This nursing home wrongful death claim was filed in Anne Arundel County after staff at Glen Burnie Health and Rehabilitation Center failed to provide adequate wound care. It was filed in Health Claims Arbitration on February 21, 2018, and it is the 88th medical malpractice case filed in Maryland this year.
An 82-year-old woman presented to Baltimore Washington Medical Center with complaints of weakness, dehydration, poor nutrition, and weight loss. At the hospital, she was diagnosed with Paget's Disease, a condition that occurs when the body overproduces new bone tissue and causes bone fragility. Her medical history also included chronic kidney disease, diabetes, asthma, gout, and high blood pressure. So she was certainly susceptible to pressure sores. This is, of course, all the more reason to keep close tabs on her, right?
Following her hospitalization, the woman was admitted to Glen Burnie Health and Rehabilitation Center (GBHRC). Both the admitting physician and the nursing staff noted that her skin was intact at the time of her admission. The woman's admission intake form also indicated a diagnosis of generalized weakness, leg weakness, and dehydration. Due to her decreased activity level, the woman needed help from the nursing staff to get out of bed, bathe, and eat.
When the woman was reassessed the next day, her strength and mobility had further declined. She was unable to bear weight and required maximum assistance for any movement. The woman also consulted with a registered dietician, who determined that she was a high risk for malnutrition and estimated her protein needs as 98 grams per day. Decreased mobility and poor nutrition are risk factors for developing pressure ulcers, so both of these evaluations supported the need for extra diligence to prevent the woman from developing a pressure wound.
After residing at GBHRC for one week, the woman was found to have an unstageable pressure wound on her coccyx. The nurse who conducted a skin evaluation the previous day indicated "no skin problems," but considering the wound's large size and moderate amount of drainage, it was unlikely that it just appeared overnight.
The next day a nurse observed that the wound had worsened, becoming inflamed with a possible abscess in the wound bed. The nurse notified the physician's assistant, but the PA never made a wound assessment. The pressure ulcer continued to grow. It was red, yellow, and black in color and developed a foul odor. The PA didn't complete a physical assessment until three days after the wound was first discovered. His exam was cursory at best, failing to indicate size, condition, stage, or any other description of the wound in the progress note.
Finally, after several days of a high temperature, high white blood cell count, and a rapidly worsening pressure wound, the woman was transferred to the hospital. At Baltimore Washington Medical Center, her wound was described as a Stage III sacral ulcer with purulent odor, greenish brown drainage, and surrounding erythema.Despite aggressive treatment at the hospital, the woman ultimately succumbed to the overwhelming sepsis and shock caused by her advanced pressure ulcer. Her cause of death is listed as sepsis, sacral ulcer infected wound, septic shock, and acute renal failure.
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