Pressure sores and ulcers due to neglect

We have been acting for the family of an elderly lady (aged 87) who sadly died in hospital during January 2017 as a result of sepsis and osteomyelitis.

At the material time, she was a widow (suffering from dementia) and had been supported intermittently by SEQOL (who provided adult community healthcare services).

The claim for clinical negligence was based upon the substandard care and treatment provided to the deceased whilst being cared for in the community such that she subsequently developed a Grade 4 pressure ulcer which developed into sepsis and osteomyelitis.

Briefly, in May 2016, the deceased had been discharged from hospital and was being cared for at home. In July 2016, her carers identified black spots on her right heel and they contacted SEQOL and one of their nurses classified this as a Grade 2 pressure ulcer. This ulcer deteriorated over the next three months until October 2016, when it was categorised as a Grade 4 pressure ulcer. In November 2016, she had to be readmitted to hospital as she was now at high risk of sepsis. Sadly, she died in January 2017 as a result of sepsis and osteomyelitis.

In our experience as a specialist clinical negligence practice, the presence of a Grade 4 pressure ulcer in most cases is indefensible and proof of neglect on the part of a carer/nurse.

A detailed Letter of Claim was sent to Swindon Clinical Commissioning Group (who were responsible for SEQOL up until October 2016).

Following our Letter of Claim, a number of breaches of duty were admitted by the Defendant and they accepted that the deceased was allowed to develop a Grade 4 pressure ulcer which made a significant contribution to her death.

The following claim was made on behalf of her estate:-

  1. Damages for the pain, suffering and loss of amenity caused to the deceased during the period of negligence (six months) up until the date of her death
  1. Financial losses including funeral expenses
  1. Care and assistance and other losses

A formal offer to settle her claim was made for £26,000.00. The Defendant counter offered with £22,000.00. After further negotiations, the parties were able to agree upon a settlement figure without the need to issue proceedings.

S J Edney Solicitors obtained compensation of £24,000.00 for the deceased’s family during 2020

Solicitor’s comment on the case

This was a tragic case. The deceased’s death was entirely avoidable.

Many older people in nursing homes and in the community will be vulnerable to developing pressure ulcers especially if they have mobility, cognition or nutrition issues which puts them at much higher risk of developing pressure damage.

This is well known to all Care/Nursing Homes and hospitals caring for older patients and those who are also cared for in the community.

With careful identification of risk factors and prompt interventions, in the majority of cases, these injuries can be avoided.

A pressure ulcer is an area of localised damage to the skin and underlying tissue caused by pressure, shear and friction and/or a combination of these factors.

The initial risk assessment carried out by a carer/nurse is crucial. A number of risk assessment models exist but the Waterlow system of scoring for risk is the best known and most frequently used.

The following steps should be taken to try and avoid these type of injuries:-

  1. Frequent moving of the patient to avoid ulcers as well as avoiding them lying in faeces and urine.
  1. Additional use of air mattresses or other mattresses, moved bed positions, sitting out of bed etc.
  1. Records should contain risk assessments, turning records, evidence of other preventative steps and, once an ulcer develops, wound charts and regular monitoring.
  1. Early referral for assessment by a Tissue Viability Nurse once an ulcer begins to develop is crucial.
  1. Early admission to hospital if the ulcer is continuing to deteriorate as the patient will be at a much increased risk of an infection/sepsis.

Lack of resources/staff is not a defence to a pressure ulcer claim.

When valuing this claim, we found the following reported pressure sore negligence claims very helpful in advising the family on the damages payable for pain, suffering and loss of amenity (PSLA):-

D’ARCY REED (ON BEHALF OF THE ESTATE OF JOHN REED, DECEASED) v MID-ESSEX HOSPITAL SERVICES NHS TRUST (2012) – Lawtel

PSLA: £20,000 (£24,141.91 RPI)*

The Claimant’s husband, who was aged 83, developed a grade 4 pressure sore on one of his heels, leading to the development of a grade 2 pressure sore on his left buttock. The sores caused pain and severely restricted mobility for him during the 14 months prior to his death.

AT v THE ROYAL WOLVERHAMPTON NHS TRUST (2018) – Lawtel

PSLA: £24,700 (£25,403.23 RPI)*

The claimant, a 74-year-old man, received £24,700 for the bilateral heel ulcers he developed in November 2015 whilst a hospital inpatient. He underwent surgical debridement, the sores took over six months to heal and as a result they affected his mobility and resulted in him suffering depression.

B (DAUGHTER & EXECUTRIX OF THE ESTATE OF T) v BUPA CARE HOMES (2013) – Lawtel

PSLA: £20,000 (£23,408 RPI)*

Deceased, aged 77, developed a grade 4 pressure sore over his sacrum and a grade 3 to 4 pressure sore over his left foot/inner ankle. Thereafter X underwent surgical debridement of his pressure sores. In May, he was discharged to a nursing home with a grade 3 to 4 pressure sore to his sacrum still present. Apart from the two week inpatient stay at hospital, X remained in a nursing home and the sacral pressure sore to his sacrum remained at grade 3 to 4 throughout. In September, X developed a urinary tract infection which progressed to cause sepsis and septic shock. X died in October.

S (ON BEHALF OF THE ESTATE OF T, DECEASED) v ROTHERHAM PRIMARY CARE TRUST (2011) – Lawtel

PSLA: £8,000 (£10,221.83 RPI)*

The deceased, who was bed-bound, had pressure areas which were not checked or managed and she suffered a necrotic right heel ulcer which developed sepsis in the heel and septic arthritis of the right knee, as well as skin tears and pressure sores on her buttocks. The Def admitted liability in respect of X’s care but denied that that had caused her death. Accordingly the settlement took into account the issue in relation to causation of death.

B v EAST LANCASHIRE HOSPITALS NHS TRUST (2012) – Lawtel

PSLA: £11,250 (£13,670.06 RPI)*

The Deceased developed a pressure sore on his left heel which did not heal for a period of 10 months, during this time he lost weight and developed oral thrush. It was not alleged that his death was related to any negligence.

If family members have elderly relatives or other family members who sustain a pressure sores (or pressure ulcer) injury whilst either in hospital/Care Home or in the community, they should seek advice from a specialist solicitor (ie. a solicitor either on the AvMA or the Law Society’s Specialist Clinical Negligence Panel) on their relative’s legal remedies.

* These valuations were made during June 2020

If you would like to make pressure sore negligence claims or any other no win no fee medical negligence claims for an elderly person please contact us. We are experienced with hospital, community healthcare, nursing and care home negligence claims and have offices in Swindon, Oxford, Cheletenham and Bristol. Or read more of our cases involving elderly patients.