Elderly Man Not Properly Cared for in Nursing Home

Michael Talve, CEO

Written by
— Updated on January 5, 2018

This senior care case involves an 84-year-old male with a medical history significant for CVA, cachexia, hypertension, type II diabetes, and mild anemia. The patient recently suffered a CVA with left hemiparesis and was discharged to a nursing home for further care. The patient’s condition deteriorated immensely upon his transfer to this facility and it was at this point he was made DNR/DNI. Over the course of his stay, the patient developed several pressure ulcers, several leg contractures, and required a peg tube as he became more malnourished. Complications over the course of one year included urinary tract infections, pneumonia, kidney failure, chronic pain syndrome, and arterial and small vessel disease. Additionally, the patient was severely dehydrated and malnourished over the last several weeks of his life, and his health began to decline so much that he was no longer able to use his dentures, even when fitted with special adhesives. He developed gangrene of his right heel and had to undergo several rounds of surgical debridement that ultimately required several amputations, including his right hand. After an unsuccessful hand transplant in the aftermath of his amputations, the patient’s health fatally declined.  The cause of death was listed as Legionella pneumonia, hypertension, hyperlipidemia, and atrial fibrillation. No autopsy was performed. An expert with a specialty in decubitus ulcer care was retained for this case.

Question(s) For Expert Witness

  • 1. Should this patient have been monitored more closely and what could have been done to prevent such outcomes?

Expert Witness Response E-005405

This is an elderly male with multiple comorbidities contributing to his functional and clinical deterioration and if anything could have been managed better it seems as though the pressure ulcer monitoring was substandard. The most important care for a patient at risk for pressure ulcers and those with bedsores is the redistribution of pressure so that limited pressure is applied to the spot of the ulcer. The frequency of turning and re-positioning depends on the level of risk in the patient. Turning patients every 2 hours has been a long-standing tradition, with some evidence to support its practice. Pressure-redistribution mattresses are used to reduce high values of pressure on prominent or bony areas of the body. This patient seems as though he was at the end of his life but that does not mean that he doesn’t deserve the same preventative care as the next patient.

Contact this expert witness

Find an Amputation Expert Witness Near You

What State is your case in?

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY