THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, August 22, 1995 TAG: 9508220281
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
DATELINE: NORFOLK LENGTH: Medium: 88 lines
For weeks during the fall of 1993, Mary Harrell complained to staff and administrators at Oakwood Nursing & Rehabilitation Center in Virginia Beach that her mother was being neglected.
She'd found her 86-year-old mother, Louise Cole, lying in her own urine or excrement, and the elderly woman had constant diarrhea and was rapidly losing weight.
Then, on Oct. 28, 1993, six weeks after Cole entered Oakwood to recuperate from a broken hip, Harrell smelled a horrible odor in her mother's room. It came from Cole's feet, which, Harrell found when she removed a pair of filthy, black socks, were slimy and scaly, with ``gunk'' between the toes. To Harrell, it looked like her mother's feet had not been washed in weeks.
What she didn't notice was the pressure sore on her mother's right heel - a sore that within a month would become severe enough to require her mother's lower right leg be amputated.
On Monday, a seven-person jury agreed with Harrell that her mother had been neglected while at Oakwood and that the home's negligence had led to the pressure sore and the eventual amputation.
The jury awarded Cole $275,000 in damages, less than the $1 million Cole's attorneys asked for, but enough to make Harrell feel that ``God has worked a miracle for us.''
The crux of the case, said Cole's attorney, Carlton F. Bennett, was that no one at the nursing home watched to make sure Cole didn't develop such a serious pressure sore.
Cole was at a high risk for developing the sores, which are common in bedridden people and can quickly become serious, opening up deep holes in the skin.
Cole had previously suffered a stroke, which left her right side partially paralyzed. That, coupled with the broken hip she'd sustained and a blockage in the main artery that supplies blood to her right leg, made her particularly susceptible to pressure sores on her right side.
So when she entered the nursing home, her doctor ordered an air mattress, which helps reduce pressure on areas like the heels and buttocks. But the air mattress didn't show up until six days after Cole arrived.
``Skin begins breaking down within one to two hours,'' Jan Whitman, a registered nurse from North Carolina and former director of nursing at a Virginia Beach nursing home, testified during the trial. ``So that was six days where a standing order was not followed that was specifically for prevention of any kind of pressure.''
On Sept. 30, a nurse noted redness and ``mushiness'' on both Cole's heels - early signs of pressure sores.
That's when the staff should have started monitoring her heels weekly, Whitman said. But such monitoring wasn't begun until Nov. 5, by which time the skin had already broken down on the right heel.
Whitman, who reviewed Cole's medical records, said they didn't show that Cole's heels were inspected before Nov. 5, or that other preventive care, like elevating her feet, was provided.
And, she said, the director of nursing and the unit manager should have been checking to ensure that the proper care was provided.
But during those six weeks - from Sept. 30 to Nov. 5 - neither the home's nursing director, Nancy Santana, nor the unit manager, Michelle L. Skinner, both of whom were named as defendants in the lawsuit, personally checked on the care being provided to Cole, according to their testimony.
``They didn't do anything about it,'' Whitman said. ``That's not the standard of care. That's below the standard of care.''
Santana was out of work for a month during that time because of injuries she received in an automobile accident; and Skinner was trying to do both her own job and Santana's. Even after Santana returned to work Oct. 23, however, she still didn't personally check on Cole's condition.
Defense witnesses testified that because of Cole's medical condition, a pressure sore on her right heel was a near certainty, despite anything the home could have done.
``In a patient with her compounding problems, the inability to move, it's a common complication to see pressure sores occur,'' said Dr. Jock Wheeler in a deposition for the defense. Wheeler, dean at Eastern Virginia Medical School and a vascular surgeon, has treated patients with problems similar to Cole's, although he did not treat her.
By the time Harrell transferred her mother to another nursing home on Nov. 29, the sore on Cole's right heel had grown so large and deep that ``there was no heel left,'' said Harrell. ``It was just gone.''
Cole, a rail-thin woman whose right leg ends a few inches below the knee, lives with Harrell now. She's often confused, but Monday, when the jury read its verdict, she understood, and sobbed with joy from her wheelchair, her attorney hugging her shoulders.
The case may be appealed, said defense attorney John Y. Pearson Jr. by CNB