The Increasing Medical Malpractice Risk Related to Pressure Ulcers in the United States

The development of pressure ulcers is a common adverse occurrence among hospital patients and nursing home residents. In recent years, there have been media reports of older plaintiffs winning up to $65 million from healthcare providers, related to the development of pressure ulcers. The passage of sweeping nursing home reform legislation as part of the Omnibus Budget Reconciliation Act of 1987 (OBRA‐87) may have influenced this trend. A review of identifiable federal and state legal databases was undertaken to investigate these issues. One hundred seventy‐three lawsuits related to pressure ulcers were identified between 1937 and 1997, with all but 11 (6%) recorded in the last 15 years. Although the majority of cases were related to the development of pressure ulcers among nursing home residents, hospitals were a defendant in almost one‐quarter of the cases. The median (range) number of cases identified annually increased significantly in the 5‐year epochs before and after passage of OBRA‐87 and increased again after publication of OBRA‐87 regulations in 1992 (2 (2–4) vs 9 (5–15) vs 19 (16–23) cases per year, respectively, P < .0001), evidence that this law has had a broad impact on medical malpractice risk. In addition, the median (range) age of patients for whom a suit was brought also increased significantly before compared with after 1987 (48 (2–81) vs 72 (5–96) years, respectively, P = .0009), evidence that the law facilitated the ability of older adults to become plaintiffs in medical malpractice cases. The median (range) monetary settlement or judgment did not change significantly during the three 5‐year epochs ($340,000 ($4000‐$2,000,000) vs $168,000 ($2200‐$2,000,000) vs $279,000 ($25,000‐$65,000,000), respectively, P = .44), evidence that the OBRA‐87 statutes and regulations established both a standard of care that should not be breached and a standard that can be achieved by healthcare providers. This article reviews these trends, provides examples of pressure ulcer cases, discusses the implications of these findings, and provides recommendations for minimizing this medical malpractice risk. J Am Geriatr Soc 48: 73–81, 2000.