Did Dennis Prager’s pressure injuries fit a pattern that Cedars-Sinai had already identified, measured and tried to correct?
Several earlier cases against Cedars-Sinai jsd similar allegations concerning pressure injuries, skin monitoring, repositioning and staffing. None proves that Cedars negligently injured Prager, but together with Cedars-Sinai’s quality-improvement records, regulatory inspections and employee complaints, they raise the institutional question.
The closest predecessor may be Parks v. Cedars-Sinai Medical Center, Los Angeles Superior Court case No. BC705530. Michael Park entered Cedars in 2016 with intact skin but was classified as being at high risk for pressure ulcers. According to the allegations, Cedars created a skin-integrity plan requiring twice-daily skin monitoring and repositioning at least every two hours. His widow alleged that the hospital repeatedly failed to carry out those measures and that Park developed Stage IV pressure ulcers. He was subsequently transferred to Barlow Respiratory Hospital, where the wounds allegedly deteriorated and he developed sepsis. The Cedars-to-Barlow sequence makes the factual resemblance to Prager unusually close. Cedars ultimately won summary judgment in March 2023, but Park’s widow was representing herself and did not oppose the motion. The court therefore had Cedars’ expert evidence and no competing expert evidence. The ruling does not establish that a contested trial exonerated Cedars. What it establishes is that years before Prager another highly dependent Cedars patient was alleged to have suffered a Stage IV pressure injury after failures to carry out an every-two-hour repositioning plan.
A more recent case gets even closer to the legal theory the Pragers are pursuing. In Martin v. Cedars-Sinai Medical Center, Los Angeles Superior Court case No. 24STCV00619, Kirk Martin alleged that he developed a pressure wound during a Cedars hospitalization running from January 14 through March 7, 2023. His complaint alleged failures to train staff, recognize skin changes, provide sufficient staffing and protect him from pressure injury. It also alleged that Cedars diverted resources away from patient care. In October 2024, Judge Barbara Scheper held that Martin’s prolonged dependence on Cedars for repositioning and hygiene was sufficient to plead the custodial relationship required for dependent-adult neglect. She also concluded that the alleged failures involving monitoring, staffing and treatment were sufficiently particularized to plead potentially reckless neglect. Again, that was a pleading ruling, not a finding that the allegations were true. But it matters because another Cedars plaintiff had already advanced a pressure-injury theory that crossed, at least provisionally, from malpractice into the Elder Abuse Act.
The most revealing precedent for the Pragers’ institutional-understaffing theory may be Watson v. Beverly Hills Rehabilitation Centre, LLC, et al., Los Angeles Superior Court case No. 23STCV28540. The plaintiffs alleged that Cedars failed to care properly for serious pressure injuries, failed to communicate adequately with physicians, failed to implement doctors’ orders and failed to document the care plan. They then aimed much higher in the organization. Their complaint alleged “chronic understaffing at Cedars by its managing agents in both number and training,” violations of California staffing requirements, and employees who lacked sufficient time or training to reposition the patient and perform skin inspections. The complaint further alleged that management knew understaffing could cause precisely these injuries. Cedars attacked the allegations by demurrer. In March 2024, Judge Daniel Crowley overruled the demurrer and refused to strike the punitive-damages and attorney-fee claims.
That ruling is potentially valuable to the Pragers for a reason that goes beyond another bedsore allegation. Watson gives them a road map. If their theory is that Prager’s missed turns resulted from chronic understaffing rather than occasional individual mistakes, another plaintiff has already pleaded essentially that theory against Cedars and survived the hospital’s initial attack.
Cedars also has precedent showing how it will try to defeat the claim. In Perez v. Cedars-Sinai Medical Center, Los Angeles Superior Court case No. 20STCV37353, the patient alleged that staff left him in feces and urine for extended periods, allowed pressure ulcers to develop and maintained inadequate staffing in order to reduce costs. In October 2022, after several attempts to amend the complaint, Judge William Crowfoot rejected the elder-abuse theory. A central problem was corporate attribution. Perez alleged inadequate budgets and understaffing but failed to identify with sufficient specificity an officer, director or managing agent who had authorized or ratified the misconduct.
That distinction could become decisive in Prager’s case. It is not enough for his lawyers to prove that individual nurses missed turns. It may not even be enough to prove that a unit was badly understaffed. To obtain the enhanced remedies available under the Elder Abuse Act against Cedars itself, they need evidence climbing the management chain: who controlled staffing, who received pressure-injury data, who knew compliance was failing, who controlled budgets, what warnings reached nursing leadership and what decisions followed.
This is where Cedars-Sinai’s own publications become more interesting.
Cedars’ 2020-21 Nursing Annual Report says its wound-care nurses detected an “unfavorable trend” in Stage II and higher hospital-acquired pressure injuries during fiscal 2020. Cedars also reported that its pressure-injury prevalence was benchmarking higher than comparable institutions in the national database. The response was not a local fix on one floor. Cedars mounted an organization-wide hospital-acquired pressure-injury prevention effort involving its Wound, Ostomy and Continence Nurses team and Nursing Administrative Leadership.
That evidence cuts both ways. Cedars can argue that it discovered a quality problem, responded aggressively and succeeded. The hospital reported a 62 percent reduction in hospital-acquired pressure injuries following its intervention. But for the Pragers the same evidence establishes something potentially important: institutional notice. Years before Dennis Prager arrived, nursing leadership at Cedars knew that hospital-acquired pressure injuries were occurring at a level it considered unfavorable compared with peer institutions, knew the mechanisms by which they could be prevented and had created a system specifically designed to reduce them.
The issue also did not disappear from Cedars’ internal quality agenda. Cedars personnel later formed a hospital-acquired pressure-injury task force because injuries continued despite the existing prevention protocol. A Cedars quality-improvement project published in 2026 described “increasing numbers” of Stage I and Stage II hospital-acquired pressure injuries on a surgical and transplant progressive-care unit. That unit recorded 36 Stage I or II injuries in 2023 and 33 in 2024. The project therefore sought another intervention to improve prevention. The abstract is available through Critical Care Nurse.
Those numbers cannot responsibly be generalized to the entire hospital. They concern a particular unit, and their significance to Prager depends heavily on where he was housed. If discovery shows that Prager spent significant time on that unit, however, the evidence becomes much more interesting. It would mean that in the same calendar year as Prager’s hospitalization Cedars personnel were confronting dozens of relatively early hospital-acquired pressure injuries on the unit and instituting another prevention project in response.
There is contemporaneous regulatory evidence of another sort. Federal inspectors surveyed Cedars in January 2025, immediately after the November and December 2024 hospitalization described in the Prager complaint. In a sample of 30 patients, inspectors identified several failures involving nursing implementation. One patient had an active seizure-precaution order that had not been implemented. An admission nursing assessment had not been completed. A required PICC care plan had not been initiated. Another infection-related care plan had not been initiated. Cedars personnel acknowledged the deficiencies. The inspection findings are collected by the Association of Health Care Journalists’ HospitalInspections.org database.
That does not prove that anyone failed to turn Dennis Prager. But it is relevant to the precise theory his case presents. The Prager complaint does not principally allege that Cedars lacked sophisticated policies. According to the pleading, his records contain repeated Braden assessments, a pressure-injury prevention plan, a specialty mattress and physician orders for repositioning. The accusation is that what existed on paper was not reliably executed at the bedside. Federal inspectors independently identifying other instances around the same period in which orders, assessments or required care plans were not implemented makes “policy versus execution” a legitimate institutional discovery question.
There is also a history of employee complaints about staffing. Roughly 2,000 Cedars workers went on strike in May 2022 while raising concerns about staffing and patient safety. The workers were largely nursing assistants, clinical partners, technicians, transporters and other employees rather than Cedars registered nurses or physicians. That distinction matters. But some of those workers perform exactly the labor relevant to immobile patients, including hygiene, mobility and assistance with repositioning. The Los Angeles Times reported that the union specifically attacked Cedars’ record on dangerous bed sores while arguing that short staffing was compromising patient care.
Union statements are advocacy, not neutral findings. They should not be presented as proof that Cedars was understaffed or that staffing caused pressure injuries. Their value is narrower. They establish that staffing and pressure-injury concerns were being raised publicly by Cedars employees years before the Prager hospitalization.
Current CMS-derived data do not portray Cedars-Sinai as an extreme national outlier for serious pressure ulcers. For the July 2022 through June 2024 reporting period, Cedars had a PSI-03 pressure-ulcer rate of approximately 0.75 per 1,000 eligible discharges compared with a Leapfrog hospital average of approximately 0.60. Numerically, Cedars was worse. Statistically, however, the estimate was not significantly different from the national rate. Current Leapfrog data also credit Cedars with meeting nursing-staffing standards. Those figures can be examined through Cedars’ profile at The Leapfrog Group’s Hospital Safety Grade.
Dennis Prager’s allegations appear against a background in which several other Cedars patients have alleged materially similar failures involving pressure injuries, repositioning, skin surveillance and staffing. Cedars itself acknowledged an organization-wide unfavorable hospital-acquired pressure-injury trend beginning no later than 2020 and built a hospital-wide prevention campaign in response. Its personnel continued running pressure-injury reduction projects using 2023 and 2024 data. Employees had publicly complained about staffing and bed sores. Federal inspectors examining the hospital immediately after Prager’s admission independently found other examples in which nursing orders, assessments and care plans were not implemented. At the same time, aggregate federal quality data do not show Cedars performing statistically worse than the nation as a whole on serious pressure ulcers.
That leaves a question rather than a verdict: were Prager’s alleged missed turns isolated bedside mistakes in an otherwise functioning prevention system, or were they another manifestation of a recurring gap between Cedars-Sinai’s sophisticated pressure-injury policies and what overburdened personnel were actually able to deliver?
The discovery necessary to answer that question is now obvious. The Pragers should seek organization-wide and unit-level hospital-acquired pressure-injury incidence data for at least 2019 through 2025, records of the hospital’s pressure-injury task force, the weekly HAPI reports Cedars says it supplied to nurse leaders, root-cause analyses of Stage III, Stage IV and deep-tissue injuries, turning-compliance audits, pressure-ulcer prevention training and competency records, and the pressure-injury history of every unit in which Prager stayed. Those records should then be matched shift by shift against nurse and clinical-partner staffing, patient acuity, required-versus-actual staffing variances and Prager’s turning flowsheets.
Most important for the Elder Abuse Act claim, the discovery should establish who received those reports. The Pragers need names. If hospital-acquired pressure-injury data repeatedly moved upward to executives or senior nursing administrators who possessed substantial authority over staffing, budgets or hospital policy, those documents may provide the missing bridge between an allegedly neglected patient in a hospital bed and the corporate “managing agent” proof California requires for enhanced elder-abuse remedies.
Somewhere in Watson may already be discovery identifying the people, committees, staffing systems and internal reports that the Pragers now need. If so, the most valuable evidence in the Dennis Prager case may have been generated before he ever entered Cedars-Sinai.
