The increasing medical malpractice risk related to pressure ulcers in the United States

The development of pressure ulcers is a common adverse occurrence among hos pital patients and nursing home residents. In recent years, there have been media reports of older plaintiffs winning up to $65 million from healthcar e providers, related to the development of pressure ulcers. The passage of sweeping nursing home reform legislation as part of the Omnibus Budget Reco nciliation Act of 1987 (OBRA-87) may have influenced this trend. A review o f identifiable federal and state legal databases was undertaken to investig ate these issues. One hundred seventy-three lawsuits related to pressure ul cers were identified between 1937 and 1997, with all but 11 (6%) recorded i n the last 15 years. Although the majority of cases were related to the dev elopment 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 befo re and after passage of OBRA-87 and increased again after publication of OB RA-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 o n medical malpractice risk. In addition, the median (range) age of patients for whom a suit was brought also increased significantly before compared w ith after 1987 (48 (2-81) vs 72 (5-96) years, respectively, P = .0009), evi dence that the law facilitated the ability of older adults to become plaint iffs in medical malpractice cases. The median (range) monetary settlement o r judgment did not change significantly during the three 5-year epochs ($34 0,000 ($4000-$2,000,000) vs $168,000 ($2200-$2,000,000) vs $279,000 ($25,00 0-$65,000,000), respectively, P = .44), evidence that the OBRA-87 statutes and regulations established both a standard of care that should not be brea ched and a standard that can be achieved by healthcare providers. This arti cle reviews these trends, provides examples of pressure ulcer cases, discus ses the implications of these findings, and provides recommendations for mi nimizing this medical malpractice risk.