The wound care specialist got a Karnofsky score that pointed to institutional care due to a complete inability to care for herself.  She was non-ambulatory and chair-bound due to a gait disturbance.  She was also incontinent.  She soon developed a sacral pressure injury after she got stuck and stayed stuck between her bed rail and mattress.  No treatment was documented for days for that and her heel lesion. COURT OF APPEALS OF TEXAS June 7, 2018

  The son was his elderly mother’s care-taker for five years before he moved her into an assisted living/memory care facility after she fractured her ankle.  A few months after admission the facility phoned the son to report a sore on his mother’s heel.  The next day the facility brought in an outside wound-care specialist.  The day after that the wound-care specialist phoned the son to report that the bed sore on the heel would have taken weeks to develop.

  Over the next two weeks the wound-care specialist informed the son the heel bed sore and others had become infected and gangrene had set in, until the son was informed his mother had died.  Six months later the facility sued the son for the unpaid balance on his mother’s bill.  The son countersued on behalf of the probate estate for her pain and suffering and wrongful death.

  The Court of Appeals of Texas ruled the countersuit could go forward against the facility, based on the expert opinions of a nursing expert and a physician the estate filed with the court.  The nursing expert stated that the facility was unable to provide the care the patient needed and should have moved her to a more appropriate placement.

  In the nursing expert’s opinion, the facility through a competent initial assessment should have known she needed professional nursing care 24/7 to monitor her skin condition, nutrition, hydration, infection potential and overall health status.  Her needs were especially acute due to her dementia.  Dementia typically gets in the way of the patient being able to care for himself or herself in a meaningful way.

  The facility should have recommended to the son that he seek a more appropriate placement, rather than leaving it to him as an untrained lay person to determine his mother’s actual needs.  Or when it became apparent or should have been apparent after admission that the patient’s needs were not and could not be met in assisted living, the facility should have recommended transfer to a more appropriate setting.

  The care the patient actually needed included a low air loss mattress for pressure relief coupled with turning and repositioning to off-load pressure on a two-hour basis, with documentation it was actually done.  There should have been an exercise program and professional monitoring of the patient’s nutrition and evaluation of her nutritional needs.  The physician went on to provide a medical opinion that competent assessment, monitoring and care by professional nurses of the patient’s skin and nutritional issues would more likely than not have prevented her skin breakdown, sepsis and early demise. Care Home v. Jones, 2018 WL 2926381 (Tex. App., June 7, 2018).