Medical malpractice trial continues with testimony of geriatrics doctor

A California doctor specializing in geriatrics testified for the plaintiff’s in a medical malpractice trial at Philadelphia Common Pleas Court Wednesday, saying he believes a now-deceased man’s death could be directly attributed to the care he received at various area medical facilities.

The medical professional, Loren Lipson, said based upon his research, Marcel Mackey, Sr. did not receive appropriate care at the Willow Terrace nursing home, nor at Albert Einstein Medical Center and St. Agnes Continuing Care Center.

The medical facilities were named as defendants in a lawsuit filed in 2009 by Philadelphian Camay Williams, the grown daughter of Mackey, who passed away in May 2008. It took two years for the case to come to trial.

The lawsuit alleged that Mackey developed pressure ulcers as a result of not being properly turned and repositioned while under the care of the defendants.

In court Wednesday, Lipson read aloud from an exhibit that was introduced by the plaintiff’s, and which was identified as Mackey’s death certificate.

Under the direction of plaintiff’s attorney Pete Giglione, of the firm Wilkes & McHugh, which is representing Williams, who is in charge of Mackey’s estate, Lipson said Mackey’s official causes of death were “severe/end-stage ulcers,” skin breakdown, sepsis and “failure to thrive.”

“In my opinion, the care given … was woefully below the [acceptable] standard of care,” Lipson told the 12-member jury and Philadelphia Common Pleas Court Judge Ricardo Jackson.

According to Mackey’s various medical charts, the former patient did not receive the appropriate number of repositionings and range-of-motion exercises, he did not receive the proper care related to his catheterization and he didn’t seem to get to get regular bathing’s, nor did he receive optimal nutrition.

Mackey did have diabetes from the get-go, even before he was originally admitted to the hospital with a stroke, but Lipson said Mackey’s diabetes would have only prevented his pressure ulcers from healing properly; they wouldn’t have caused the ulcers directly.

The ulcers, Lipson said, developed while Mackey was recovering at the Willow Terrace nursing home.

“As time went on … the ulcer kept increasing in size,” Lipson testified. “The wounds were so big and open to the atmosphere and [open to] constant fecal contamination.”

The testimony painted a picture of widespread failure on the part of nurses at Willow Terrace and St. Agnes, as well as medical professionals at Albert Einstein Medical Center to properly diagnose and treat Mackey, who was nonverbal because of his earlier stroke.

Lipson said Mackey would have been able to feel pain, and while he wouldn’t have been able to verbally tell the doctors he was hurting, he could have made movements to indicate the presence of pain.

“There was not adequate planning to prevent getting worse pressure ulcers,” Lipson testified.

The day’s questioning began with Giglione asking Lipson whether medical charts indicated Mackey was receiving the appropriate level of care for a man in his condition.

“Given the fact that he had significant skin breakdown in two areas, he needed to be observed closely,” Lipson said.

But, according to medical records, Mackey did not receive that proper care, Lipson said. The patient’s catheter was not changed on a regular basis, the witness said. And Mackey didn’t seem to be bathed regularly.

Lipson said records show that Mackey eventually developed a penile wound that was caused by “catheter erosion” over time.

“It was a situation of pressure and irritation, if you will,” Lipson said on the stand.

Lipson also said some of Mackey’s tissues were “so damaged,” that they were unable to be stitched closed properly, leading to more complications.

In hindsight, some measures could have been taken to offer Mackey adequate pressure relief, Lipson said, so to ensure that the patient’s ulcers would have been minimal or prevented all together.

These include having a proper bed that could offer better comfort and relief, and turning and repositioning the patient on a more frequent basis.

“In addition, that hygiene be meticulously carried out,” the doctor added.

Of course, proper fluid and hydration would have helped Mackey as well, she said.

“These are the classic things that keep skin breakdown from occurring,” Lipson said.

The trial continues.