Nursing Home Resident Develops Infection in Surgical Wound

Life Care Center of New Port Richey has been cited by the Florida Agency for Healthcare Administration for “failing to provide the care and services, monitoring, assessment or hygiene of the right foot [of a resident] for twenty four days in accordance with professional standards.” This resident was admitted to the nursing home after surgery with a walking boot on her right leg and was unable to put weight on that leg.

This citation describes the actions the facility should have taken in caring for a resident who had just been admitted. The nursing home should have gathered information about how to care for the resident’s surgical wound, created a “comprehensive base line care plan” for the resident’s twenty-four days in the walker boot, completed an assessment that accounted for the resident’s limited range of motion, and identified a fracture that required surgical attention. After reviewing nursing home files and interviewing the risk manager, nursing, therapy, and administrative staff, a family member of the resident, the resident’s doctor and surgeon, the Florida Agency for Healthcare Administration found that the nursing home failed to follow through on all of these highly necessary actions to care for the resident.

The resident’s orthopedic surgeon noted in a post-operative report that the resident “did well in her 1st postoperative visit and sutures were removed.” The resident had surgery on her ankle after a fall that resulted in a fracture. After the surgery, she had to stay in a nursing home for rehabilitation. When the orthopedic surgeon, who knew the resident well, saw the patient four weeks later, however, the resident was not doing well. She was still in the walking boot, “developing skin breakdown over the lateral malleolus,” or the bone on the outside of the ankle.

The surgeon also noted that “hardware was exposed and there was a foul odor.” The doctor’s recommendations were necessary to care for the resident’s infected ankle, but did carry risks. The citation records this doctor’s statement regarding their actions: “I sent her to the hospital where she was admitted and placed on antibiotics. I recommended moving forward with irrigation and debridement with removal of hardware. I personally obtained informed consent from her understanding the risks and benefits, including but not limited to infection, blood loss, vascular injury,…embolism, arthrofibrosis, need for future surgery, death.”

The resident was sent to the emergency room complaining of an infected right foot, with protruding hardware and swelling. Although it was clear there was an open ulcer on the resident’s right ankle in the previous surgery location, the hospital did a test of the tissue to be sure. The hospital’s test revealed that the resident’s ankle was infected with Rare Coagulase-negative Staphylococcus (CoNS). The hospital staff also noted that the resident’s ulcer was 3 cm in diameter and that orthopedic hardware was visible. This citation does not clearly state what type of surgery the resident had, but many ankle surgeries that use hardware to repair a fracture do not require removal of that hardware. It is likely that the surgeon intended soft tissue to grow over the surgical wound and heal during the resident’s time at the Life Care Center of New Port Richey. The next day a surgeon was able to perform corrective surgery in the hospital.

Through interviews with nursing home staff, the state investigator found that the resident had been in another nursing home a month or so before being admitted to Life Care Center of New Port Richey. She left that facility and went to the hospital with a urinary tract infection (UTI), then moved to the nursing home profiled in this citation. It is important to note that nursing home residents move between facilities due to the wishes of their family or even deficiencies in care. This resident’s living situation was unpredictable and could have caused her emotional pain in addition to the physical pain she endured.

A family member of the resident provided an account as well:

No, the nurses never removed the boot off of her right leg. The surgeon was dumbfounded that they did not provide care to her foot. They never even removed the boot to look at it. Yes, they gave her showers with the boot on. The smell coming from the boot at the surgeon’s office was so bad you could hardly stay in the exam room with her. Yes, I was there. I met [the resident] at the surgeon’s office. I called and reminded the staff of the appointment the day before.

The first facility she went to after her surgery they removed her boot and checked on her wound. The wound was healing but she ended up back at the hospital with a urinary tract infection. Of course the hospital nurses took the boot off, cleaned her foot and put lotion on her skin. Then she was discharged from the hospital to this facility…. You realize she was at that facility for almost a month with that boot on and no one ever looked at her foot to see how it was healing? This is just inexcusable…. [The resident] requested not to go back to the previous facility.

The Nursing Home Administrator stated in an interview that the resident’s true injury may have come from a breakdown of the surgical hardware that was used to repair the resident’s ankle fracture. The resident’s orthopedic surgeon had a clear assessment of the nursing home’s role in the resident’s injury: “Because the nurses did not provide any care to [the resident’s] right leg that was in a boot while she was in the facility, the resident had to undergo another surgery to remove the hardware because the ankle was infected. Well, if they did not receive any orders on how to care for her leg, they should have just called. There is no excuse.”

If you suspect nursing home abuse, we will provide a free, confidential case evaluation with no obligation to hire us. We treat our clients with compassion and aggressively represent their rights, making nursing homes take responsibility for abuse. Distasio Law Firm has the expertise and ability to advocate for victims of nursing home abuse and neglect, even if a case goes to trial.

COVID-19 Update

During this difficult time of quarantine, self-isolation, and social distancing throughout Florida and the nation, we want you to know that there are ways to check on any loved ones in a nursing home facility. While you likely won’t be able to visit in person, below are a few tips for checking on your loved one to make sure they are getting the care they need.

  • Call every day. Set a time to catch up with your loved one, even if it’s just a five minute call. If your loved one is tech-savvy and uses FaceTime, check in that way! Just one call can help ensure your loved one is still getting the care you expect from the nursing home.
  • Call after each shift. Find out when each shift starts and ends, and talk to the nurses after each shift to check on the consistency and quality of your loved one’s care.
  • Find out what you can or can’t do. During this time, most nursing homes won’t permit you to enter the nursing home facility in order to protect you and your loved ones. Some, however, let families enter when the loved one is on hospice. Be sure to clarify the rules with the facility so you can plan for any situation.

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