Pressure sore negligence

 

60 seconds with a medical negligence lawyer

Over the following year we will be sharing a series of question and answer articles about our day-to-day lives in the medical negligence team. This week, it’s Rachel Carey's turn, a solicitor in the team.

Rachel qualified in April 2016 and joined the Clinical Negligence team at Boyes Turner in November 2016. Rachel’s clients have suffered obstetric and gynaecological injuries, Erb’s palsy, pressure sores, disability resulting from delayed diagnosis and treatment of cancer. She acts for the bereaved spouses and children of patients who have died as a result of negligent medical care.

What made you choose a career in clinical negligence?

The driving force behind my decision to study law and specialise in claimant clinical negligence work was my desire to help David, rather than Goliath. I have a keen interest in medicine and enjoy using my skills and expertise to help our clients get back on their feet or live a more fulfilling and stress free life following a medical accident. I find it incredibly satisfying to be in a position which allows me to guide clients through the legal process which I know many will find daunting and overwhelming.

Which personal skills does it take to succeed at this type of work? 

It is really important for a clinical negligence solicitor to have empathy, be able to show understanding and have the ability to remain calm in stressful situations. As the majority of the medical accidents we deal with cause life changing injuries which devastating consequences to our clients and their families, I ensure that I always bear that in mind and treat them sensitively and patiently.

What is the most rewarding part of your work? 

I recently met with a young client’s Mum on a case where the hospital had admitted liability. She told me how relieved she was to know that, as a result of the compensation, her son, who has cerebral palsy, would be looked after and taken care of for the rest of his life when her and her husband were no longer able to. She was excited to be able to move into a more appropriately sized and adapted home which could cater for her son’s needs. I could see how much that meant to her and to know that the work I had been a part of had helped was incredibly rewarding and made me realise even more how important the work we do is for people.

£300,000 compensation sought for pressure sore which led to bone disintegration

During a series of hospital stays in 2008 and 2009, Christine Reaney developed a pressure sore at the base of her spine.

Christine had been in hospital at the North Staffordshire Royal Infirmary, Cannock Chase Hospital and Stafford Hospital several times between 2008 and October 2009.  In January 2009, three weeks after her first admission, signs of a pressure sore were first noticed.

Unfortunately, staff failed to notice the sacral ulcer that had begun to develop, until it became so bad that it ate into the bones of her sacroiliac joint between her pelvis and her hips. It also destroyed two joints of the sacral vertebral coccyx.

On 17 July 2014, the matter went before the High Court. Whilst the NHS Trusts had admitted liability for allowing the sore to develop and deteriorate, the amount of compensation that Christine really was due was in dispute.

It will now be a matter for the Court as to the compensation that Miss Reaney is awarded.

She is claiming £300,000. Miss Reaney now suffers from hip dislocation, and cannot sit upright or walk, and is bedridden.

The case is ongoing.

Treatment of pressure sores - a postcode lottery

APIL (the Association of Personal Injury Lawyers) has recently reported on the best and worst performing Trusts in Britain in relation to pressure sores

Pressure sores are caused when the skin and underlying tissue breaks down, when it is placed under continuous pressure. These types of sores can be very debilitating for those who are unfortunate enough to suffer them, and the sores can deteriorate very quickly and in the worse cases, lead to exposing of the bone.

Elderly people are often at risk of pressure sores, as are inpatients in hospital, because they have to sit or lie for extended periods of time with little or no movement.

APIL’s research has identified that some hospital Trusts have more than 50% of pressure ulcers which deteriorate to critical levels, while other Trusts have a much better record.

Pressure sores are often found on the heels, bottoms, elbows or shoulder blades of a patient.  Whilst also trying to manage the pain caused by the sore itself, the individual has to try to avoid putting continued pressure on the affected area to allow it to heal.

According to NHS England, the cost to the NHS of treating pressure ulcers and related conditions is up to £4 billion per year.

For those who live in care homes, additional support has to be provided to residents who develop pressure ulcers, and dressings need to be changed very regularly.  The pressure ulcer also needs to be treated with more specialist approaches, if it continues for a prolonged period of time.

Care homes also have to try to identify individuals who are likely to be at risk of pressure ulcers developing, and give appropriate care to avoid this happening.  This may be by providing a pressure relieving mattresses, or regularly moving an individual who has to stay in one position and is incapable of moving themselves by even the smallest amount.

APIL have developed a 5 point plan to tackle this painful and debilitating condition.  This plan hopes to ensure that a dedicated tissue viability nurse is available for every care home in the country, and to ensure that there is mandatory training of staff on the relevant guidelines issued by the National Institute of Clinical Excellence, where patients or residents could suffer from a pressure ulcer.  The government is already supportive of the initiative “Stop the Pressure” campaign which is to be circulated to all care providers.

Julie Marsh solicitor with Boyes Turner’s medical negligence claims team comments:

“The majority of pressure sores that develop are avoidable, with appropriate treatment and care.  It is alarming to hear that such a large number of NHS Trusts are still failing to manage patients to avoid pressure sores or to fail to treat them effectively.  Something that begins as so small, can become severely debilitating over a very short period of time if not treated appropriately”.

Serious prescription errors in one in twenty prescriptions

Last year a review by the General Medical Council,  based on 1,200 patients, showed that mistakes were being made as often as in one in twenty prescriptions, but that serious complications were more rare.  The GMC found high error rates in prescriptions for over 75s and children under 14.

As a result of the report, a recommendation was made that GPs should have further training and additional systems of checking their prescribing practices. It was also acknowledged that time pressures on GPs may be leading to further errors. The recommendation was that GP consulting appointments were increased from 10 to 15 minutes to reduce errors.

Clinicians providing incomplete information on the prescription was identified by the review as the most common prescribing error.  Prescribing errors regarding dose and timing were the next most common errors.

The rate of error in the average patient was 18% but this rose to 38% for patients over 75.

In the category of severe errors were patients being prescribed drugs they were known to be allergic to and a lacking of monitoring when prescribing potentially risky drugs, such as Warfarin, a blood thinning drug.

The report makes a number of recommendations for improving the safety of prescribing including:

  • Promoting the effective use of clinical computer systems for safe prescribing.
  • Increasing the prominence given to therapeutic knowledge and the skills and attitudes needed for safe prescribing during GP training.
  • Promoting the reporting of adverse prescribing events (and near misses) through national reporting systems.

In addition, the research suggests that pharmacists can play a greater role in mitigating the occurrence of error, through reviewing patients with complex medicines regimens at a practice level, and in identifying and informing the GP of errors at the point of dispensing.

Emma Newman, a paralegal specialising in clinical negligence law at Boyes Turner, commented on the review:

“In 2013 the General Medical Council issued guidance to GPs in the form of ‘Good Practice in Prescribing and Managing Medicines and Devices’ which lists a number of checks which must be made before a doctor can sign off a repeat prescription. It is hoped that this will go some way to reducing the number of serious prescribing errors that occur every year although unfortunately we have have experience of prescribing error cases which continue to occur.  If you have suffered injury as a result of a prescribing or medication error by your GP or pharmacist and would like to make a claim, please contact the team on 0800 029 4683  or email us at mednegclaims@boyesturner.com“.

Mother awarded £30,000 compensation after developing pressure sores post-birth

In 2010 a 34 year old woman was admitted to hospital to deliver her first child. Following the delivery she was transferred to the maternity ward. She demonstrated signs of being at risk of developing pressure ulcers/sores.

She was seen by various members of staff between 17 and 20 March, including a tissue viability nurse. Whilst they recognised the development of a minor pressure sore area, they failed to manage and treat it appropriately. As a consequence, she went on to develop extensive grade 2 pressure sores over her left and right buttocks. It took four to five months for these to heal and the sores impacted on her ability to care for her daughter during the first few months of her life. Her pre-existing anxiety disorder was exacerbated.

The woman brought a claim against the hospital trust. She argued that they had failed to assess her risk of developing ulcers, had failed to ensure that her sitting position was changed regularly whilst she was under the effects of an epidural, had caused her to sit in a damp environment for a prolonged period, again whilst she was under the effects of the epidural, had failed to clean and dress the grazes on her buttocks once they had been discovered, had failed to nurse her from side to side following a decision to do so, and had failed to implement a plan of care to prevent the ulcers from developing further.

The trust admitted these failings.

The woman was awarded £30,000 in compensation. £26,000 of this was for the injury itself, £3,000 was for care and travel and other miscellaneous items and £1,000 was for cognitive behavioural therapy to assist with the exacerbation of her anxiety disorder.

Nicola Anderson, experienced pressure sore negligence claim lawyer, commented on the case:

“In the vast majority of cases, pressure sores are easily preventable provided that nursing care is of an adequate standard, which is no doubt why the hospital trust admitted their failings in this particular case. We have acted for many clients who have developed extremely nasty sores which can sometimes take a considerable length of time to heal”.

Hospital fails to prevent and treat pressure sores

On 4 April 2011, a man was admitted to hospital for removal of his urethra, prostate and bladder in order to treat his bladder cancer. He was also a type 2 diabetic with chronic kidney disease. On his admission, a risk assessment was carried out and his waterlow score was recorded as 4.

The man underwent his surgery on 5 April 2011. He was left on the operating table for two hours and identified at being at risk of developing a pressure sore. His pressure areas were not checked until 2.00 am on 6 April 2012 when a waterlow score of 20 was recorded. The hospital did not provide him with a specialist pressure relieving mattress.

The man’s pressure areas where checked on 8 April, 10 April and 11 April and noted to be intact.

On 15 April at 11.00 am, it was recorded that he had scabbed sores on his scrotum and penis. His sacrum was noted to be red but blanching. His waterlow score was recorded as 20 and a profiling mattress was ordered. By 22.35 on 15 April, the scrotum was recorded as having a black area on it. Both bottom cheeks had purple areas but there was no broken areas noted. The sores were treated and monitored throughout his time in the critical care unit.

On 20 April, the man was provided with a pressure relieving mattress. He was discharged on 27 April and his discharge note stated that he has suffered grade 2 pressure sores on the sacrum.

The district nurses visited the man every other day for approximately four weeks after his discharge. The man has now recovered from the sores but has a 2cm scar to the scrotum.

The man sought legal advice and brought a claim against the hospital. The hospital admitted liability was admitted and the man recovered £12,500 in compensation.

Sita Vaghela, a medical negligence solicitor for Boyes Turner, commented on the case:

“This case shows that even though risk assessments were conducted and the man was noted to be at high risk, he should have been continually assessed and provided with pressure relieving devicesas soon as possible. It is vital that patients are monitored throughout their hospital stays to avoid preventable pressure sores occurring”.

Pensioner dies after pressure sores in lower leg amputation

A 79 year old former toolmaker died at the North Devon Hospital in Barnstaple in August 2010, after being admitted for a hip operation in May of the same year.

After the operation, the patient’s doctor went on holiday, and it was only on his return that he realised the patient had not been discharged.

By the time the surgeon realised that the patient was still in the hospital, and he reviewed the patient, he had developed bed sores which became so bad he required an amputation of both lower legs.

An inquest has recently been held into the death of this patient, and recording a narrative verdict, the Coroner has said that the pensioner died from complications of the hip operation, and that neglect was a contributing factor.

During the inquest, it came to light that when the surgeon returned from holiday, it was a further ten days before he realised that his patient was still at hospital.

There was a lack of continuity in his care, and the Coroner confirmed that the need to amputate both lower legs could have been avoided, and the patient may not have died when he did but for the neglect of hospital staff.

During the inquest, the hospital was criticised for the lack of documentation relating to the progression of the pensioner’s pressure sores, and a failure to identify a window of opportunity to treat them.

The Chief Executive of North Devon Healthcare Trust has apologised formally to the family, commenting, “this was a very sad case with tragic consequences for the patient and his family”.

The Trust has confirmed that measures are now being undertaken to try to prevent the same thing happening again.

Julie Marsh, an expert amputation negligence claim solicitor at Boyes Turner, commented on the inquest:

“This patient is a clear example of somebody who needs to be assessed for pressure sore development, due to his lack of mobility after a hip replacement. Given the failure to realise the patient was still in hospital, and the time it took for the surgeon to realise his patient still required review, it is possible that appropriate measures were not taken to prevent pressure sores developing. The Coroner openly criticised the hospital for failing to document the deterioration and the pressure sores, which sadly led to the double amputation. We are seeing more cases where hospital staff are failing to appreciate the importance of assessing immobile patients, and undertaking measures to prevent pressure sore development. In this case, it is clear that the amputation and the death could have been avoided, but for the negligent care at North Devon Hospital”.

Compensation awarded for Grade 4 pressure sore

On 10 June 2009 Mr X was admitted to hospital with a suspected hematoma in his left groin. Despite the fact that he was quite elderly and had a longstanding and complex vascular medical history, no assessment was carried out as to the likelihood of him developing a pressure sore (a Waterlow assessment).

On 18 June Mr X complained about pain on his right heel, but no action was taken by the hospital staff to place him on a pressure relieving mattress or examine his pressure areas. There were no turning charts in place, and he was not regularly moved to decrease pressure on certain areas of his body.

Mr X was discharged home on 23 June with a referral to the district nurses. The following day a blister was noted on his right heel, and subsequently Mr X was readmitted to hospital on 16 July.

Following further investigations Mr X was discharged on 28 July, but continued to suffer from mobility problems due to the pressure sore on his right heel.

On 29 March 2010 Mr X was readmitted to hospital with bilateral cellulitis. At the time he had blisters on his feet, heels, legs and ankles. A wound assessment was carried out on 10 May, and a tissue viability nurse recommended he be repositioned every two hours.

In June 2010, another wound assessment nurse noted deterioration in the damage to the right heel, which had developed into a grade 4 pressure sore. In addition, Mr X had developed a grade 2 pressure sore on his left buttock.

On 19 June Mr X was discharged home, but unfortunately his condition continued to deteriorate, and as he was bedridden, the pressure sores became worse. He died on 19 July 2010.

Mr X’s widow brought a claim on behalf of her late husband alleging that the hospital was negligent in failing to carry out a Waterlow assessment, and failing to examine the areas of pressure. It was also alleged that the hospital failed to record the pressure sore on the right heel in the discharge letter to the district nurses in June 2009, and then failed again to take appropriate measures to alleviate pressure during his hospital admission in July 2009.

Liability was admitted in this matter, and compensation was agreed in the sum of £20,000.

Julie Marsh, an experienced pressure sore claim solicitor at Boyes Turner, commented on the case:

“It is standard practice for a hospital staff to carry out a Waterlow assessment when they are admitting an individual with a complex medical history and with limited mobility. Due consideration must be given to the ability of the patient to reposition themselves, and regular checks need to be carried out to ensure that pressure sores do not develop. The Waterlow assessment allows staff to prioritise patients, and if they are at risk of developing pressure sores, to try to prevent them developing by using measures such as a pressure relieving mattress.

Such a basic failing in the care of Mr X has resulted in very severe pressure sores over a number of areas, and potentially contributed to his death.”

Retired teacher dies after suffering from a bed sore

Retired teacher Eileen Cliggett, 79, went home from hospital with a pressure sore, after being in hospital for a week.

She was subsequently readmitted a month later, when the sore became severely infected. She died a few days later. The official cause of death was recorded as the pressure sore.

Mrs Cliggett received care at Llandough Hospital in Cardiff, and health chiefs from the Hospital Trust have now apologised to Mrs Cliggett’s family for the substandard care she received there.

Mrs Cliggett had recently been admitted to hospital for a hysterectomy, following cancer in June 2011. She had received an epidural anaesthetic, and therefore had to stay in bed for a week.

A risk assessment had been carried out, but staff had not followed the appropriate NHS procedures to prevent a bed sore developing.

It was only when Mrs Cliggett was visited by a district nurse, that the bed sore was flagged to the family.

The Cardiff and Vale University Health Board carried out a thorough investigation, and this has led to changes in the processes involved in preventing and reducing pressure ulcers.

Julie Marsh, expert pressure sore negligence claim solicitor at Boyes Turner, commented on the case: “This is yet another example of failings in the care provided to immobile patients in hospital. Although procedures are in place to assess immobile patients, if the process of regularly turning and moving these patients is not strictly adhered to, pressure sores can easily develop.

It is completely unacceptable that in this case Mrs Cliggett was discharged home having sustained a bed sore, without appropriate measures being taken to manage the sore or prevent it becoming infected. Sadly this had tragic consequences for her family.”

Man died after developing pressure sores

A man, aged 74 years, was admitted to Darent Valley Hospital in Kent after suffering a minor stroke. A risk assessment was carried out and it was noted that he was at high risk of developing pressure sores as he could not turn himself over or support himself in bed. Unfortunately, the man did develop pressure sores which gradually worsened and became infected. Sadly, he died of MRSA and sepsis.

The family sought legal advice and consequently the hospital trust admitted that there were failures in communication and that the staff were not trained adequately.

An inquest was carried out which recorded a verdict of neglect. There were various errors highlighted which were said to have caused the man’s death, namely:

  • He was given a pressure relieving mattress but the staff did not notice that the mattress was not working.
  • The nurse responsible for managing the pressure sores did not examine the man until he had been suffering with the sores for more than two weeks.
  • When the pressure sores were identified, the staff failed to treat and/or managed them appropriately.

The pressure sores increased in severity and then became infected with MRSA, which led to sepsis. The man’s condition deteriorated and he tragically died, six weeks after being admitted.

Sita Vaghela, a medical claim solicitor at Boyes Turner LLP, commented on the case:

“This case demonstrates the importance of not only undertaking appropriate risk assessments but also providing appropriate pressure relieving equipment and continuing to maintain that equipment. It is vital that once the sore has been identified that appropriate measures are taken to treat the sore and prevent it becoming infected.”

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The service was personal, professional and considered. I was treated so kindly and in the end I knew that not only had I found the right organisation but also the right person.

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