'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 three 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 were 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 stated, "Allevyn's heel remains intact on the right heel".

On the sixth day postoperatively 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.

Medical negligence 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 four hours. No such regular inspections were carried out. By the time the foot pump had been stopped it was too late to prevent further development of tissue damage to the heel.

Settlement secured

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