Our client suffered a deep tissue injury when he was switched from a standard wheelchair to a specialized wheelchair called a Tilt-in-Space wheelchair, he was no longer able to self-propel in his wheelchair, but would slide back and forth in his chair. The injury he sustained caused an infected wound which resulted in him undergoing an operation where a 15×20 cm section of his buttocks was surgically debrided.
The client was a retired elevator constructor who suffered from dementia and a rapidly diminishing ability for him to walk safely. After an illness resulted in a hospital admission, his family concluded that it was no longer safe for him to be at home, so they sought a nursing home where he would be admitted as a long term-resident. Over time, his dementia advanced and his ability to walk independently declined further, to the point where he was wheelchair-bound. Even though he was no longer able to walk, he was able to use his feet to self-propel in the wheelchair. The ability to self-propel coupled with the advancing dementia caused a number of problems for the staff in that he would go into other resident’s rooms without invitation, would disrupt activities, and would occasionally run into staff or other residents with his wheelchair.
Throughout the nearly two years he was a resident at the defendant nursing home, he underwent periodic assessments for his risk of developing bed sores (or pressure ulcers). The defendant nursing home used a standardized tool for this called the Braden scale. The Braden scale assigns points to the various risk factors associated with the development of bed sores and your risk level depends on the number of points your score adds up to. It is a common tool used in the nursing home industry because it does a good job of capturing the different risk factors.
One risk factor that is addressed in a Braden assessment is shear. Shear occurs when there is a combination of pressure and friction between the skin and a flat surface. The most common example of shear is when someone is dragged across the bed sheets. Shear causes injury to the skin by stretching and then rupturing the small blood vessels that supply the outer layers of skin. Shear is closely associated with a type of pressure ulcer called a deep tissue injury. In this case, all of the nurses agreed that being able to identify when a resident is being exposed to shear is a basic skill for nurses working in a nursing home setting. Throughout his admission to the defendant nursing home, our client was assessed as being at low risk for the development of pressure ulcers.
The nursing home administrator received a sales call from a vendor who was selling a product called a Tilt-in-Space wheelchair. This was a specialized wheelchair which was recommended for resident who were wheelchair-bound. It had a special seating assembly which would move as one piece and provide pressure relief by moving the pressure points on the skin depending on the angle at which the chair was tilted. However, its use was contraindicated for residents who were able to self-propel because the chair is too heavy for most residents to be able to move themselves and because their feet do not adequately contact the ground when the seat assembly is tilted back. The nursing home administrator obtained a physician order for the use of the Tilt-in-Space wheelchair and ordered one without first obtaining the consent of the family.
As soon as the chair arrived, the family observed client sliding back and forth in the seat as he tried to move the chair forward with his feet as he had with his old wheelchair. This is a classic example of exposing the skin to shear. Within ten days of the arrival of the Tilt-in-Space chair in the facility, the client began to show the first signs of skin breakdown since he was first admitted to the defendant nursing home two years earlier. This occurred despite him being considered at low risk for the development of pressure ulcers. Over the next week, he developed multiple skin breakdowns on his buttocks until the director of nursing ordered the Tilt-in-Space taken out of service.
Our theory of liability was that he was improperly placed in the Tilt -in-Space wheelchair because he was able to self propel. The Tilt-in-Space wheelchair effectively became a restraint for which proper procedures were not followed before putting into use. Further, once he was placed in the new chair, the staff failed to recognize that the sliding back and forth in the Tilt-in-Space wheelchair was exposing his skin to shear and increasing the risk of skin breakdown.
Immediately after the Tilt-in-Space wheelchair was taken out of service, the client was sent to the emergency room because he was lethargic and had abnormal labs. Once at the emergency room, the doctors there determined that the skin breakdowns were not stageable and likely infected. A surgeon was brought in for a consultation and she determined that a surgical debridement was necessary. He was taken to the emergency room where a 15×20 cm section of his buttocks was debrided. An infectious disease physician determined that the client suffered from sepsis and that the infected wound was the cause of the sepsis.
The client was transferred from the hospital to another nursing home where he was placed on a wound vac and underwent multiple debridements of the wound to promote healing. He passed away 6 weeks after leaving the hospital due to aspiration pneumonia. The cause of death was hotly disputed as he did not die directly from the wound or the related infection. Our position was that the increased debility associated with the development of the wound, the infection, and the related debridements resulted in him being bedbound and resulted in the aspiration event which caused the pneumonia. The defense position was that the client had pre-existing difficulties with swallow unrelated to the injuries and that he had in fact suffered other aspiration events in the past.
The case settled for $320,000. (Cook County)
