Paralyzed Patient Develops Stage IV Sacral Pressure Ulcer, Nursing Home Settles

At all times relevant while under the care of the nursing home from 9/24/08 until 9/29/08, a 92-year-old female was at high risk to develop pressure ulcers. Specifically, she was entirely dependent on the nursing home’s staff for all aspects of her care, due to paralysis in both legs, contractures in both arms, limited range of motion in all limbs, weakness, incontinence of bowel and bladder, severe cognitive impairment, history of CVA, and foot drop.

On 10/15/08, a stage II pressure ulcer was first observed on the patient’s sacrum. The sacral pressure ulcer was documented as having remained the same size but developing a “raw, red center” and draining “moist blood,” for the following month. On 11/15/08, it deteriorated to a stage IV, measuring 3 cm x 3 cm x 2 cm, with a “raw center with dark areas,” moist drainage, and a foul odor. The following day, the pressure ulcer was documented to be 4 cm x 4 cm x 3 cm, with necrotic tissue, moist drainage, and a foul odor. On 11/17/08, the pressure ulcer was described as “raw with necrotic tissue.” By the next day, the pressure ulcer had gotten much worse quickly per the nursing home staff’s notes.

On 11/23/08, the pressure ulcer on the patient’s sacrum was described as “raw with brown slough,” “moist brown” drainage, and a foul odor. The patient complained of pain. From August through November 2008, the nursing home failed to indicate in her chart or care plan that she was not to be placed onto her back or that she was supposed to be turned and repositioned more frequently than every two hours. Staff often left her wet after incontinence episodes and also left her lying on her back with the head of the bed elevated for hours on end.  

The patient was not given a pressure-relieving mattress until 11/17/08, after she had already had a pressure ulcer for three months. The patient’s family was not informed of the pressure ulcer(s) to her buttocks/sacrum area until 11/18/08, when one family member visited the patient after receiving a telephone call from her mother telling her the patient did not look well. At that time, an LPN informed the family that the patient had a “Stage II red place” on her bottom. The nurse told the family the “place” would go away, and they would treat it with medication and a dressing. The family then looked at the patient’s records and learned the patient’s staff had known about the pressure ulcer for weeks. The nursing home received a survey deficiency for its failure to notify the patient’s responsible party of her change in condition.

On 11/26/08, the patient’s family requested that she be sent to the emergency room due to a fever. At the hospital, the pressure ulcer was described as a “very deep” stage IV pressure ulcer measuring 5 cm x 5.5 cm x 3.5 cm, with serous purulent drainage, a foul odor, and “muscle and bone exposed.” Wound debrided and PEG tube was inserted. On 12/4/08, the sacral pressure ulcer was stage IV with tunneling and drainage. The patient died on 12/6/08 due to septicemia from the infected sacral ulcer.

The family contacted us to pursue claims against the nursing home for failing to provide proper pressure ulcer prevention and treatment for injuries suffered from those pressure ulcers. We were able to obtain a settlement award for the patient’s family.