LARGE AND infected bedsores were a major contributory factor in the death of an elderly woman at Mayo General Hospital within days of her being transferred there from a private nursing home, a jury at the inquest into her death has ruled.
The inquest at Castlebar courthouse yesterday heard that Árd na Gréine nursing home in Enniscrone, Co Sligo, began dressing a bedsore on 91-year-old Julia Slattery’s lower back in July 2009.
It improved but by that October it was deteriorating again, by which time she also had a second bedsore between her shoulders.
When she was seen by her GP on October 31st, he found her to be in a distressed and dehydrated state and recommended she be admitted to Mayo general. She died there eight days later on November 8th.
The dead woman, who had worked as a priest’s housekeeper in Crossmolina, Co Mayo, had been a resident of the nursing home since 2003 and had suffered a stroke in 2004.
The home submitted that she got the best possible care but two of the woman’s nieces told the coroner for Mayo South, John O’Dwyer, they had an issue with the fact that she was not transferred to hospital earlier, though they were happy with how she had been looked after over previous years. Maura Dowling, one of the nieces, said the first she knew of Ms Slattery’s deteriorating condition was when she and her sister Phil Galand arrived at the home unannounced on October 31st, 2009. She said she lived in Carlow and last visited her aunt six weeks earlier. “I was shocked at the level of discomfort that Julia appeared to be experiencing. Also, Julia was normally fully dressed when we visited and I was appalled to see that in her nightgown she was in such a state of emaciation which had not been obvious prior to this.
“I have an issue with the fact that my beloved aunt had been suffering for some time with bed sores without getting proper medical attention for the treatment of a condition that appears to have been outside the scope of the nursing home.” Ms Galand said she “held it against” the nursing home that her aunt wasn’t hospitalised earlier.
Dr Fadel Bennani, the pathologist who carried out the postmortem, said he found the cause of death to be massive pulmonary thrombo-embolism (a clot in the lung) with large and infected bedsores as a “major contributing factor”.
Margaret MacPhee, director of care at the nursing home, gave evidence that Ms Slattery was immobile and required total care since her stroke in 2004. She said although Ms Slattery was at high risk for pressure sores in her condition, good nursing care, use of special equipment and input from physiotherapy and occupational therapy prevented her from developing a sore until July 2009.
When a sore developed it was dressed and her GP, Dr Seamus Higgins, prescribed antibiotics. When the GP saw her again in September the wound was healing. But when it deteriorated in October a wound specialist was consulted and antibiotics were again prescribed by another GP, Dr Jude McSharry, on October 22nd. “We feel that all efforts humanely possible were made initially to prevent bedsores developing and later to provide nursing care in line with best evidence-based practice,” she said.
To questions from John Slattery, a nephew of the deceased, who claimed his aunt lost about 2½ stone between April/May 2009 and when she was admitted to hospital – by which time she was six stone – Ms MacPhee said his aunt regularly refused food and fluids, but food supplements were obtained for her.
Dr Higgins said the reason he decided Ms Slattery should be transferred to Mayo general on October 31st, 2009, and not earlier was because she was in a distressed state. He believed her advanced age, immobility and chronically poor appetite were factors that hindered her recovery from the bed sores.
Dr Pat McHugh, a consultant physician who reviewed the dead woman’s file on behalf of the nursing home, said Ms Slattery had been well cared for. He said pressure sores occur “even in the best institutions”.