Poor Nursing Care for 84 year old retired HGV Driver

Mr W was an independent man of 84 years of age and in reasonable health when he developed cellulitis of his left big toe. He attended his GP surgery several times over the following two months as the condition worsened and he was in significant pain and discomfort.

The GP identified that Mr W was possibly suffering from peripheral vascular disease and also that he had now developed a pressure ulcer on his heel, which was infected. The GP referred Mr W to the District Nurse Team for treatment of the pressure ulcer.

The District Nurse visited Mr W at home and noted that his ulcer was necrotic. She dressed the wound but failed to take important ankle brachial pressure measurements to check the blood flow to the infected area. District Nurses visited regularly over the following months but the ankle brachial pressure tests were not undertaken. It was identified that Mr W should be referred to a tissue viability nurse but the referral was never made. Mr W’s condition continued to deteriorate. In addition to the heel ulcer there were further areas of skin breakdown between the third and fourth toes and also under the base of the big toe.

Despite further regular visits by the District Nurse team over the following 6-7 weeks Mr W’s condition deteriorated until his toes were pale, cold and he had little sensation. He could not elevate his legs to lie down due to pain and he had to sleep in his chair. There was extensive ulceration of the whole foot. When his ankle brachial pressure tests were eventually undertaken (nearly three months after his original referral to the District Nurse) there were barely any audible pulses on his feet highlighting that blood was not flowing properly.

Mr W was referred urgently to a vascular surgeon who sadly advised amputation of the left leg – below the knee. Devastatingly after the surgery Mr W’s stump began to breakdown and he had to undergo an above knee amputation. Whilst in hospital he developed more preventable pressure ulcers on his sacrum and heel. Mr W’s amputation left him wheelchair bound. He lost his independence and was forced to move home. He required care, help and support. He was saddened and depressed by his sudden incapacity and loss of independence.

Mr W took legal proceedings against the District Nurses who failed to devise an adequate care plan, refer him to a tissue viability nurse and take ankle brachial pressure tests. He also sued the hospital Trust for failing to take appropriate simple preventative measures to prevent yet more pressure ulcers developing on his right heel and sacrum. These failings in care were admitted by both Defendant NHS Trusts but sadly compensation was refused on the grounds that even if staff had carried out their jobs properly Mr W would still have required an amputation in any event. No compensation was offered in relation to the preventable pressure ulcers that developed in hospital. In light of the Defendants’ refusal to compensate Mr W notwithstanding the admitted failings in care, he was forced to issue Court Proceedings and pursue protracted litigation.

It was finally accepted that with proper treatment Mr W would not have undergone the above knee amputation nor would he have developed the further pressure ulcers and that as a result he should be compensated. Sadly, this admission came too late for Mr W to benefit from his damages as he had passed away during the course of the legal proceedings and the Executor of his Estate had to finalise the case.

Whilst the case was successful it was very sad that acceptance of fault and payment of damages was not forthcoming at an earlier stage when Mr W could have benefited from his compensation. It is incredibly frustrating for many of our clients when this happens. Mr W’s Solicitor, Partner Madeline Seibert commented “significant time, effort and legal costs can be saved by early admissions and payment of damages when it is right and just to do so. Sadly this occurs in very few cases”.