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Failure to Turn Woman Blamed for Pressure Sores and Death $65,000 Illinois Verdict
By: Radha V. Bachman, Esq.
Buchanan, Ingersoll & Rooney, P.C.
Suzanne Gruszka, RN, MAS, CLNC, LHRM
Administrator, Clinical Support Services
News: A 76-year-old woman is taken to the hospital after collapsing at home. While at the hospital, the woman experiences an allergic reaction to the medications administered, resulting in a rash and blistering. Doctors ordered the woman to be turned every two hours to prevent pressure sores from forming. This course of treatment, however, was allegedly neglected, resulting in septicemia and eventual death.
Background: The plaintiffs brought this action on behalf of the decedent, a 76-year-old woman. Because of the woman's chronically low blood pressure, the decedent regularly took vasopressors, a powerful class of drugs intended to induce vasoconstriction, thereby elevating arterial pressure. Additionally, the woman was diagnosed as an uncontrolled diabetic and suffered from hypertension, coronary artery disease, and peripheral vascular disease. The woman collapsed while at home and was not discovered by her family for two days.
She was promptly rushed to the hospital, where she was diagnosed with emphysematous pyelonephritis in her left kidney. Emphysematous pyelonephritis is a severe necrotizing infection characterized by gaseous build-up typically caused by the E. coli bacteria. This systemic infection caused septic shock and multisystem organ failure. Additionally, upon arriving at the hospital, the woman suffered a partial myocardial infarction.
Four days after admission, the woman underwent surgery to remove the left kidney. As a result of this surgery and the aggressive treatment of her extremely low blood pressure, the woman gained 40 pounds of fluid during the first week following the surgery. Additionally, medications administered to the woman resulted in a severe allergic reaction, characterized by a bodywide rash and extensive blistering.
After one week of hospitalization, the nurses noted a tear in the skin over the sacrum and received consults from a dermatology service and a wound care team. The wound care team examined the woman's condition and ordered a specialty bed, a bowel management system, and ordered nurses to turn the woman every two hours to prevent further development of pressure sores.
Despite the wound-care physician's explicit instructions, the woman's pressure sores worsened, and she required three sharp debridements. These pressure sores rendered the woman septic, resulting in anoxic encephalopathy and recurrent mucous plugging of her tube.
The woman remained at the hospital before being transferred to another hospital. She remained at this second hospital for about one month before being transferred to a nursing home. The woman died several days after being transferred to the nursing home. The woman's death certificate listed coronary artery disease as the cause of death.
The plaintiffs, however, claimed that the death was ultimately the result of the pressure sores suffered while in the hospital's care. The plaintiffs claimed that the hospital's nursing staff failed to follow the wound care physician's instructions to turn the woman every two hours. Additionally, the plaintiffs contend that the hospital's nutritionist failed to provide proper nutrition necessary to prevent and promote healing of the pressure sores.
The defendants claimed that the woman was turned every two hours, but that the hospital's staff failed to consistently chart the treatment. The defendants contend that the pressure sores were not caused by inadequate turning of the patient. Instead, the defendants claim the pressure sores were a result of the woman's severe edema and skin allergies. Finally, the defendants claimed that the death was not the result of a skin condition and noted that the woman's skin condition had been improving upon her discharge.
The case proceeded to the jury, and the jury awarded $65,000 against the defendants on the survival count.
What This Means to You: This is a case of a 76-year-old woman who suffered from multiple comorbidities, who had become ill at home, collapsed, and was not discovered for two days. Upon examination at the hospital, she is diagnosed with emphysematous pyelonephritis. This is a common infection in people with diabetes and can result in a severe and life-threatening condition if not recognized and treated promptly.
Among the bacteria associated with this infection, 66% of the time E. coli is isolated. The mean age of people with this type of infection is 55, and this condition is more likely to occur in women. Ninety-five percent of the patients have diabetes. A patient diagnosed with emphysematous pyelonephritis should be treated with aggressive medical management and possibly prompt surgical intervention, as necessary. Untreated, these cases result in death. Postoperative wound infection is common in these patients as wound healing is compromised.
Consequently, on presentation to the hospital, it was noted that the woman had suffered a myocardial infarction. It appears that she was stabilized and then underwent surgical intervention to remove her left kidney.
Postoperatively, the woman was treated with vasopressors for her low blood pressure and had become edematous, gaining 40 pounds of fluid after the surgery. She also had an allergic reaction to a medication that had been administered, which resulted in an overall bodywide rash and blistering. This condition of the skin, the edema, along with her history of diabetes, peripheral vascular disease, hypotension, and cardiovascular disease predisposed her for the development of pressure sores and poor wound healing overall.
Once the nurses identified a tear in the skin over the sacrum, the appropriate consults were obtained from both dermatology and the wound care team. The treatment prescribed was appropriate for the treatment of the developing pressure sore and the prevention of further skin breakdown. Unfortunately, the woman's pressure sores worsened, and she required debridements of the area(s). She eventually was diagnosed with sepsis.
The plaintiffs claim that the woman's death was due to the pressure sores she developed and that the nursing staff failed to follow instructions to turn the woman every two hours. The defendants state that the woman was turned every two hours, but that the hospital staff failed to document the intervention consistently in the medical record.
This discrepancy is unfortunately a common one, as nurses and staff often perform the ordered treatments or tasks, but do not necessarily document their interventions into the medical record. This gives the appearance of the treatment or task not being performed. This is a growing concern among hospitals and attorneys. How can you defend something that is not objectively documented? As hospitals embark on electronic documentation, this issue becomes greater. Documenting on a computer takes more time than documenting on paper, and unfortunately pertinent items get forgotten. There are many barriers to nursing documentation, whether on paper or electronically. It is impractical to carry the laptop or chart with you the entire shift, so nurses document retrospectively and rely on their recollection of the event, treatment, or task. The safety of medication administration has greatly improved using scanning devices, which document the administration by scanning the medication and the patient and matching both. The administration is immediately documented in the medical record. However, if the scanning device isn't working properly or the medication isn't scanning appropriately, work-arounds are employed, so that efficiency is not lost. This is where important information is lost, and patient safety is compromised.
Charting by exception has also been a controversial issue for the past 20 years. It leads the nurse to chart only if something unexpected happens. When retrospectively reviewing a medical record, it appears that no one was really assessing the patient. It goes back to something all nurses learn in training: "if it isn't documented, it wasn't done."
While it is understandable the defendants claim that the patient's pressure sore development was due to her severe edema and skin allergies, the hospital staff did not adequately document their actions in response to the physician's orders, which violates the physician's orders and policies of this organization.
Cook County (IL) Circuit Court, Case No. 06L-13360.