91-Year-Old Patient Develops Pressure Ulcer (Bed Sore) and Dies; Nursing Home Settles for $400,000

A 91-year-old patient of a nursing home was allowed to develop a pressure ulcer (bed sore, bedsore, pressure sore, decubitus ulcer) on her sacrum (low back).  The pressure ulcer deteriorated and she died three and one-half months later. 

On admission to the nursing home, the patient did not have any pressure ulcers.  She was, however, dependent on the nursing home’s staff for turning and respositionStage IV Sacral Pressure Ulcer (Bed Sore, Bedsore, Pressure Sore, Decubitus Ulcer)ing due to mobility and cognitive deficits.  The patient's family contended the pressure ulcer was caused and deteriorated because staff at the nursing home did not use proper transfer techniques, which resulted in friction and shear forces on the sacrum, and did not consistently turn and reposition the patient in bed.

Within three weeks after the pressure ulcer (bed sore, bedsore, pressure sore, decubitus ulcer) was first observed, the wound was documented to have been "worsening, with more maceration seen on wound edges."  Several days later, the pressure ulcer was noted to have increased in size from 4.0 cm x 2.5 cm to 5.0 cm x 3.5 cm and 50% of the wound bed was documented to have been comprised of necrotic tissue.  

The patient thereafter was admitted for one week to a local hospital for reasons unrelated to the wound.  On admission to the hospital, the patient's pressure ulcer (bed sore, bedsore, pressure sore, decubitus ulcer) was documented to be stage II with dimensions of 7 cm x 3 cm – a 20% increase in size in the three days before her hospital admission.  When she was discharged from the hospital one week later and returned to the nursing home, the pressure ulcer (bed sore, bedsore, pressure sore, decubitus ulcer) was "unstageable" with dimensions of 5.0 cm x 6.2 cm and 80% dark brown slough.  The nursing home claimed the hospital was  to blame for the deterioration of the ulcer during the patient's hospitalization.  We contended the deteriStage IV Sacral Pressure Ulceroration of the patient's ulcer was inevitable whether the patient was in a hospital or some other health care facility because the ulcer was bad and getting worse before the hospitalization.  

As the nursing home's failures to turn and reposition the patient continued, the pressure ulcer continued to deteriorate.  Within a couple of weeks after the patient's hospitalization, and despite aggressive wound therapy, the wound measured 11.0 cm x 11.0 cm, had purulent drainage (pus), an odor, and was contaminated with MRSA.  The patient was discharged from the nursing home to her own home with hospice care.  Even though pain medication was prescribed for use at home, the patient frequently experienced "breakthrough pain" from the ulcer, especially before and after dressing changes and when repositioned.  The patient died several weeks later as a direct result of sepsis (systemic infection) caused by the pressure ulcer (bed sore, bedsore, pressure sore, decubitus ulcer).  She was survived by two daughters and a granddaughter. 

The nursing home contended the patient's pressure ulcer was unavoidable because of the patient's age, poor nutritional status, and chronic end stage kidney disease.  Her kidney disease prevented her from eliminating waste products and fluid from her blood.  She had pre-existing hypoalbuminemia (low protein), which typically would have required her protein level to be supplemented.  However, if she had received additional protein, an even greater buildup of protein would have occurred because of the kidney disease and kidney failure would have resulted.  The nursing home also contended that, despite the family's claims, the patient was consistently and timely turned and repositioned  

The case settled for $400,000 well before trial.
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Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia

5 comments (Add your own)

1. John Spraker physical therapist wrote:
I am preparing a paper on positioning patients in order to prevent pressure ulcers. I am a rehab director at a NJ Extended care facility. Pressure ulcers usually start from the bone out TOWARD the skin. Even though this patient did not have any broken skin, she likely had tissue damage under intact skin. A proper assessment at admission could have alerted the staff that the patient was at risk. Also, textbooks and training most often refer to caucasian skin tones. Nurses might have been able to spot "non blanching erythema" on a caucasian, but the same does not apply to african patients.

Fri, April 3, 2009 @ 9:01 PM

2. roberta wrote:
my mum had an at risk sore and on each admission to hospital for other reasons the sore was allowed to break (twice) on the 1st occassion a sticky dressing was left on for ten days and god knows how long the excrement was left next to an open wound the second was the same only minus excrement although her skin was very isceamic? the dressings tore from her tail bone straight down the right cheek of her bottom and she died only weeks later although she had lung cancer with spinal mets i just think level of care is disgusting thank you for listening

Wed, June 3, 2009 @ 10:19 AM

3. leanne wrote:
I am a nurse and work in a hospital and see many elderly patients com into us from nursing with very bad pressure sores i think it is digusting and more things should be done to regulate some of theses awful places

Sun, June 28, 2009 @ 3:07 PM

4. clarke wrote:
my uncle died because of a stage 4 pressure sore leading to blood poisioning the care he received was terrible another case of the nhs and care at its best

Tue, January 29, 2013 @ 1:06 AM

5. Mz Diva wrote:
It's so sax thats why the hospital asked do u have any open sores bed sores they inspect you bottom etc its SAS if your not being talking care,of turning back fourth of the patient it can kill you just lost my cousin Monday infection took over the body and the iv antibiotics wouldn't work n was on the strongest they had .

Thu, January 23, 2014 @ 4:14 PM

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