Adding insult to injury – A case study highlighting the risks and consequences of pressure sores in spinal cord injury.

19 Nov 2020

Tom Hartigan, Partner at Trethowans, acted on behalf of a claimant who had been a wheelchair user since sustaining a serious spinal cord injury some 13 years earlier. A clinical negligence claim was brought against the NHS Trust after he developed a severe pressure sores during a stay in hospital.

Mr M understood the importance of keeping his skin intact. He had always taken very good care of his skin, and established a sensible routine of skin care.

He was unfortunately taken to hospital with a severe nose-bleed (he took warfarin daily) and initially treated in A&E. Both the ambulance crew and A&E staff were informed that he was paraplegic and on warfarin. He was admitted to hospital and transferred to a ward later the same evening. Over the next few days he did not receive any assistance with the management of his paraplegia. He was only provided with an inflatable mattress, which at one stage completely deflated during the night, rather than any specialist spinal mattress. He was also not turned regularly during the day or night, which was a key part of his skin care regime at home. As a result of this neglect over a period of several says he developed severe pressure sores around his coccyx, buttocks and the top of his legs.

Medical evidence obtained from a consultant in rehabilitation medicine found that Mr M and his wife had developed a very effective regime of skin care and management since his spinal injury. This had ensured his skin was in good condition despite the obvious risks of pressure sores and infection given his paraplegia.

Sadly all of this good work and care over many years was effectively destroyed by the failure of the hospital staff to adequately manage his needs whilst in hospital. This led to irreversible breakdown of the skin and development of severe pressure sores. Mr M was left at a greatly increased risk of suffering further skin breakdown / sores in the future. He also required significant additional care.

The NHS Litigation Authority dealing with the claim on behalf of the Trust accepted a breach of duty in relation to the nursing care provided in hospital, however causation was denied and remained an issue even after court proceedings were commenced.

Despite the continued lack of an admission, the NHSLA ultimately agreed to deal with the claim and initially offered the Claimant £25,000 in full settlement of his damages claim. This initial offer was firmly rejected on our advice. Further medical evidence as to causation, condition and prognosis was obtained. This prompted further negotiation and NHSLA were eventually persuaded to substantially increase their offer of settlement, in order to avoid going to trial.

The eventual award of damages was a large six figure sum, which provided financial security for Mr M and the funds to provide the additional care he needs for the rest of his life.

Tom Hartigan comments: “It is terribly sad that in this day and age simple care and assistance is not always made available for spinal cord injured people in hospitals. The risk of developing pressure sores is a well known risk and has been for some considerable time, and the need for a skin bundle (to plan and implement all of the factors involved in maintaining skin integrity when planning care for a patient) is widely accepted, but often not implemented. The consequences of a skin breakdown can be significant and irreversible, as the individual is likely to left prone to further breakdown and infection in the future. Trethowans are delighted to join and support SIA’s very important campaign to highlight and raise awareness of the risk of pressure sores.”

The Spinal Injury Association are highlighting the huge impact that pressure ulcers can have with using the global awareness campaign ‘Stop the Pressure Day 2020’ on Thursday 19 November, for more information click here.