This case involves an elderly patient, undergoing treatment for many conditions, who developed a distal right common iliac thrombus occlusion. During the hospital stay, the patient underwent an embolectomy and femoral-popliteal bypass. The patient also developed cellulitis of the right lower leg, ecchymosis, and a grade 1 ulcer on the right heel. While under the care of this hospital, the patient developed several decubitus ulcers that went unchecked for a significant amount of time. The hospital failed to make a proper, adequate, and timely diagnosis, which led to a delay in treatment of the bedsores. The patient died and the cause of death was a severe staph infection linked to the ulcers. An expert with a specialty in decubitus ulcer care was retained for this case.
Question(s) For Expert Witness
- 1. How much medical attention should be given to pressure ulcers in a patient who has several comorbid conditions?
Expert Witness Response E-000970
The first step in resolution is to reduce or eliminate the cause, that is, pressure. A multidisciplinary approach can lead to maximum benefit for the patient. Consultations with a neurosurgeon, urologist, plastic surgeon, orthopedic surgeon, and general surgeon all may be indicated in a particular patient. A rehabilitation medicine specialist, social worker, and psychologist or psychiatrist may work together with geriatricians or internists to improve the patient’s health, attitude, support structure, and living environment. When medical management has been optimized, many stage I and stage II pressure sores heal spontaneously. Stage III and stage IV ulcers, however, almost always require a surgical approach. Plastic surgeons perform most pressure sore reconstructions, and consulting a plastic surgeon with any complex or chronic wound is appropriate.