Blog | February 10, 2026

Navigating Wound Infection Claims in Long-Term Care

Pressure injuries continue to represent over 22% of all closed claims, and average close to $240,000, across independent living, assisted living and skilled nursing communities.  Allegations of negligence, improper treatment, and defective products are common, making a strong defense essential.  At the recent DRI Senior Living and Long-Term Care Seminar, experts Sammi Renken and Eric Walker, MD delivered a detailed review of medical causation and litigation strategies specifically designed to counter these accusations.

Framework for Challenging Claims Related to Wound Infections

Understanding the medical causation is the key to successfully challenging wound infection claims.  A key overriding argument is that wound infections can and do occur in the absence of negligence.  The presenters stressed retaining the correct expert, typically infectious disease, plastic/general surgery or geriatric physicians, to refute plaintiff’s arguments relating to causation, cause of death and damages.  The following were key issues to address to combat plaintiff claims in these areas:

Causation:  Plaintiffs claim the cause of the infection is whatever the care provider did or did not do, including failure to employ proper treatments, improper incontinence care, failure to keep resident clean and violation of infection control policies.  The defense must assess:

  • If the wound was infected (microorganisms causing symptoms and disease) or colonized (microorganisms present, no symptoms)
    • What technologies, such as autofluorescence imaging, were used to assess the presence of colonization vs. clinical infection to inform treatment options.
  • If the wound was unavoidably infected in a patient with high risk for infection, including those with
    • vascular disease,
    • low oxygenation,
    • heart or kidney failure,
    • immobility,
    • poor nutrition,
    • obesity,
    • metabolic changes,
    • diabetes and other underlying comorbidities.
  • If infected, what was the clinical impact on the patient
  • The type of infection documented:
    • Wound infection identified by redness and swelling around wound, pain or tenderness, warm to the touch, drainage, foul odor, wound edges not healing or separating and fever
    • Osteomyelitis identified by bone biopsy or MRI
    • Systemic Infection identified by blood cultures. Systemic Inflammatory Response (SIRS) identified by temperature of 100.4 or greater, heart rate over 90 bpm, respiratory rate over 20 bpm, elevated white blood cell count
    • Necrotizing Fasciitis typically caused by streptococcal infection or Fournier’s gangrene and cause rapid tissue death.

Cause of Death: Plaintiffs claim the wound infection caused or contributed to the death.  The defense must argue that the presence of a clinically infected wound does not necessarily mean it was the cause of death.  The source of the infection may be a UTI or pneumonia, and the organism in the blood culture may not match the organism in the wound culture.  Again, use of expert testimony to demonstrate the difference between clinical infection and systemic infection is critical.

Damages:  Plaintiffs claim all bills incurred relate to a specific infection.  The defense must show which treatment was related directly to the wound infection versus other concurrent infections and/or conditions.

Medical Chronology
Turning and Repositioning Report
Care Calendar/Touch Chart
Case Summary

Documentation Reviews to Support the Defense

For over 20 years, Excelas has partnered with senior living providers, insurers and defense counsel in the defense of wound cases.  Our experienced medical analysts review medical and other pertinent records and develop focused reports including:

  • Turning and Repositioning Chart – a simple, visual layout to demonstrate the consistency of care given to a resident.
  • Care Calendar – an interactive calendar to visualize the date and time of all interactions with a resident.
  • Medical Chronology – a customizable report of all documentation related to the resident’s care, which can be easily sorted by topic, record type, or provider of care.
  • Case Summary – a high-level summary of the medical history including an opinion by our medical-legal analysts on whether the records support or refute the allegations and comments on any additional areas for investigation
  • All reports include hyperlinks to the page(s) in the medical record where the care is documented.

Each of these work products are used to assist counsel in evaluating the merits of a claim/case, and in developing defense strategies in relation to causation, cause of death and damages.  Contact Excelas today for a demonstration of how our software, analytic tools and reports can be a cost-effective and powerful tool in defending wound infection cases.

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