Shoosmiths has secured compensation of £55,000 - believed to be among the largest ever such court-ordered settlements in a case like this - for an elderly client who suffered Grade 4 pressure sores whilst receiving care in her home.
Joan MacAuley, now 92 years old, did not have mental capacity to bring her claim having suffered a vascular accident in 2010. Her daughter, Judith acted as her Litigation Friend in the claim.
Duty of care owed
From September 2014, Joan was cared for by the Community Nursing Service of Gloucestershire Care Services NHS Trust (the defendant) with carers visiting her at home three-four times a day. It was evident from the outset that Joan, like others of her age, was at very high risk of developing pressure ulcers and was owed a duty of care to both prevent this possibility and manage the situation should pressure sores develop.
Bed Sores: grades of severity
Pressure sores (also referred to as pressure ulcers or bed sores) are graded at four levels of severity:
- Grade 1 – skin discolouration, usually red, blue, purple or black
- Grade 2 – some skin loss or damage to the uppermost skin layers
- Grade 3 – necrosis (death) or damage to the skin patch, limited to the skin layers
- Grade 4 – necrosis or damage to the skin patch and underlying structures, such as tendon, joint or bone
Untreated pressure sores can lead to very serious secondary conditions, including sepsis, bone and joint infections and cancer (squamous cell carcinoma).
Shoosmiths investigates the claim
The family approached Sarah Cunliffe, a lawyer in the serious injury team at Shoosmiths who specialises in cases involving vulnerable adults, to investigate a claim. After reviewing the evidence, Sarah said:
‘It soon became apparent that Joan’s care was negligently inadequate. There were problems with staffing levels, sickness absences, a high staff turnover and no consistency in communication or treatment. Frequently, there were too few staff available to allow Joan to be hoisted so that she could be adequately bathed and assessed for risk of pressure ulceration.’
In March 2015, carers noted that Joan had developed a Grade 2 pressure ulcer on her sacrum but failed to advise more senior care staff or refer her to a specialist tissue viability nurse as they should have done. Record keeping was woefully inadequate, and an ever-changing roster of different nurses had no idea what had been done to manage the ulcer day-to-day There was no consistency in treatment. The wound dressing would frequently become dislodged or contaminated with faeces. Despite her sacral pressure sore, carers also left Joan sitting in a chair for long periods of time.
Failure to provide care had severe consequences
Consequently, Joan’s condition deteriorated still further and by September 2015 the sore had increased in severity to Grade 4 and she developed sepsis. She was finally rushed to hospital where she underwent debridement of the wound. Joan was transferred to a community hospital in November 2015 and then to a care home in January 2016, where she still resides. The pressure ulcer took many months to heal and the skin remains fragile and susceptible to breakdown and infection.
The defendants admitted several breaches in their duty of care, including a failure to plan and assess the care given, provide enough competent or sufficiently experienced staff, manage the sores adequately and keep accurate records. They also admitted failures in not referring Joan for early medical intervention.
Of the £55,000 compensation obtained, £35,000 was awarded for General Damages (i.e. losses that can't easily be assigned a monetary value, such as pain and suffering and emotional trauma) with £5,000 to cover the family’s various travel costs during the claim and the balance going towards residential home fees for Joan’s ongoing care. Sarah Cunliffe commented:
‘This was a troubling case where a clear breach of the duty of care owed to Mrs MacAuley could have had much more tragic consequences. Whatever the reasons and failings, sub-standard care led to a Grade 4 pressure sore developing, which is indefensible in any circumstances. Compensation in claims such as these involving elderly clients is never normally huge - usually only a few thousand pounds. The amount awarded reflects the severity of the failures in care and the suffering Mrs MacAuley and her family had to needlessly endure.’