On March 18, 2016, plaintiff Gevorg Haroutunyan, 81, a retiree, was placed on BiPAP therapy at Hollywood Presbyterian Medical Center, in Los Angeles, after there was no response to progressive respiratory therapy and oxygenation methods were unsuccessful.

Haroutunyan was previously admitted to the emergency department at Hollywood Presbyterian Medical Center for a humeral fracture to the right arm on March 15, 2016, which was one day before his 81st birthday. The fracture occurred at home, where Haroutunyan lived with his daughter and son‐in‐law. Upon his admission to the hospital, he was noted to be dehydrated and have acute renal failure and respiratory distress. He was also noted to have a long history of multiple medical conditions, including end-stage chronic obstructive pulmonary disease, Parkinson's disease, diabetes mellitus type 2, benign prostatic benign hypertrophy, obesity, moderate Alzheimer's dementia, coronary artery disease, and a pacemaker.

Two days after his admission, a closed reduction was performed, but Haroutunyan's respiratory condition and renal function continued to worsen. He was subsequently placed on BiPAP therapy on March 18, 2016, after there was no response to progressive respiratory therapy and oxygenation methods were unsuccessful, but his perfusion was poor, so intubation was recommend. However, the family refused. The next day, it was noted that Haroutunyan had some areas of deep tissue injury, and excoriation on his lower back and sacral area. The family eventually agreed to have Haroutunyan intubated in the late afternoon of March 22, 2016. However, when Haroutunyan was intubated and the BiPAP mask was removed, it was noted that Haroutunyan had developed a deep tissue injury on his nose.

Haroutunyan, through his guardian ad litem, Ruzanna Khachatryan, sued the operator of Hollywood Presbyterian Medical Center, CHA Hollywood Medical Center L.P., and a subcontractor that provided respiratory therapists for the hospital, Gem Medical Management LLC.

Gem Medical Management ultimately settled out of the case on the second day of trial.

Plaintiff's counsel argued that the deep tissue injury that developed on Haroutunyan's nose was the result of respiratory therapists from GEM Medical Management not properly monitoring the BiPAP mask and that the respiratory therapists and GEM Medical Management were acting as agents of the hospital. Counsel contended that a protective barrier should have been used when the mask was initially placed, but that it was not. Further, plaintiff's counsel argued that the mask was not properly removed for "rest" periods and that records that reflected mask changes were fraudulent or erroneous.

As to the sacral/back wounds, plaintiff's counsel argued that the hospital's nursing staff failed to properly assess (pursuant to the Braden Score), Haroutunyan's potential for development of skin breakdown and, therefore, failed to institute appropriate preventative measures. Specifically, counsel contended that the nursing staff failed to keep Haroutunyan clean and failed to timely reposition Haroutunyan every two hours.

Thus, plaintiff's counsel argued that all of the failures in care were not only negligent, but constituted elder abuse and/or neglect.

Defense counsel for CHA Hollywood Medical Center contended that both the device-related pressure injury and pressure sores to Haroutunyan's nose and sacrum/back were the result of unavoidable medical conditions that pre-existed Haroutunyan's hospitalization, including his end-stage COPD, which ultimately required a tracheostomy and ventilator dependency to survive. Thus, counsel argued that all appropriate measures were taken by both the respiratory care staff and nursing staff to prevent skin breakdown, but that in order to save Haroutunyan's life, the patient had to be placed in a position in bed (bed raised -- known as semi-fowlers), which caused additional pressure to Haroutunyan's lower back and sacrum in order to prevent him from decompensating. Defense counsel also contended that offloading was done to alleviate pressure, mask changes were performed, and routine skin checks were done on the nose in relation to the BiPAP mask. In addition, counsel contended that a protective barrier was placed on Haroutunyan the day after the mask was placed to prevent skin breakdown, but that, ultimately, the wounds developed despite the best of care.