The deterioration of an elderly person's bedsores after discharge
By Zhang Shuang, reporter at the Li Case Investigation Studio, with graphics by Zhou Jianwen
Severe Condition
At 9:30 on the second day, Wu Bing came to visit her mother and found that she was lying in bed unlike before when she could move freely. She quickly sent her mother to a nearby Chinese medicine hospital where she was diagnosed with a femur fracture. Subsequently, Tan Shulan was transferred to Chaoyang Hospital for surgery.
The verdict saw a new change. In May 2011, after deliberation, Daxing Court believed that Wanming Hospital had failed to fulfill its obligation to keep medical records, and the missing medical records led to the inability to determine the hospital’s fault; therefore, it should bear corresponding damages compensation responsibility. The court ruled that Wanming Hospital should compensate the three siblings of the Wu family with over 220,000 yuan. The appeal court upheld the original verdict.
After much discussion, the three siblings decided to send their mother to a nursing home. Wu Bing knew that both of her brothers were unwell—her elder brother had cancer, and her second brother suffered from lumbar disc herniation and needed financial aid while recuperating at home. "If it weren't for the nanny going back home, I wouldn't have thought of sending my mom away," Wu Bing said.
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Six days later, Wanming Hospital notified the family to transfer Tan Shulan to Chaoyang Hospital for treatment and prepaid 5,000 yuan for medical expenses.
She also visited Songtang Care Hospital near Shuangqiao in Chaoyang District and compared Wanming Hospital online. "From the website, Wanming's environment looked particularly good, like the back garden of the Forbidden City."
Although she could walk normally, her mind became increasingly confused. Her daughter, upon returning home from work, discovered that her mother always smeared excrement everywhere, even though there was always a nanny taking care of her at home. Moreover, her mother had gone missing a few times.
In September 2011, out of the 17 lost pages of medical records, 16 had been recovered. Zheng Jilong was reluctant to disclose how the medical records were lost.
After 2002, Tan Shulan developed Alzheimer's disease. At first, her daughter Wu Bing noticed that her mother just had some memory loss. Gradually, Tan Shulan no longer recognized her husband, mistaking him for a stranger. "How can you live here? I'm not married yet," Tan Shulan's words made her husband laugh and cry.
"I heard from one of the hospital staff that they are discussing revising the medical records. We're afraid they might tamper with them." Wu Bing said.
"Since 2005, we have been operating under debt, and the hospital has been struggling to stay afloat. There is indeed no property available for execution," Zheng Jilong told the judge about his difficulties. Weibo Recommendation | Today's Hot Topics on Weibo
From time to time, Wu Bing would visit her mother. Once, she wanted to wipe her mother's face and asked the nurse Zhang Da-jie where the towel was. "She pointed to a random towel which was extremely dirty. I cried while washing it in the bathroom," Wu Bing said unhappily.
Half a month later, Wu Bing sent her mother over.
Wu Bing was also dissatisfied with another matter: "I paid for the standard of one-to-two nursing care, but the nurse actually did the work of one-to-four nursing care. The two elderly people next door who required nasogastric feeding were also taken care of by Zhang Da-jie."
Room 208 at Wanming Hospital, the window outside was covered with an iron guardrail net. Dean Zheng Jilong said that this was the only room in the entire hospital with a guardrail, specifically installed for Tan Shulan.
"At the hospital, we feared she might climb out of the window," Zheng Jilong said, noting that from the day she was admitted, Tan Shulan was in a "crazy" state.
On October 24, 2009, Tan Shulan was admitted to Wanming Hospital, sharing a ward with a paralyzed Ms. Guo and being cared for by Nurse Zhang Da-jie. The fee for one-to-two nursing care was 1,900 yuan per month, plus a food allowance of 405 yuan.
At Chaoyang Hospital, Tan Shulan was diagnosed with Alzheimer's disease, urinary tract infection, hypoalbuminemia. During her bedridden period, a 3x3 cm-sized pressure sore developed on her sacrum (a chronic ulcerative condition caused by prolonged pressure and friction).
The hospital faced a financial shortage dilemma.
The enforcement judge was caught between a rock and a hard place: on one hand, the family needed compensation, while on the other, the hospital, operating under debt, faced the risk of closure, potentially leaving dozens of elderly people and children without care.
On January 25, Tan Shulan was transferred from Chaoyang Hospital to the Beijing Armed Police General Hospital. She was diagnosed with multiple pressure sores and infections, cachexia, hypoalbuminemia, Alzheimer's disease, urinary tract infection, diabetes, and various other conditions.
"We fear she might climb out of the window," Zheng Jilong said, stating that since the day she was admitted, Tan Shulan had been in a "confused" state.
In 2006, Tan Shulan's husband passed away, and her condition gradually worsened, losing her ability to speak and communicate with her family.
Because the medical records played a crucial role in the two trials, having recovered most of the original medical records, Zheng Jilong recently filed an appeal to the Beijing Higher People's Court. "No matter what, the hospital must continue," he said.
There were more than 40 elderly people and children nearing the end of their lives residing in the hospital, facing the potential of being left uncared for...
"I don't understand what a hospice care hospital is. When others ask, I always say my mom is in a nursing home," said 44-year-old Ms. Wu Bing to the reporter from the Li Case Investigation Studio.
Litigation Triggered
Two years ago, Wu Bing sent her 73-year-old mother, Tan Shulan, to a hospice care hospital—Beijing Wanming Hospital.
Zheng Jilong claimed that the hospital never altered the medical records. To demonstrate the authenticity of the records, he allowed the family to review each page, sign them, and seal them with a sticker.
The three siblings sued the mother to Daxing Court on grounds of inadequate care, resulting in a judgment against Wanming Hospital for over 220,000 yuan in compensation.
However, Wanming Hospital argued that as a hospice care hospital, patients entering the facility were all in the late stages of life. The hospital only provided care and did not offer medical treatment. Tan Shulan's death was attributed to her own physical condition and the progression of her illness.
Family Dissatisfaction
She didn’t expect that within less than five months, her mother suffering from Alzheimer's experienced falling and fracturing, becoming bedridden, developing decubitus ulcers, and then painfully passing away.
The hospital informed her that her mother's decubitus ulcers had already scabbed over, shrinking in size, and recovery was imminent. Wu Bing believed this to be true.
In 2006, Tan Shulan's husband passed away, and her condition gradually worsened, losing her ability to speak and communicate with her family.
Medical Record Loss Leading to Compensation of 220,000 Yuan
Wu Bing believed that the hospital did not fulfill the promises outlined in the agreement but did not raise objections with the hospital administration. "What's the use of arguing with them?" she believed the hospital would not admit any responsibility.
The family awaited compensation, but as a private hospice care hospital, Wanming Hospital operated under debt, putting this lawsuit at risk of closing the facility.
On the night of November 30, 2009, the nurse had fallen asleep, and Tan Shulan got up alone, slowly moving her legs to stand. A stumble caused her to fall and sit directly on the ground.
When Nurse Zhang woke up, she found the elderly woman sitting on the floor and carried her back to bed without reporting it to the hospital.
This news also reached Wu Bing's ears. "There are serious issues with the hospital's medical records. Even if they find them, who would dare send their elderly relatives there?" Wu Bing consistently suspected that her mother's medical records had been altered.
Wanming Hospital's Dean Zheng Jilong did not expect such a verdict.
Daxing Court's Enforcement Division Judge discovered that Wanming Hospital had no fixed assets. "The hospital account balance was only in the single digits," explained presiding judge Zhao Zhiyong.
In July 2010, the court deemed that Wanming Hospital bore a 30% secondary responsibility in terms of nursing and sentenced Wanming Hospital to pay Wu Bing and her two siblings over 40,000 yuan in compensation. Subsequently, both parties appealed, leading to the First Intermediate People's Court remanding the case back to Daxing Court for retrial.
At this point, 17 out of the 19 pages of Tan Shulan's medical records had mysteriously disappeared, leaving Wanming Hospital able to submit only 2 pages of medical record originals to the court.
Subsequently, Wu Bing and her two brothers sued Wanming Hospital in court, believing it failed to meet its nursing obligations, ultimately leading to Tan Shulan's death, demanding compensation for various losses.
Tan Shulan could no longer wander around as she used to and could only lie in bed all day. To control the decubitus ulcers, she needed to be turned every two hours.
"This situation, we once suggested her daughter opt for one-on-one nursing care, but her daughter did not agree," said Assistant Dean Ou Yangyanfei.
The Situation of the Mother's Illness
"When the medical records were lost, we reported it immediately. I sent text messages to several people who had access to the medical records, urging them to return them promptly," said Zheng Jilong.
On January 17, 2010, during the nurse's attempt to turn Tan Shulan over, the scabbed skin suddenly ruptured, oozing pus. The flesh inside the wound had rotted, worsening her decubitus ulcers.
Tan Shulan was unable to move around as she used to and could only lie in bed all day. To control the decubitus ulcers, she needed to be turned every two hours.
"To address this issue, the hospital does bear some responsibility. To comfort the family, we promptly arranged for a vehicle to take the elderly woman to a third-party hospital for examination and prepaid 20,000 yuan for treatment costs. Additionally, we assigned a nurse to assist in caring for her," said Dean Zheng Jilong.
On the morning of January 29, 2010, Zheng Jilong recalled that Wu Bing and three family members arrived "fiercely" at Wanming Hospital, demanding he hand over Tan Shulan's medical records.
Beijing native Tan Shulan and her husband raised three children. She and her husband lived together with their youngest daughter.
She consulted Dongfang Comprehensive Nursing Home, with monthly fees exceeding 4,000 yuan, but the nursing home was uncertain whether they would accept her. "To be honest, many nursing homes do not accept patients with Alzheimer's disease. My mother's retirement pension was over 2,000 yuan. If the cost was too high, it would be a heavy burden for all three of us," Wu Bing said.
She went to Wanming Hospital with her sister-in-law and was satisfied with the hospital's conditions. "We chose it because the nurses lived with the elderly, nurses checked rooms daily, and doctors made rounds every few hours."
"Under such circumstances, we once suggested her daughter opt for one-on-one nursing care, but her daughter did not agree," said Ou Yangyanfei.
Daxing Hongmen Town Wanming Hospital, the bed by the window in Room 208 remained empty. The 74-year-old Tan Shulan spent her final days on this bed.
Elderly Person Sustains Fracture After Falling at Midnight
On December 21, 2009, Tan Shulan was discharged from Chaoyang Hospital and sent back to Wanming Hospital by her daughter.
To care for her mother, Wu Bing hired many nannies. In 2009, due to the nanny resigning and returning home, Wu Bing thought that hiring another nanny wouldn't give her peace of mind, so she discussed her mother's future care arrangements with her two brothers.
She handed a box of decubitus ulcer patches she bought from Chaoyang Hospital to the nurse, instructing her to use one patch daily.
"The doctors at Chaoyang Hospital all said, 'This is clearly due to neglect.' The nursing department definitely did not turn her over on schedule or clean her properly; otherwise, it wouldn't have deteriorated to the point where the decubitus ulcer reached the bone in less than a month." Wu Bing felt immense pain seeing her mother's wounds as large as a bowl.
The elderly person lying in bed was tormented by pain, emitting only wailing sounds.
On March 7, at the Armed Police General Hospital, Tan Shulan stopped breathing due to heart and kidney failure.