When a Hospital Causes a Bedsore: What Texas Patients and Families Need to Know

By J.T. Borah | Texas Medical Malpractice Attorney | Texas Super Lawyer
The Borah Law Firm, PLLC — Austin, Texas

Your family member went into the hospital for a procedure. Before admission, their skin was intact. After two weeks in a hospital bed, they have an open wound on their tailbone that nobody on the nursing staff mentioned to you. When you finally asked, you were told it was “common” given their condition. That answer is almost certainly wrong.
Hospital-acquired pressure injuries — also called HAPIs, bedsores, pressure injuries, pressure ulcers, or decubitus ulcers — are not an inevitable consequence of being hospitalized. The Centers for Medicare and Medicaid Services (“CMS”) classifies them as the most often preventable adverse event in hospitals in the United States. More than 2.5 million Americans develop them every year. When a hospital fails to take basic preventive steps, patients pay for that failure with their skin, their health, and sometimes their lives.
What follows is a plain-language explanation of how hospital pressure injuries develop, why CMS treats them as preventable, what Texas law says about hospital accountability, and what compensation Texas law allows when a hospital causes this kind of harm.

What Is a Hospital-Acquired Pressure Injury, and How Does One Develop?

A hospital-acquired pressure injury is a wound that develops on a patient’s skin during a hospital stay. It forms when sustained pressure on a specific area cuts off blood flow to the underlying tissue, causing that tissue to break down. The most common sites are the tailbone, heels, hips, and shoulder blades — bony areas where the body’s weight concentrates when a patient lies still for extended periods.

These injuries are clinically staged using the classification system maintained by the National Pressure Injury Advisory Panel (NPIAP). A Stage 1 injury is intact skin with a reddened, non-blanchable area. Stage 2 is partial skin loss — a shallow open wound or blister. Stage 3 involves full-thickness skin loss reaching into the fat layer. Stage 4 is the most severe: full-thickness tissue loss with exposed or palpable bone, tendon, or muscle. Two additional categories apply in specific situations: an unstageable injury is one covered by dead tissue that prevents visual depth assessment, and a deep tissue pressure injury presents as a discolored area of intact skin over damaged tissue beneath.

Preventing these injuries is straightforward. Repositioning patients at least every two hours, using pressure-redistributing mattresses, maintaining adequate nutrition and hydration, and conducting skin assessments at admission and throughout the stay are all established standard-of-care practices. When hospitals follow those protocols, almost no pressure injuries develop. When they do not follow them, the result is often harm that was entirely avoidable.

Why Does CMS Say That Hospital Bedsores Should Never Happen?

CMS classifies hospital-acquired pressure injuries as the most often occurring preventable adverse event in U.S. hospitals, and they are the second most common claim in medical malpractice lawsuits nationally — behind only wrongful death. Because CMS treats these injuries as preventable, it stopped reimbursing hospitals for treating Stage 3 and Stage 4 pressure injuries that develop during a patient’s stay.

That nonpayment policy began in 2008 under the Hospital-Acquired Conditions Present on Admission (HAC POA) program, established by the Deficit Reduction Act. You can review the current program at CMS’s Hospital-Acquired Conditions page. The Hospital-Acquired Condition Reduction Program, created by the Affordable Care Act, adds a further consequence: hospitals in the bottom quartile of HAC performance receive reduced Medicare payments.
That nonpayment determination carries weight in litigation. When CMS’s own reimbursement policy reflects a regulatory judgment that Stage 3 and Stage 4 pressure injuries are preventable, it is harder for a hospital to stand in court and argue its nurses did everything right. The policy is not a legal finding of liability, but it is powerful context for an expert witness testifying about the standard of care.

Can a Texas Hospital Be Held Legally Responsible for a Bedsore That Developed During a Stay?

Yes. A hospital can be held liable for a pressure injury that develops during a patient’s stay when the injury resulted from nursing care that fell below the accepted standard. A “health care liability claim” — the legal term for a malpractice lawsuit against a hospital, doctor, or other provider — is the vehicle for that accountability under Texas Civil Practice and Remedies Code Chapter 74.
The federal Conditions of Participation for hospitals at 42 C.F.R. §482.23 require hospitals to provide nursing services adequate to meet the needs of all patients. Skin care, repositioning schedules, and wound assessment fall within that requirement. Texas law runs parallel: the Texas Hospital Licensing Law (Health and Safety Code Chapter 241) requires all licensed Texas hospitals to maintain standards of care for their patients, and Texas Administrative Code Title 25, Chapter 133 establishes detailed licensing standards enforced by the Texas Health and Human Services Commission.
What the hospital’s own medical record shows is central to every pressure injury case. Admission skin assessments, Braden scale risk scores, repositioning documentation, wound care orders, nursing notes, and physician notification entries are all discoverable. Gaps in that record — missing risk assessments, absent turning schedules, delayed wound care consultations — are often where a case is built. Texas malpractice cases also require a qualifying expert report under §74.351 of the Texas Civil Practice and Remedies Code, served within 120 days of the defendant’s answer.

What Is the “Unavoidable” Defense — and Why It Often Fails?

Hospitals often argue that a pressure injury was clinically unavoidable given the patient’s underlying condition. That defense only holds if the hospital can prove it assessed the patient’s individual risk factors, developed a specific prevention care plan, implemented those interventions consistently, evaluated their effectiveness, and revised the plan as needed — and that the injury developed despite all of that. In practice, the medical record often tells a different story. 
What we often see in litigation is a Braden scale assessment completed days after admission, no documented turning schedule in the nursing notes, and a wound that progressed from Stage 1 to Stage 3 over several days without a documented physician notification or wound care consultation order. That is not an unavoidable injury. That is a documentation trail that supports a hospital negligence claim. I can honestly say that in all of my years of practice I have never seen an unavoidable pressure injury.  All of them could have been avoided with even a minimal amount of effort on the part of the hospital staff.
Expert witnesses — typically wound care certified nurses or physicians with wound care expertise — review the full clinical record and testify whether the hospital met or fell below the standard of care. Their analysis of documentation gaps, missed assessment windows, and delayed treatment decisions is often the most compelling element of a pressure injury case.

What Documentation Should You Gather After a Loved One Develops a Hospital Bedsore?

Request the complete electronic medical record. It is important for you not to request a hard copy of these records. And make sure you request a complete record and not just the discharge summary.  We will need all of the nursing notes, admission skin assessment forms, Braden scale scores, wound care orders, progress notes, repositioning documentation, and physician notification records.  These documents will determine whether a hospital met or failed to meet the standard of care.
If your family member is still hospitalized, take dated photographs of the wound at every visit and note the date, time, and stage designation each time. If they were transferred to a nursing home or rehabilitation facility after discharge, request those records as well. Wound progression after hospital discharge can establish the true severity of what developed during the hospital stay. If the wound heals it will be proof that it was not an unavoidable pressure injury.
Under Texas Health and Safety Code §241.153, patients and their authorized representatives are entitled to access hospital medical records. Submit requests in writing and keep copies. If a records request is denied, delayed, or incomplete, that too is documentable evidence of institutional misbehavior.

What If the Pressure Injury Led to Sepsis or Death?

A pressure injury that goes untreated or is mismanaged will often become infected. When that infection spreads into the bloodstream, it causes sepsis — a life-threatening condition and a leading cause of hospital deaths in the United States. A patient admitted for a routine procedure who develops a Stage 4 pressure injury due to inadequate nursing care and dies from the resulting sepsis infection may have a family with viable claims for both the pressure injury and the death itself.
Under Texas Civil Practice and Remedies Code §71.002, surviving spouses, children, and parents of a deceased patient can pursue a wrongful death claim against a Texas hospital when negligence caused or contributed to their loved one’s death. The estate can separately pursue a survival action for what the patient suffered before death, the medical bills that were incurred in treating the pressure injury along with any lost earnings. Wrongful Death claims and Survival actions require early investigation, because hospital wound care documentation — when the wound was identified, what treatment was ordered, whether physicians were notified — is central to establishing liability.

What Damages Can a Texas Family Recover for a Hospital Bedsore?

Texas limits some types of compensation in health care liability claims — but not all of it. Knowing which limits apply, and what they leave untouched, matters as much as winning the case itself.

Non-Economic Damages — Texas Civil Practice and Remedies Code §74.301

“Non-economic damages” is the legal term for compensation that is not a bill or a paycheck: physical pain and suffering, disfigurement, physical impairment, and loss of consortium — a spouse or family member’s loss of their partner’s companionship and support. Texas caps these.

Under §74.301, a “claimant” is everyone seeking recovery from a single person’s injury or death: the patient, the estate, surviving parents, the spouse, and the children — all of them together, regardless of how many, count as one claimant.

The caps work like this:

• Doctors and individual providers only (any number): The claimant can receive up to $250,000 total for non-economic damages.
• One hospital: The claimant can receive up to $250,000 total for non-economic damages.
• Multiple hospitals: Each hospital is capped at $250,000 per claimant, but the total across all hospitals cannot exceed $500,000 per claimant.
• Doctors plus one hospital: The claimant can receive up to $500,000 total for non-economic damages. Up to $250,000 from the doctors and up to $250,000 from the hospital.
• Doctors plus two or more hospitals: The claimant can receive up to $750,000 total for non-economic damages. Up to $250,000 from the doctors and up to $500,000 from the hospitals.

If the patient died, the wrongful death cap at §74.303 applies instead of this combined cap.

Wrongful Death and Survival Action Damages — Texas Civil Practice and Remedies Code §74.303

A “survival action” is the claim by the deceased patient’s estate for what the patient suffered before death. A wrongful death claim belongs to surviving particular family members.  Only spouses, children, and parents can be compensated for their own losses. No grandmother, grandfathers, aunts, uncles, cousins, nieces, or nephews. 

The cap for a case involving the death of a patient, under §74.303, is a combined $500,000 per claimant for non-economic damages and lost earnings together — regardless of how many doctors or hospitals are involved. But that number is not fixed. It adjusts annually for inflation using the Consumer Price Index — a federal government measure that tracks the rising cost of goods and services over time, measured from a baseline date of August 29, 1977. 

What the Caps Do Not Limit

“Economic damages” — the hard costs a jury can actually calculate — are not subject to these caps. Past and future medical bills, past and future lost earnings, past and future loss of household services, and custodial care can all be recovered in full, with no ceiling. Economic damages can be substantial in a serious Stage 4 pressure injury case that requires long-term wound care, multiple debridements, flap surgeries, and ongoing skilled nursing.

We Can Help

At The Borah Law Firm, PLLC, we only handle medical malpractice cases, nothing else. As part of our practice, we stand for patients and families across Texas in cases just like the one discussed in this blog. If you believe a loved one received substandard care — whether in a hospital, nursing home, or assisted living facility — that resulted in a pressure injury, we can help you understand whether a case exists and what your options are.
Contact us today so you can tell us your story.
FAQs
How Long Do I Have to File a Lawsuit If My Loved One Got a Bedsore in a Texas Hospital?

Texas imposes a two-year statute of limitations for health care liability claims under Texas Civil Practice and Remedies Code §74.251. That clock generally starts on the date of the negligent act, not the date you discovered the injury. A ten-year statute of repose sets an absolute outer deadline regardless of discovery. Texas also requires a qualifying expert report under §74.351 within 120 days of the defendant’s answer — a procedural deadline entirely separate from the statute of limitations. Missing it results in dismissal. Contact an attorney as early as possible; the investigation timeline matters as much as the filing deadline.

What Is the Difference Between a Stage 3 and a Stage 4 Pressure Injury?

A Stage 3 pressure injury involves full-thickness skin loss reaching into the fat layer. Bone, tendon, and muscle are not visible. A Stage 4 injury goes deeper: full-thickness tissue loss with exposed or palpable bone, tendon, or muscle. Stage 4 injuries carry a high risk of bone infection and sepsis. Both are classified by CMS as hospital-acquired conditions for which hospitals are not reimbursed under Medicare, reflecting the regulatory determination that both are preventable with proper nursing care.

Can a Hospital Claim a Bedsore Was Unavoidable to Avoid Being Sued?

Hospitals frequently raise this defense, but it requires documented proof: an individualized clinical risk assessment, a specific prevention care plan, consistent implementation and monitoring, and the injury developing despite all of that. In many cases the medical record shows none of it — no documented turning schedule, no timely skin assessment, a wound that progressed through multiple stages without a physician notification. That is not unavoidable. That is inadequate care, and it forms the basis of a liability claim.

What Evidence Do I Need to Prove a Texas Hospital Caused My Loved One’s Pressure Injury?

The complete medical record, including nursing notes, is the foundation. Specifically: the admission skin assessment, Braden scale risk scores, repositioning documentation, wound care orders and nursing notes, physician notification records, and wound care specialist consultations. Dated photographs of the wound are important if available. A nursing negligence or wound care expert witness will review those records and render an opinion on whether the hospital’s care met the applicable standard. The strength of the case often turns on what is in — and what is missing from — that record.

About the Author: J.T. Borah is a Texas-licensed medical malpractice attorney and Texas Super Lawyer at The Borah Law Firm, PLLC in Austin, Texas. He has testified before both the Texas House and Senate on patient safety issues and focuses exclusively on medical malpractice cases statewide.

About this article: AI writing tools assisted Mr. Borah in drafting this article. All legal analysis reflects his independent professional judgment. This article is for general informational purposes only. It is not legal advice and does not create an attorney-client relationship.

Link: CMS Hospital-Acquired Conditions Present on Admission Program