Not So Happy: Hospital Acquired Pressure Injuries (HAPIs) Are Second Most Common Lawsuit In Healthcare Settings

Legal NewsMedical Devices

Hospital Acquired Pressure Injuries (HAPIs) occur because of patient immobility, pressure, friction, shear, poor nutrition, and poor blood circulation, affecting more than 2.5 million patients annually. The cost of treating HAPIs is roughly $10 billion per year, according to

In extreme cases, HAPIs, which are also called “pressure ulcers,” can cause tissue loss, severe pain and even death. In fact, according to the Agency for Healthcare Research and Quality (AHRQ), approximately 60,000 people die every year because of pressure ulcers. 

AHRQ says that more than 17,000 lawsuits are related to pressure ulcers annually, which makes HAPI the second most common claim after wrongful death. HAPI lawsuits outnumber falls and emotional distress.

More unhappy HAPI states, courtesy of AHRQ: The cost of treating a pressure ulcer per patient can exceed $150,000, and back in 2007, Medicare estimated that each pressure ulcer added over $43,000 in costs to a hospital stay.

Minor cases of HAPIs most often manifest as skin discoloration (red or purple). But the coronavirus pandemic has exacerbated the problem of pressure injuries acquired in hospitals, especially for COVID-19 patients who required lengthy ICU care. 

And pressure injuries are not just caused by immobility-induced friction. Many HAPIs are acquired from the prolonged pressure of a medical device. suggests more than 30% of all HAPIs are the result of intense and/or prolonged pressure on the skin that is in constant contact with a medical device, such as a ventilator. 

The treatment of COVID-19 with a ventilator places patients in a prone position for lengthy periods of time, in order to increase oxygen saturation in the lungs. This causes pressure injuries to areas of the body such as the face, that pre-pandemic, were quite rare. 

Can COVID-19 Cause Pressure Injuries? 

According to, the National Pressure Injury Advisory Panel (NPIAP), says that SARS-COv-2, the virus that causes COVID-19, itself can induce skin changes that mimic a deep tissue pressure injury. After all, the coronavirus can injure organs and the skin is the largest organ in the body. 

The virus causes blood to coagulate (blood becomes sticky and semi-solid) and chokes off blood flow in tiny blood vessels (capillaries). These physiological alterations cause the skin to turn purple, which is why it’s easy for a healthcare worker to confuse a pressure injury with coagulation. 

Therefore, “it is important that wound care experts involved in the care of these patients have assessment skills that can help differentiate between HAPI and COVID-19 Coagulopathy,” the Panel concluded in a report

This article was adapted from a longer version here.


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