Our client was admitted to defendant hospital on May 13, 2003, for elective surgery and an expected quick recovery. A diabetic treating with oral medication, plaintiff had developed a right heel ulcer in August, 2002 as the result of a pedicure. Although she continued to work full-time as an office administrator for an accounting firm in Center City, Philadelphia, her heel ulcer did not heal. She had no other area of skin breakdown. Arterial ultrasound demonstrated bilateral lower extremity occlusive disease; plaintiff was referred to a vascular surgeon, who recommended bypass grafting. Plaintiff agreed.
Surgery was performed successfully at defendant hospital on May 14, 2003. Because of the nature and extent of her surgery, plaintiff was taken to the Surgical Intensive Care Unit under heavy sedation and intubated. She remained on a ventilator, unconscious and immobile, for approximately two weeks thereafter. In addition, the surgery triggered acute renal failure, requiring temporary hemodialysis and compromising nutritional status. It was while in this helpless state that plaintiff developed a pressure sore on her sacrum that enlarged, deepened, and became infected, ultimately claiming her life.
By way of background, pressure ulcers occur when the skin and deeper tissues are compressed between an outside surface and a bony prominence, such as the sacrum. These deeper, compressed tissues can die under seemingly intact skin and initially present as red discoloration or bruising (Stage I). Without aggressive intervention, a Stage I pressure ulcer progresses from inside out, developing into a deep crater of necrotic tissue (Stage IV). Weight offloading is the key to prevention of pressure ulcers for patients at risk. Plaintiff clearly was at risk. Before her admission to defendant hospital, plaintiff had known peripheral vascular disease and diabetes, both of which are well-established risk factors for the development of pressure ulcers. After her surgery, plaintiff was sedated on a ventilator and nutritionally compromised, additional risk factors for pressure ulcers. Assessment of these risks and prompt intervention are mandatory in the care plan for any critically ill patient. The staff at defendant hospital did neither. Despite plaintiff’s known peripheral vascular disease and diabetes, despite her immobility and compromised nutritional status, she was not rigorously assessed at any time for the risk of developing sacral pressure ulcers and not one single measure was taken to protect her against them. At no time during, her nearly two month admission to defendant hospital was plaintiff consistently placed on a specialized surface to offload weight from her low back; at no time until shortly before transfer to a community hospital in Montgomery County, Pennsylvania, was she regularly turned or repositioned. This, despite a classic presentation of discoloration of sacral skin, followed by a sacral skin tear, followed by a widening, deepening crater of necrotic tissue that measured 10 cm. by 15 cm. at time of transfer to community hospital. Put simply, the staff at defendant hospital, a tertiary care facility, did not do its job.
Increasingly frustrated at delegated responsibilities and empty reassurances, plaintiff’s family decided to transfer her care to the community hospital on July 9, 2003. Within one week, plaintiff was taken for surgical reconstruction of what was described as “a giant sacral decubitus ulcer” in an attempt to promote healing. Although plaintiff initially appeared to improve after this surgery, she died twelve days later. Her death was caused by multiorganic system failure due to sepsis from osteomyelitis of the sacral ulcer.
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