A young girl has been awarded £20,000 following negligence by medical professionals led to pressure sores on her skin after an operation.

Following an operation on her spine for a cyst, Sally was paralysed from the chest down and is paraplegic. She has no use of her left hand. She subsequently developed scoliosis of the spine and for some time would wear a body brace to try and correct this. Unfortunately this was unsuccessful and eventually she underwent spinal surgery. As Sally grew, further revision of the rods in her back had to take place.

Negligence post-operation

When she was 10 years old, Sally was admitted to hospital for spinal rods revision. Post operatively Sally was transferred to the high dependency unit (HDU). Sally was put in a semi-upright position, with a view to preventing the development of any chest infection. Two days after the operation Sally was transferred from the HDU to a ward, remaining in the same position. Sally remained in a semi-upright position for a week. She was not turned, nor was her position changed.

On the 7th day post-operatively Sally's mother was about to administer a phosphate enema to enable Sally to open her bowels when she noted an area of skin and tissue damage on Sally's buttocks. This was drawn to the attention of the medical staff.

Sally was examined by a Consultant Plastic Surgeon and underwent a further procedure under general anaesthetic to obtain a skin graft on her right thigh. She was discharged home after a month. When Sally returned home, she was unable to return to school and remained on complete bed rest, until re-admission for further surgery. She underwent a third operation for a rotational skin graft after six months.

With JMW's help, the family of an elderly woman have been awarded £25,000 compensation after negligent care and treatment of her pressure sores sadly led to her death.

Beryl was a resident at a care home and whilst a resident was assessed as being at very high risk of developing pressure sores. Advice was given for her to be placed on a pressure relieving mattress, checked thoroughly due to her double incontinence and that any sign of pressure ulcer should be reported to the nurse, for referral to the tissue viability nurse.

Unfortunately, Beryl developed a pressure sore in her sacrum and she became unwell, requiring hospital admission for antibiotics to treat the sacral sore, which had become infected. The abscess successfully healed, although there was a red area in the sacral area which was treated with barrier cream. Beryl was eventually discharged back to the care home 2 weeks after being admitted to hospital.

Advice was given at the care home for Beryl to be placed on a pressure relieving mattress, to be checked and washed regularly and, if a pressure ulcer developed, to advise the nurse of the situation, who would then refer the patient to the tissue viability nurse.

Beryl developed a further pressure sore over the next month and was reviewed by her GP, who prescribed antibiotics. Her GP also noted that 2 further pressure sores had developed in Beryl’s sacrum and back.

Beryl passed away

The pressure sores deteriorated, one of which grew to measure 5cm x 5cm. No further action was taken until the following month, when Beryl’s GP came to visit her and advised that she be referred to the tissue viability team. Unfortunately, this referral was not actioned and the pressure sore developed further into a 6cm x 6cm, Grade 4 sore. She was admitted to hospital and unfortunately passed away 6 weeks later due to sepsis, caused by a chest infection and the sacral pressure sore.

Inquest

The matter was referred to an inquest, where the Coroner ruled that the cause of death was linked to the pressure sore and Beryl would unlikely have died when she did had there not been omissions in the nursing care provided. Criticisms were raised at the inquest of the failure to refer Beryl to the tissue viability nurse prior to her hospital admission.

Settlement

The case was settled by one of JMW’s expert solicitors for £25,000.

JMW has secured a £31,000 settlement for an elderly woman after she was left with severe pressure sores following negligent care in the hands of medical professionals.

Doris, an elderly lady, developed severe pressure sores which became infected and left her severely debilitated. District nurses, who were supposed to be caring for her in the community, had failed to take measures to prevent them.

Her family sought help from Steven Brown, one of the specialist solicitors in the medical negligence team at JMW, and she was later awarded £31,000 in compensation. Mr Brown is currently handling several pressure sore cases and you can read his latest press release about the issue here.

Start of ordeal

Doris’ ordeal began when she was admitted to hospital suffering from water retention and uncontrollable pain due to osteoporosis. She was discharged six weeks later and had developed red marks on her heel and toe. The hospital arranged for district nurses to visit Doris three times a week to monitor her condition and provide basic care and her family visited her daily.

Doris’ daughter-in-law asked the district nurses if they could provide Doris with pressure relieving devices. However the nurses said that they did not supply these items.
Despite Doris being at significant risk of pressure sores due to her poor mobility, the district nurses who attended to her did not undertake a proper risk assessment. As such they did not formulate a plan to ensure steps were taken to manage her condition and prevent pressure sores from developing.

Deterioration

Due to this lack of basic care over the coming weeks Doris developed pressure sores on her heels and one of her toes, which became more and more severe. They were now causing Doris significant pain and discomfort and she would often cry because of this and at times became very confused.

Despite Doris’ poor mobility from the deteriorating pressure sores on her heel and toe an appropriate care plan was not put in place and this resulted in her developing a further pressure sore on her sacrum. However yet again the nurses responsible for her care failed to ensure these were treated effectively. In addition the nurses failed to refer Doris for hospital treatment or to her GP despite the severity of her injuries.

In just a few weeks the pressure sores on Doris’ heels had deteriorated from grade one to grade four due to the poor care from the district nurses. The pressure sore that had developed on her sacrum was also now grade 4.

Hospitalisation

Doris’ condition eventually deteriorated to the point that she was hospitalised with delirium. As well as the extensive pressure sores she was also suffering from dehydration, diarrhoea, worsening anaemia and liver function problems.

Her daughter-in-law called the district nurse team to let them know how upset the whole family was with the treatment Doris had received under their care.

A few weeks later Doris was discharged from hospital and went to live in a nursing home as she was now unable to live in her own home due to the deterioration in her health.

Successful case

Doris’ family were so appalled by the care she had received under the district nurses and how it had affected her both mentally and physically that they turned to the specialist medical negligence team at JMW for advice. Doris’ case was taken on by Steven Brown and although nothing could make up for such suffering he was able to secure Doris £31,000 in compensation to help her to cope.

Post Surgery Pressure Sores in Care Home. Compensation: £5,625

JMW has been successful in helping an elderly woman receive a £5,625 compensation settlement after negligent post-surgery care in her care home led to pressure sores.

Mavis' story exemplifies the importance of post-surgical care within care homes

Mavis had a past medical history of dementia and kidney failure. She was a resident at a care home when she sustained a fall, which led to a fractured hip. She was admitted to hospital and underwent surgery to repair the hip fracture. She was discharged back to the care home 2 months later. She unfortunately developed a sacral pressure sore which eventually healed after 5 months.

However, 3 months later, Mavis developed a further pressure sore which deteriorated to eventually reach Grade 4. She was admitted to hospital and unfortunately passed away a few weeks later. The cause of death listed the infected sacral sore secondary to poor mobility as contributing to death.

A number of failings were identified with respect to the care that Mavis received at the care home, including a failure to perform pressure ulcer risk assessments, failure to ensure regular repositioning of Mavis to minimise the risk of pressure sores developing, failure to adequately manage the sores, failure to conduct and record regular skin inspections, and a failure to maintain Mavis’ nutritional status.

JMW represented Mavis’ family and secured a settlement of £5,625.

Annie was referred to hospital with a history of discomfort in the right hip. It was decided she would undergo hip replacement surgery. The GP noted that she had varicose veins with extensive varicose eczema. Annie was particularly concerned about skin problems if she were to proceed to surgery.

Past history of skin problems noted

The past history was noted and the treating Consultant proposed to use Clexane, an anticoagulant whilst in hospital and to use foot pumps to prevent DVT as an additional measure if these could be tolerated. The nursing note following her admission recorded a history of ulceration to the leg although the skin was not then broken.

After Annie returned to the ward following her total hip replacement Flowtrons (foot pumps) were started as instructed. Post-operative nursing notes for the next 3 days recorded that pressure care was effective and that no problems had been observed.

Conflicting medical records

On the fourth day after the operation the records were again ticked for the morning, afternoon and night showing pressure care effective, however a handwritten note stated "heel to left leg very pink around AV bootstrap. Boots removed. Leg elevated over trough". This note was contradicted by the records indicating pressure care remained effective.

On the fifth day post-operatively the records showing pressure care as being effective was again ticked for the morning, afternoon and night.

However, a note recorded "right heel two areas 0.5 x 0.5 cm blue in colour but not broken". A further timed note hours stated "Allevyn heel remains in tact on right heel".

On the sixth day post operatively Annie's medical records did not contain any description of her foot, however a District Nursing Referral dated the same day referred to "right heel discoloured, Cavilon spray applied". The treatment required was indicated to be "wound check and heel check".

Diagnosis of a pressure sore

At the time of her discharge from hospital Annie had a black blister the size of a 50 pence piece surrounded by swollen flesh to the heel. Subsequently, Annie was diagnosed as suffering a pressure sore to the right heel which took approximately 18 months to heal.

The claim

JMW Solicitors alleged that the care afforded to Annie by the hospital was negligent in that they failed to adequately monitor the heel skin particularly given her history of vulnerability to skin damage. The hospital should have inspected Annie's heels at least every 4 hours. No such regular inspections were carried out. By the time foot pump had been stopped it was too late to prevent further development of tissue damage to the heel.

Settlement

Although the hospital denied liability (negligence) the case was settled and Annie received £20,000 compensation.

Patients who are at the highest risk of developing pressure sores are those who are confined to a bed or chair and are unable to move without assistance from others. This includes patients with a significant disability, paralysis, anyone who is recovering from major surgery and those with high BMIs. 

As moisture can hasten the onset of pressure sores, patients who are incontinent of either the bladder or bowel are particularly at risk, as are those suffering from dehydration because their skin may already be in a poor condition.

Pressure sores are graded in terms of severity, with Grade 1 being the least severe and Grade 4 the most severe. Grade 4 includes pressure sores that have penetrated through most of the soft tissue covering the bone. Of these, many never heal and this can have serious ramifications on the patient’s quality of life.

Pressure sores are treated by the removal of the dead tissue, followed by infection control. Diet is altered in order to ensure the patient is receiving an adequate supply of nutrients. Care must be taken to ensure there is no pressure on the wound and specialised mattresses can be used with certain patients.

The more severe forms of pressure sores can result in serious complications. These include sepsis and gangrene. A small percentage of patients may go on to develop renal failure.