Patient Develops Severe Pressure Ulcers, Nursing Homes And Hospital Settle

An 88-year-old female patient was admitted to the hospital on December 2, 2009. She did not have any pressure ulcers on admission. On December 8, 2009, the patient was noted to have developed a stage II pressure ulcer on her sacrum. By December 12, 2009, she was noted to have developed a stage I pressure ulcer on her left heel. By December 13, 2009, she was noted to have developed a stage I pressure ulcer on her right heel. 

On December 18, 2009, the patient was transferred from the hospital to a nursing home. On admission to the nursing home, the patient was documented to have a pale, pink wound on her sacrum with dimensions of 2 cm x 0.5 cm x 0.5 cm and a red area on her right heel measuring 2.5 cm x 2.5 cm. By December 24, 2009, the patient had right heel redness measuring 2.4 cm x 2.5 cm and an open sacral pressure ulcer with dimensions of 6 cm x 6 cm and serosanguineous drainage. 

On December 30, 2009, the patient was transferred from the nursing home to the hospital. On admission to the hospital, the patient was noted to have a stage IV pressure ulcer on her sacrum and pressure injury to her heels. 

On admission to the second nursing home, January 4, 2010, the patient was noted to have discoloration of her left heel, boggy heels bilaterally, and a stage III pressure ulcer on her buttocks with “eschar tissue in center of wound bed.” She was also documented to have an unstageable pressure ulcer on her buttocks with dimensions of 15 cm x 12.5 cm, 2 cm of undermining, and 80% necrosis, as well as pressure ulcers to both heels over the entire heel. On January 5, 2010, the patient’s left and right heel pressure ulcers were unstageable, and the patient was documented to have an unstageable pressure ulcer on her buttocks. The patient’s pressure ulcers were the source of severe pain.

On January 10, 2010, the patient was documented to have three stage IV pressure ulcers. On January 14, 2010, the patient was documented to have a stage IV pressure ulcer over “both buttock folds” with a surface area of 10 cm x 9 cm, 0.2 cm undermining, and 70% necrosis. She was also noted to have pressure ulcers covering both heels. By January 20, 2010, the patient’s stage IV sacral/buttocks pressure ulcer had “worsen[ed],” had dimensions of 13 cm x 8 cm with 0.2 cm undermining, and demonstrated 70% necrosis. The sacral/buttocks pressure ulcer was the source of foul odor. By January 22, 2010, the patient was observed to have developed three skin tears to her lower legs. The patient continued to complain of severe pain from the sacral/buttocks pressure ulcer. By January 26, 2010, the pressure ulcer on “both buttock fold” had deteriorated with dimensions of 14 cm x 12 cm, 0.5 cm undermining, 70% necrosis, “large serous, purulent exudate,” and “increased odor and tunneling.” 

On January 29, 2010, the patient was transported to the hospital with a fever of 104° F. At the hospital, the patient was noted to have “bilateral heel breakdown” with unstageable and necrotic wounds, an unstageable pressure ulcer to her left ankle with a surface area of 9.4 cm x 4.06 cm, two stage II pressure ulcers on her right leg measuring 8.89 cm x 4.06 cm and 5.59 cm x 3.81 cm, a right medial calf blister 2.8 cm in diameter, a wound on her abdomen, necrotic areas on four toes, and an unstageable pressure ulcer on her sacrum measuring 13.21 cm x 11.43 cm x 5.59 cm with 1.7 inches of sinus tract, yellow slough, black eschar, a foul odor, and serosanguineous drainage. 

On or about February 1, 2010, the patient’s physician noted her sacral pressure ulcer had “apparently not [been] responding to the care that she [was] able to receive in the nursing facility.” On February 4, 1010, the patient was admitted to an alternate hospital for restorative and rehabilitative care with a diagnosis of sepsis from an infected sacral pressure ulcer. The patient was noted to have eschar on both heels and “very large sacral decubitis with some slough in bases and extensive tunneling.” Specifically, the patient was noted to have a pressure ulcer on her sacrum measuring 5.94 cm x 11.02 cm x 3.81 cm with moderate serosanguineous drainage, pressure injury to her lateral left calf with a surface area of 3.81 cm x 8.89 cm with black eschar, pressure injury to her right calf measuring 3.18 cm x 5.08 cm with black eschar, and pressure injury to both heels with black eschar. 

On March 3, 2010, the patient was documented to have the sacral ulcer with sepsis. Her sacral pressure ulcer was described as “enormous.” On March 7, 2010, the patient was noted to have a serosanguineous pressure ulcer on her sacrum, an unstageable pressure ulcer on her left calf with yellow slough and black eschar, an unstageable pressure ulcer on her right calf with pink and yellow slough and black eschar, and unstageable pressure ulcers on both heels with black eschar.

On March 11, 2010, the patient was found unresponsive due to “hypotension and massive sepsis.” On March 17, 2010, the patient was noted during a wound care consult to have a pressure ulcer on her left calf “extending down to the tendon level.” On that same day, the patient’s sacral pressure ulcer was documented to have dimensions of 8.5 cm x 5.5 cm with undermining, yellow slough, and serosanguineous drainage. The patient’s doctor noted “her wounds have continued to progress and [have] not healed significantly.” He observed “that there really is no other significant intervention that [the hospital] can do to improve these” and predicted that the patient was “undoubtedly going to get sick . . . pretty soon and decompensate.” On March 18, 2010 the patient was discharged from the hopsital. The patient’s family returned her home for hospice care. The patient died on May 27, 2010.

The family contacted us to pursue claims against the nursing homes and hospital for failing to provide proper care to prevent and/or treat her pressure ulcers. We were able to obtain a generous settlement award for the patient’s family.