A SPECIALIST nurse told a fatal accident inquiry yesterday that she believed the death of a retired Ross-shire veterinary surgeon could have been avoided had she been hospitalised and treated sooner.
Distressing evidence has been heard at the inquiry at Dingwall Sheriff Court this week into the death of 87-year-old Jamesina Mackenzie, a resident at Wyvis House private care home in the town.
Delia Law, a specialist vascular nurse with NHS Highland was on holiday when a call to her was made by staff at Wyvis House about their concerns for Miss Mackenzie.
Miss Mackenzie died from an infection caused by pressure sores on May 31, 2009, in Invergordon's County Hospital, nine days after she was admitted.
Ms Law, who first examined Miss ?Mackenzie on May 8, was on leave when her condition deteriorated a week later and nursing staff at Wyvis House put in a call to her.
The inquiry at Dingwall Sheriff Court heard yesterday that when they couldn't contact Ms Law they contacted a local GP.
But Ms Law said doctors took the view that Miss Mackenzie was dying anyway and it was decided not to move her from Wyvis House.
Ms Law said when she examined Miss Mackenzie on May 8 she expected her to recover because the sores appeared to be healing.
But two weeks later, after being on leave, she said she did not recognise the patient because of the deterioration in her condition.
In evidence, she said when she examined Miss Mackenzie on May 8 she was able to put four fingers into a wound in her hip. She assessed her sores as "grade three" and she expected them to become a grade four and she explained that verbally to home staff. However, she did not put this in writing until her return to work on May 21 because of her heavy workload.
Ms Law said she contacted the home on May 20 to be told that Miss Mackenzie was "poorly" and that a GP was on the case and they felt it wasn't necessary for her to attend.
Ms Law said she didn't believe the staff were trying to conceal anything from her but when she went to examine Miss Mackenzie on May 22 she thought she had been taken to the wrong room because she didn't recognise the patient.
"I could see she had lost a lot of weight, was very gaunt, very unwell and was quite distressed," she said.
A sore on her hip had not been properly dressed and there was no dressing on another sore on her heel.
Ms Law told the inquiry on this visit she was greatly concerned by Miss Mackenzie's general condition.
"Her teeth were dirty, her lips were cracked and dry," she said. "She had no dressing on her heel and her hip was not properly dressed."
Ms Law said Miss Mackenzie's nappy was also sodden.
Ms Law said she believed if Miss Mackenzie had been admitted to hospital on May 15, given fluids and antibiotics intravenously she may well have recovered.
"By the 15th it should have been considered to put her into hospital," said told the inquiry. "I suspect it might have made a big difference whether she would have recovered or not. I find it surprising she was not admitted to hospital sooner."
Asked by Niall Ramsay solicitor for care home owners RDS Healthcare if it would surprise her that the decision was taken by doctors that "There was no point (putting her to hospital) because she was dying anyway".
Ms Law replied: "It may have been they felt she could not recover but I don't know that I would agree with that."
Miss Mackenzie, who was originally from Torridon in Wester Ross, was admitted to the hospital after being examined by Ms Law on May 22 but she died from infections to the bedsores on her body on May 31.
Asked by Mr Ramsay if she was understaffed Ms Law said she did need an assistant and had been quite vocal on this issue to her NHS employers.
But she said although GPs didn't have her level of expertise on such wounds they would recognise "when the wound is overwhelming a patient's condition".
Earlier this week the inquiry heard from consultant pathologist Rosalind Rankin that in most cases pressure sores were avoidable.
She had known of only two cases where bed sores had caused death in a career spanning over 30 years.
"If her sores had been treated earlier, this lady could have lived for many more years," said Ms Rankin.
Questions have also be raised about record keeping at the home.
Alison Britton (45), who was deputy manager at the home at the time of Miss Mackenzie's death, was unable to explain gaps in the records and the complete absence of a turning chart which she told the inquiry she implemented to ensure Miss Mackenzie was moved regularly to relieve pressure.
A trained nurse, she refuted suggestions that Miss Mackenzie's care was inadequate.
"That lady received the best care that staff could give," she told the hearing.
Miss Mackenzie's nephew Murdoch Macdonald (61), from Evanton, told the inquiry his aunt had worked abroad before moving to London then Perth then to the Highlands.
He said she was very lucid and mobile but she went into the home when she was no longer able to live independently.
He said he and his wife, a former hospital ward sister, became increasingly concerned about her health and asked for her to be moved to a local hospital.
"At first the request was refused because we were told my aunt was dying and it was better to leave her where she was," said Mr Macdonald.
"However, I wasn't happy with that and I asked another doctor strongly that she be moved to Invergordon."
The inquiry before Sheriff Alasdair MacFadyen continues.