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Written on 23rd March 2023 by Fran Rothwell

Boyes Turner’s medical negligence team have secured a compensation settlement and apology for a widow whose husband died after negligent hospital care for a pressure ulcer (sore).

The 74-year-old man had multiple pre-existing health conditions, including type 2 diabetes, peripheral vascular disease, peripheral neuropathy and transverse myelitis (inflammation of spinal cord), and would eventually have needed a wheelchair and carer support to live at home. The claim was made on behalf of his widow and his estate for the severe pain and suffering he experienced over a period of 15 months leading up to his death, as a result of the failure by two hospitals to treat his pressure sore and manage his nutrition.

Delays in managing nutrition increased risk of weight loss and pressure sore injury

The deceased was admitted to hospital for treatment of a urinary tract infection (UTI) and acute kidney injury (AKI), and investigations into his worsening mobility over the preceding six months. A week later a ‘small graze’ was noted on his buttock, and the tissue viability nurse (TVN) was asked to review a ‘grade 2 hospital acquired pressure ulcer’ on his sacrum (triangular shaped bone at the base of the spine). When his weight was finally checked nine days after admission, he had a BMI of 19 and was borderline underweight with a medium risk of nutritional problems. No food charts or malnutrition assessments were carried out and he was not seen by a dietician.

Failure to provide correct pressure ulcer care led to deterioration

He was transferred to another hospital for further investigations by their neurology team. At the second hospital a 4cm x 2cm grade 2 pressure ulcer was noted. No medical photographs were taken and no further description noted to suggest an examination, but the need for two-hourly pressure care was noted. He was nursed on a hybrid mattress which provided pressure reduction rather than pressure relief. Three days later, photographs show that he had an unstageable pressure ulcer with suspected deep tissue injury, suggesting at least category 3 pressure damage. The TVN recommended  a hydro fibre dressing. Despite the severity of the wound the records continued to refer to it as  grade 2 over the next few days, during which time he spent prolonged periods lying on his back or sitting in a chair or in bed.

He became unwell suddenly and was transferred to the critical care unit (CCU) with a diagnosis of profound sepsis, thought to be from a UTI or pressure ulcers. He was given IV fluids, antibiotics, oxygen and blood pressure medication and fed via a nasogastric (NG) tube. When he was returned to the ward four days later, his pressure sore wound was noted to be grade 3 to 4. His NG tube had come out but had not been replaced. He was again allowed to spend long periods sitting or lying on his back. Over the next few weeks the dieticians noted concerns about his poor feeding and weight-loss but made no mention of his pressure ulcer.

Delayed referral to a plastic surgeon

Two and a half months after his admission to the second hospital, he was seen by a doctor and the TVN. He was finally referred to a plastic surgeon as bone was now visible within his grade 4 sacral pressure ulcer wound, measuring 10 x 10cm.  The plastic surgeon advised that the wound needed debridement (surgical cleaning out of dead tissue) and vacuum treatment. The plastics advanced nurse practitioner then noted that no surgical options were viable owing to his complex health conditions, and the ward staff did not have the training or experience to carry out topical negative (vacuum or TNP ) therapy. He was transferred to another ward where TNP therapy was started the next day.  

Over his four months in the second hospital he lost five stone in weight and became cachexic (from muscle wasting). He was eventually discharged to a nursing home, with no plan of care. The community TVN recommended dressing arrangements for his grade 4 wound with 35% bone visible. A community dietician found him to be dangerously underweight, despite his having been overweight before his hospital admission. Months later, during readmission to the first hospital with urosepsis, it was three days before two-hourly pressure care was begun, despite his noted grade 4 ulcer. On his discharge back to the nursing home they found that the wound had deteriorated. He continued to suffer an open grade 4 ulcer until his death from respiratory infection some months later.

Claim leads to compensation for bereaved family

We helped the family make a medical negligence claim against the two hospitals. The claim was based on multiple failings in care, including failing to recognise, correctly categorise and treat the pressure ulcer, and delayed referral to the plastic surgery team. The claim also included multiple failings in the monitoring and management of the deceased’s worsening malnutrition. With correct care, our experts believed that the pressure sore should have healed within two months. Instead, our client’s treatment left him bedbound, leading to severe weight loss, malnutrition and frailty, which weakened his immune system leaving him unable to overcome the respiratory infection from which he died.

NHS Resolution responded to the claim with an admission of liability and a formal apology for the family. The claim concluded with an out-of-court settlement.

If you have suffered serious injury or bereavement as a result of medical negligence, or have been contacted by HSIB/HSSIB, MNSI or NHS Resolution after your hospital care, you can talk to one of our solicitors for advice about how to respond or make a claim for compensation by contacting us here.