The daughters of an elderly man who died of a severe infection last month in Langley, B.C., believe inadequate care by overworked staff at his publicly run care home contributed to his painful death.
"This health system is in total collapse as far as I'm concerned," said Elaine Walton. "He was a casualty. He was collateral damage."
"That's not the way we are supposed to die," added her sister, Barb Carlson. "We are in a civilized country."
Their father, Fred Porteous, 93, lived in Maple Hill, a long-term care facility adjacent to Langley Memorial Hospital. He had poor circulation due to diabetes, leaving him particularly susceptible to infection in his extremities.
In the spring, his daughters noticed he had a sore on his toes.
"They didn't even bandage it, and both Elaine and I had told them several times this is not good health care," Carlson said. "It just got progressively worse and worse."
Not enough qualified staff: family
They said their father was looked after by care aides but seldom by nursing staff.
"They [care aides] are burnt out. And this is tough on them, too, I know it is," Walton said. "They are being stretched beyond their limits."
The sisters said they pushed staff constantly to keep a fresh dressing on their father's sore. Carlson said she even complained to the manager on site.
"That person in charge stated, 'I promise you, Barb, things will get better. Several neglectful situations have been overlooked and I apologize,'" Carlson recalled.
To put the manager's statement to the test, Carlson said, she wrote her initials — B.C. — on the bottom of her father's bandage. Two days later, her initials were still there, she said.
To complicate matters, she said, Porteous often refused to take antibiotic pills.
Carlson said a consulting physician suggested her father's infection should be treated intravenously, but the manager told her that couldn't be done at Maple Hill because none of the staff is qualified to handle the procedure.
The Fraser Health Authority, which runs the facility, confirmed nurses don't administer IVs there because it is a specialized skill set not often needed in long-term care.
Gangrene set in
"His pain was absolutely atrocious," Carlson said. "He was in agony."
At one point, Walton said, she lifted her father's bandage and was shocked to find his whole foot had turned black from gangrene.
She said she urged staff to take her father to Langley Memorial hospital, which is in the same complex, but she said they told her there wasn't enough staff to do that either. So Walton and Carlson took their father to the emergency room themselves.
"The two doctors that were on call in the emergency ward both said, 'Where did this gentleman come from?' and we said 'Maple Hill, across the street' and [one doctor] said, 'My gosh, why is this the first time we have seen him?' "
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Dr. Michael McBryde, medical director of Fraser Health's residential and assisted living program, was not involved directly and said he couldn't go into detail about the case. However, he said Porteous was frail and elderly, and his underlying diabetes and poor circulation made infection very difficult to treat.
"There are situations — and this one that you are referring to would be one — where really there is no further treatment that is going to be curative or even that is going to prolong life," McBryde said.
In the emergency room, Carlson said, her father was given intravenous antibiotics but that treatment lasted only a few days. Back at Maple Hill, his condition deteriorated again. A care aide hired by the family took Porteous back to the ER in October, Carlson said, but he died soon afterward.
McBryde confirmed infection from the spread of gangrene was the cause.
"I really want to extend my sympathies and condolences to the family, because I know that what they are going through at the moment is really, really tough," McBryde said.
Carlson said doctors at the hospital told her amputation could have prolonged her dad's life, and alleviated his suffering if he had been treated sooner.
"If he had arrived in the early beginnings when there were just little sores they could have amputated the toes, but because of the long delay nothing was done," Carlson said.
Health authority sees no wrongdoing
McBryde insisted the health authority did nothing wrong. He said amputation could have also increased the elderly man's suffering.
"I really don't think there is anything that could have been done different than what was done in this situation that would have made a material difference," McBryde said. "Amputation carries with it risks, and so there is a risk that if you amputate the person may not survive the procedure."
Carlson and Walton aren't buying that explanation. They believe inadequate staffing levels and qualifications at Maple Hill caused their father to suffer needlessly.
"It seems kind of like a lackadaisical to say, 'Oh well, he's diabetic and maybe he'll get gangrene in his foot,' " Walton said. "Gangrene! Can you imagine? In our day and age, in a hospital. Why did he have to die like that?"
McBryde said Fraser Health is increasing direct staff time with patients in all long-term care facilities by 15 per cent starting in January.
"We feel that the mix that we are introducing will produce a better level of care than we have experienced to date," McBryde said. "And we are committed to continue to increase those direct care hours throughout the next two years."
Care time to increase
Patients will get more one-on-one care time from care aides and licensed practical nurses, McBryde said, and less from registered nurses: "There's very good evidence that the more direct-care hours that you give the better the care is."
Documents from the B.C. Nurses Union show RN staff levels will be cut by more than half at Maple Hill, where Porteous died. With fewer nurses watching, union president Debra McPherson predicted, patients like Porteous will be more even vulnerable.
"When complications are setting in, the registered nurses are not having enough contact with the patients to rescue them from what could be fatal complications and that will get worse," McPherson said.
At one facility in the Lower Mainland, McPherson said, a single nurse is responsible for four floors of patients.
"I think we are now starting to see what nurses predicted would happen, and that is that we are seeing an increase in adverse events."
Carlson said she expected the health authority would not see any wrongdoing in her father's case, but she plans to file a formal complaint nevertheless.
"I think I should have spoken up and yelled sooner," Carlson said. "We didn't want to put dad's care in jeopardy by having the staff mad at us. Now, we couldn't care less if they are mad at us."