Need help with huge bedsore

[uni321]

I have a relative of mine, in her 70s, that was involved in an accident several months ago. She suffered an incomplete C5 injury. We wanted to get her to rehab as soon as possible but that seems far off in the future. Right now she is battling a large stage iv ulcer that developed in the sacral area. She has been through four hospitals. Because of Medicare policy she is not allowed to be at any one hospital for more than 30 days in a row.

The bedsore probably started at the first hospital and it got really bad at the second hospital. This is when it became a stage IV. We did not know what was going on. She had been expressing a lot of pain. The nursing staff was clueless. We were all shocked when we saw a large hole in her sacral area with the bone exposed. It was a huge dissapointment because otherwise my relative was showing steady improvements (weened off the ventilator and the feeding tube) since the accident. The staff members were not repositioning her. After arguing with the hospital's manager and CEO they admitted that they goofed up. The CEO even told us they used to have personel dedicated to turning patients over but got rid of them a while back. They finally put her on a special mattress (too little too late) and then did a flap on that area. At this point it was already past 30 days in that hospital (Medicare does not pay beyond 30 days) and they wanted to get rid of her as soon as possible.

The 3rd and 4th hospital gave her more attention and turned her over regularly but the wound wasn't really healing (in fact it was getting bigger). They recommend we do another surgery. Now after reading a lot of posts here it seems like we should go to an experienced wound clinic, treat whatever infection there is, do the surgery, and then have her rest for 6-8 weeks. Problem is she needs care at an inpatient facility and is not ready for home yet. Medicare dictates a patient can't stay at a facility for more than 30 days in a row. The wound clinic we want to go to (in Sarasota) is only for outpatients. We don't know what to do.

Her situation appears similar to this one:

https://www.carecure.net/forum/sci-c...r-with-new-sci

[SCI-Nurse]

Suggest you see an attorney and look into a malpractice suit against the first two hospitals. Prevention of pressure injuries should be a top priority for new injury SCI patients. Their failure to prevent this is definitely a result of negligence. Unfortunately, all too often I see acute hospital staff write-off elderly people with new SCI/D because they believe they have no potential for rehab and are unlikely to survive long (which certainly can be the case with neglect that led to a stage IV pressure injury!). Medicare should also be fining those facilities for allowing a pressure ulcer to develop.

At this point, I would suggest getting her moved to a good quality inpatient LTAC (long term acute care) facility that is not only an inpatient wound care center, but also is knowledgeable in providing care to persons with SCI. A discharge planner or case manager at the hospital where she is now should be able to identify such a facility locally. If not, you may need to have her taken to such a facility a distance away in areas such as Tampa, Orlando, or Miami. She would need to remain there while her wound heals (and a second surgery may indeed be required) sufficient for her to start rehab in a good SCI acute rehab program. There are none of those in your area either.

Meanwhile, suggest that someone get in touch with the Florida Spinal Cord Injury Resource Center to see what assistance they can provide: https://www.tgh.org/services/rehabil...njury-resource

Another resource I would recommend is the Christopher & Dana Reeve Paralysis Foundation: https://www.christopherreeve.org/get...sk-us-anything

Please keep in touch and let us know what you are able to find as care for this unfortunate woman. You are a good friend to be helping her out.

(KLD)

[uni321]

Thanks. I'll definetely look at those resources.

[HACKNSACK44]

I was injured 31 years ago. I ended up getting a stage IV bedsore at the trauma center I was at. I was sent to Tampa General Hospital where they did a flap surgery on the bedsore and rehab.

[uni321]

I contacted both Florida Spinal Resource Center and Reeve and haven't got a response from them.

[SCI-Nurse]

Did you call them or just send an e-mail? Best to call. (KLD)

[uni321]

The Reeve Center did call me back this morning. I guess they are closed on the weekends.

[uni321]

So I understand you are supposed to keep off of the wound. A wound doctor at one hospital told us that she is supposed to always be on her side at a 90 degree angle to the mattress. At another hospital a wound nurse told us that she can lay on her back for a couple hours and then 45 degrees on her sides for a couple hours. The bed is a clinitron.

[baldfatdad]

get hold of Morgan and Morgan, huge law firm. the guy that started it had a brother that is a quad that got the same bad treatment your friend it. she will need years of care to get better.

[SCI-Nurse]

Everthing that I would have said (for the most part has been said). I would also encourage you to get your relative a physiatrist who specializes in SCI.
He/She should be able to direct you to appropriate resourses. You definitely should also get an attorney involved.
ckf

[uni321]

Thanks. I'll keep that in mind.

[uni321]

The doctor just told us that the wound infection was untreatable. But he suggested that a new flap should be done anyway so the area doesn't become even more infected. I don't know where all this is going. He did the first flap a couple months ago which failed (back then he told us that rehab was right around the corner in 2-4 weeks). I doubt the area at the time had even been tested for infection, let alone treated.

[Tetracyclone]

The doctor just told us that the wound infection was untreatable. But he suggested that a new flap should be done anyway so the area doesn't become even more infected. I don't know where all this is going. He did the first flap a couple months ago which failed (back then he told us that rehab was right around the corner in 2-4 weeks). I doubt the area at the time had even been tested for infection, let alone treated.

A. second or third opinion is in order. Whomever is her family advocate needs to ask for a copy of the C &S report on the infection. That stands for Culture and Sensitivity. I find the doctor's advice very puzzling.

[SCI-Nurse]

If she has a bone infection (osteomyelitis), they are considered to not be curable. They do go into quiet (or remission) and can stay that way for a long time. Either way, I would think that it needs to be treated. I would concur with above- a second and maybe a third opinion needs to be gotten. Even with osteomyelitis, a repeat flap may be considered prudent but only after treatment of the infection.
ckf

[uni321]

We've been told by a doctor that her sacral bone is too thin to be shaved. So I guess it would be antibiotics primarily?

[SCI-Nurse]

Bone biopsy for culture should be done and an infectious disease physician should consult on appropriate antibiotic therapy. Typical is 6-8 weeks of IV antibiotics for osteomyelitis. (KLD)

[SCI-Nurse]

The osteoyelitis shouldbe treated with antibioics. I know of a few people who have had their sacrums removed but honestly do not remember the circumstances. You might want to ask the physician about that.
ckf