. I assure you that it is not possible to prevent all pressure sores in all patients, regardless of the quality of attention that they may enjoy. Very few have access to the elite healthcare that Mr. Reeves enjoyed, many more suffer profoundly without much attention at all. Maybe this is where we should focus your claims of neglect and responsibility.

Posted by: Dr. Farmer at November 1, 2004 02:19 PM

All three of the above are correct. And perhaps I can elaborate.
As a plastic surgeon, my specialty is the ultimate authority in the etiology, course, prevention, and particularly the (surgical) treatment of pressure sores. Dr. Farmer is apparently not a plastic surgeon but he knows what he's talking about. Mr. Dunham is also correct from his perspective. Pressure sores (bedsores) are caused by pressure that causes ischemia (lack of blood flow) to the the tissues for too long which causes the tissue to necrose (die) in a widening area from a point on the skin to a large area against the bone under the pressure point. Like burns (how much heat for how long), it depends on how much pressure for how long as well as the hardiness of the tissues (for example scarring from previous insults). Usually this happens only in areas that have no sensation because the body shifts the pressure even when you're asleep if the area has sensation. The other people that get bedsore besides paraplegics and quadraplegics are those comatose from drugs or disease or are bedridden to the point of immobility. You can monitor or turn someone in an intensive care unit and prevent bedsores but not in a chronic care or ambulatory setting.

Dr. Farmer is correct that all paraplegics and quadraplegics get various forms and levels of pressure sores eventually in spite of the best care, but Mr. Dunham is correct that neglect by the patient him or herself (even intentional) or by helpers or medical staff can result in pressure sores that are, in effect, caused by neglect or at least could have been prevented. Mr. Reeves was probably pushing himself, perhaps even against medical advice and was up too long and developed a pressure sore. In spite of the best care available.

The trial lawyers don't really care who's at fault or what the actually liability is because they have a huge vested interest in the outcome of their own suit. They only care that it's someone they can convince a jury to blame (or intimidate into settling) and who has money to go after. John Edwards didn't care that the doctors didn't cause the cerebral palsy he sued them for. He only needed to convince a jury of lay people to award millions of dollars to make himself rich (and now to get elected). And the figure of 100,000 deaths caused by medical mistakes every year that the trial lawyers and their supporters bandy about is lying with statistics.

The real cause of death in pressure sore cases isn't the pressure sore, it's the dead tissue and the abscess and infection that develops behind it. Medical doctors who are usually managing patients with or potentially could get pressure sores, don't always realize the surgical urgency of infection under pressure sores (the patient still can't feel it and there are plenty of other sources of a fever or signs of infection and, of course, the patient might ignore the signs of infection too). Like any abscess, if the infection gets going too far before it's recognized and surgically drained, the person can die from systemic (generalized or overwhelming) infection. Statistically, quadraplegics usually die of some event like this. Paraplegics usually last longer.

So like the John Ritter case, the plaintiff attorneys are going to argue that whoever has money to go after was negligent in not diagnosing the infection and treating it properly in time. Then the statistical liars will say it's another death caused by a medical error. And of course we'll all be better off after the lawyers make a few million off the case, because HOPE IS ON THE WAY!

Posted by: Scott L. Replogle MD at November 2, 2004 06:41 PM

Thank you, I am a rural hospialist and FP. Unfortunately in my situation, there is no ultimate authority on anything within 60 miles of me. We would be thrilled to have a plastic surgeon as a primary wound physician, but such is not plausible. We are left with a community that relies on our nurses to combat such common problems, and they have been spectacular. I make my point in their defense, as the legal industry is profiting by blaming them for situations beyond their control.

Posted by: Dr. Farmer at November 3, 2004 02:01 PM