Case study: £40,000 compensation for man who died as a result of pressure sores
Our client, Mr W, was an 80-year-old male with a pre-existing diagnosis of vascular dementia, Type II diabetes and congestive heart failure, and had previously suffered both a stroke and a heart attack. He had a history of falls and had previously suffered pressure sores on both heels that had been treated in the community.
Admission to hospital after a fall
On 28th October, Mr W had a fall at home and was taken to the hospital. Mr W was admitted with a potential hip/pelvic injury as a result of the fall and he was also suffering from shortness of breath. This was thought to perhaps be a recurrence of pleural effusion (known as ’water on the lungs’).
Our client had a small pressure sore on his left heel that had been treated successfully for the previous few months by a community podiatrist. This was not noted on admission.
Insufficient assessment of pressure sore
Mr W’s initial checks on the first day of admission wrongly showed no skin damage to his left heel. The wound management chart was not updated until 10th November, 12 days later, when a broken blister on the right heel was noted. However, no risk assessments were performed.
The wound management chart was revisited again on 12th, 13th and 18th November, which showed a broken blister on the right heel, and that dressings were expected to be reapplied daily. The family had raised concerns about the pressure sores on their father’s feet and heels on 17th November, but further charting on 20th November reported only an intact blister on the left heel.
It was decided that Mr W would be discharged from hospital on 23rd November. A risk assessment showed he was at high risk of pressure sores and therefore needed a pressure-relieving mattress. He was not using a pressure relieving mattress as a hospital inpatient
Treatment in the community
A district nurse was asked to visit our client to monitor his blood sugar levels. Mr W was reviewed immediately after discharge and the nurse reported multiple Grade II pressure sores on the left foot and heel, and an ungradable pressure sore on the right foot and heel. His risk assessment showed he was at high risk of pressure sores and had added risks as a result of vascular dementia, limited or no mobility and the inability to reposition himself in bed.
The district nurses visited regularly and documented the continuing deterioration of both heels. A podiatrist assessed Mr W on 5th December and recorded a 7cm x 3cm necrotic callus on his right heel and a 0.8cm x0.5cm pressure sore on the left heel.
Re-admission to hospital
The district nurses continued to report a deterioration in our client, particularly on the right heel, which was noted to be black, necrotic and possibly infected. By 19th December, our client’s overall health was deteriorating and he was readmitted to hospital with sepsis. On assessment, necrosis was present in both heels and the left heel had suspected osteomyelitis (infection in the bone).
On 28th December, for the first time, our client was seen by a Tissue Viability Nurse. She removed the dead and loose skin from the wounds on both heels. After this, Mr W was on occasion only reviewed once per day and the records rarely showed he was repositioned to relieve the pressure areas, despite the severity of the wounds.
A further pressure area on the buttocks was identified on 24th January. This was the first reporting of it and was noted to be Grade II.
By early February, our client was referred to the vascular team for possible surgical intervention. He was unable to weight bear by this point and was still having irregular checks and dressings on the wounds. He was no longer responding to antibiotics.
Osteomyelitis in the right heel was confirmed on 15th February. However, Mr W was discharged from hospital on 7th March. He was unable to walk due to the severity of his pressure sores and needed to be hoisted. He was also incontinent and the osteomyelitis was not responding to antibiotics.
Sadly Mr W passed away on 16th March at home. One of the causes of death was osteomyelitis.
Proceeding with a medical negligence claim
Our Medical Negligence team were approached by Mr W’s family for assistance in bringing a claim against the Defendant hospital. Following receipt and review of medical records, a Letter of Notification was sent to the Defendant, citing multiple failures in Mr W’s care, contrary to the NICE Guidelines (pressure ulcers: prevention and management).
This included the failure to:
- Risk assess Mr W when first admitted to hospital in October, and throughout his treatment;
- Take into account Mr W’s pre-existing health conditions when treating the small ulcer on his left foot, especially as it was clear that Mr W was at high risk of deterioration;
- Notice the presence of the sores, particularly on the right heel and the buttocks;
- Provide a pressure-relieving mattress; and
- Reposition our client at least every four hours.
These breaches continued throughout the second admission, starting in December. If the pressure sores were treated sufficiently, Mr W would not have suffered a pressure sore to his right heel or his buttocks and his left heel would have healed. Our client would not have passed away when he did.
Mr W’s family wanted to make an early offer in the absence of expert evidence. This offer was for £22,320 and made at the time of the Letter of Notification.
Response to claim from Defendant hospital
The Defendant Hospital did not respond to our initial letter and subsequent Letter of Claim. We chased their insurers for a response and, after eight months, they responded with partial liability for development of our client’s pressure sores, but denied that this resulted in Mr W’s early death.
We were instructed to issue and serve proceedings and, as a result, sought life expectancy evidence. This demonstrated that Mr W would have lived for a further two years.
Proceedings were issued on 30th August. The original offer of £22,320 was withdrawn.
A Defence was served to us on 29th October which admitted liability to an extent similar to that in the Letter of Response, but the Defendants were disputing the presence of osteomyelitis or that the disputed osteomyelitis contributed to his death.
We supported the family to respond, particularly highlighting the medical records. This included x-rays showing that Mr W suffered osteomyelitis and that it progressed significantly up to the point of his discharge in March, even though Mr W’s medical records showed that microbiologists had considered how best to address the bone infection.
Reaching a settlement
Following the service of proceedings, the Defendants made an offer of £15,000 which was rejected. A further offer of £30,000 was made on 14th November, which was also rejected.
The Solicitor acting for our client’s family telephoned the Defendant’s solicitor to try and resolve the case. Mr W’s family found the process particularly upsetting in light of the issues raised by the Defendants in their Letter of Response and Defence. The conversation resulted in a further offer of £40,000 being made by the Defendant, which was accepted by Mr W’s family.
The case was settled just over 18 months following our client’s preventable death.
This case reflects the importance of understanding the signs of pressure sores and the correct treatment of them. Although a settlement cannot undo the negligence experienced by Mr W and his family, we were able to help them receive compensation for their loss.
If you or a loved one have suffered lasting health damage or loss due to untreated pressure sores, you may be able to claim compensation.