Miss PM suffers from spina bifida and was a wheel chair users, she had been diagnosed with, and listed for routine surgery for removal of kidney stones.
Miss PM attended the Defendant’s Hospital for a pre-operative assessment, during which investigations and assessments indicated that she had a urinary tract infection. As a result she was admitted to the Acute Medical Unit. Despite identifying that Miss PM was at high risk of pressure damage and a Grade 2-3 pressure sore being identified on her left leg, no care plan for the management of her pressure areas was prepared.
Miss PM was discharged 9 days later. The discharge note sent to her GP did not refer to any pressure care assessment. The referral to the district nursing team referred only to catheter care and the need for a hoist at home.
Two days later Miss PM was admitted to hospital for planned surgery to remove her kidney stones. Due to complications she was transferred to the Intensive Care Unit (ICU), where she remained for 5 days. She spent a further day on a ward prior to being discharged home. During this time there was no appropriate assessment of her pressure sore areas and no plan of care. On discharge there was no mention to the district nurses or Miss PM of pressure damage and the need for continuing pressure care.
Miss PM had no prior knowledge of the existence of pressure sores, she had no sensation in that area, was bed bound and could not roll onto her side for the area to be examined due to her recent surgical wound. She was unaware of any issues until blood was discovered 1 month later on a waterproof wheelchair cover which was being used to assist moving her.
Miss PM attended the Accident & Emergency department of the hospital with extensive and significant pressure damage to her sacrum and the back of her thighs. The pressure sore was assessed as being Grade 4. It had developed as a result of inadequate position changes during her stay on the ICU.
Two days later Miss PM underwent debridement and a defunctioning loop colostomy. She retained in hospital for a period of 7 months, during which time she suffered from a number of infections and underwent skin grafting, which was unsuccessful.
Miss PM suffers from extensive scarring and very severe scar tissue and tissue distortion. The sacral wound heals and then breaks down in a cyclical nature because the skin is friable and she has no subcutaneous fat in the area to act as a cushion. The quality of her life is greatly affected because when the wound breaks down district nurses visit to change her dressings and she never knows for certain when they are going to arrive. She is now limited to sitting in her wheel chair for four hours at a time on a Saturday, Sunday, Tuesday and Thursdays. These are the only times she is permitted to be out of bed.
Miss PM spent a great deal of time on bed rest following the development of her pressure injury. This has resulted in generalised muscle weakness, which has affected amongst other things her upper limb strength and function and thus her ability to independently self-propel a manual wheelchair. Her fragile scar tissue prohibits her from self-transferring and using a self-propelled wheel chair because of the friction.
Miss PM wears a two-piece stoma system, which she empties once a day. The whole system is changed 2-3 times per week. She suffers from intermittent prolapse of the stoma, and she has to take spare clothes and equipment with her when she leaves the house in case the stoma leaks.
Miss PM sent a letter of complaint to the Hospital regarding her care and the letter of response apologised for failure to make an adequate assessment of her pressure needs. The Defendant Hospital made an offer of £10,000.
Following investigation of Miss PM’s care a letter of claim was sent to the Defendant who admitted some failings and having caused the initial pressure sore, but they denied having caused the grade 4 pressure sore and argued that Miss PM was also to blame for her own misfortune by not having returned to hospital sooner following her discharge.
Following the letter of claim the Defendant made a further offer of £30,000 with their letter of response.
During the course of the claim the Defendant also sought to adduce expert evidence which conflicted with the limited admissions made and an application was made to debar the Defendant from relying on this expert.
Having obtained additional expert evidence on Miss PM’s condition, prognosis and losses from experts in the fields of: general surgery, plastic surgery, nephrology, tissue viability, nursing, occupational therapy, and mobility prognosis, and the claim was settled out of court at a joint settlement meeting, Miss PM in the sum of £550,000.
By virtue of her underlying spina biffida, Miss PM has a limited life expectancy, but now she can use her damages to put in place a care package with aids and equipment to reduce the risk of further wound breakdown and speed up healing should it occur. She will also be able to purchase a powered wheelchair and car which can accommodate it so she can get back out and about in the community and see family and friends. She has a Case Manager to help here with the setting up and management of her care package and is receiving advice from an IFA to maximise her funds.