After repeated demands to see mother’s bedsore, family horrified when nursing home reveals gangrenous, cantaloupe-sized hole on her back

WARNING: DISTURBING IMAGE INCLUDED BELOW
The smell of something putrid hung in Natalie Babineau’s nursing-home room.
Her daughter Noella noticed it first. She sniffed, and sniffed again.
“There’s a terrible odour from my mother,” she told the nurse. “What could it be?”
The nurse told her not to worry. “I’ll look after it,” she said.
One day later, around Nov. 21, 2002, another daughter, Martina, was dismayed by the strong odour. Like Noella, she asked the nurse what it could be. Again, she was told not to worry, that staff would check into it.
Medical records kept by the hospital that later treated Natalie show that on Nov. 21, staff at the nursing home noted a serious bedsore that was necrotic, meaning it was gangrenous.
For the next two weeks, the sisters tried to figure out the source of the smell. They worried that their mother, who was always able to go to the washroom on her own, had become incontinent.
They wanted to check for themselves, but Natalie always pushed them away.
Martina went to the nurses’ station and again told the staff, “We think that mom has soiled herself.” Over and over, the nurses told them not to worry, that they would look after everything.
After the two weeks passed, a nurse mentioned to Martina that her mother had a bedsore. She didn’t tell them it was serious, and Martina thought bedsores were relatively harmless spots on the skin.
“Can I see it?” Martina asked. The nurses refused, explaining: “We just put a seven-day bandage on it.”
Eventually, the staff told Martina her mother would no longer be allowed to sit upright in her wheelchair. She’s bedridden now, they said. They didn’t say why. Martina assumed it was because of Natalie’s overall decline since the summer, when her leg was accidentally broken by a young aide working in a training program. The nurses did bring in a special air mattress to help Natalie’s sore heal.
Geriatric-care experts have tracked four stages of deterioration in bedsores — pressure ulcers, as professionals call them.
Stage one is when the skin turns pinkish red, which can appear after a couple of hours. Stage two involves the start of an open wound. During stage three, the sore digs down to the fatty layer of the skin.
Stage four — and it can take several weeks to reach this point — occurs when the flesh eats through the muscles, down to the bone.
And in the very worst of cases, the late stages appear with an ugly companion — necrosis — commonly known as gangrene.
On Dec. 10, nearly three weeks after the smell first appeared, Martina came extra early for a visit with her mom. She found her sitting upright in a wheelchair, moaning and alone in the hallway. Exasperated, Martina corralled an aide in the hallway. “My mother is not supposed to be sitting up,” she said.
“I didn’t know that,” the aide said. Together, they lifted Natalie on to the bed. As Martina changed her into a nightgown, she noticed a large and bloody bandage on her lower back.
“I want to see what this is now,” she demanded. The aide brought back a nurse, who pulled back the dressing.
“Oh my God!” Martina gasped.
A gaping hole of angry red flesh lay at the bottom of her mother’s back.
Pus oozed from the opening, which was the size of a large cantaloupe. The inner flesh had been eaten down to her tailbone. It was black with gangrene.
Her body was rotting from the outside in. That was the reason for the smell.
“Take her to the hospital,” Martina said. “Take her now.”
The nurse refused. “Not unless the doctor orders it.”
The depth of her mother’s pain crystallized in Martina’s mind; a few minutes earlier, Natalie had been sitting in a wheelchair, on her raw, exposed tailbone. Martina sobbed, feeling guilty for not knowing. Then she remembered that for the past few weeks, her mother had complained about pain, motioning with her hand to her lower back. The daughters hadn’t understood the reason for her moans. They thought she was talking about pain in her hip, from an injury years ago.
She sat at her mother’s bedside that night and read aloud, tears rolling down her face. At the end of the night, she went to Noella’s house and wept with her over the kitchen table.
They decided to insist that Ridgeview take their mother to the hospital. The next morning before 8 a.m., the sisters were in her room, and this time the nursing staff agreed to call an ambulance. It was after lunch before the ambulance appeared.
At Henderson Hospital’s emergency room, the reaction was swift.
“How did this happen?” the doctors and nurses demanded.
“They did this to her at the nursing home,” Martina said.
The nurses hooked Natalie to intravenous tubes and fed her fluids because she was so dehydrated. They gave her morphine for the pain. Nurses said the smell of the wound meant it was badly infected. Martina recalled one of the hospital staff saying the ulcer had eaten past her mother’s tailbone and into her internal organs.
A social worker came to see the sisters. “The police will have to be called in,” she said.
“Go ahead,” they told her.
Officers from the Hamilton-Wentworth police department investigated. They did not lay charges against Ridgeview, based on the opinion of the geriatrician on shift.
Dr. Brian Misiaszek, a recent graduate of McMaster University’s medical school, told police he had heard of a new study that said it may be unfair to point fingers at nursing homes because some pressure ulcers can cause irreversible tissue damage within a few hours.
In his physician’s progress notes, dated Dec. 23, 2002, Misiaszek wrote: “Reviewing the timeline provided by the long-term-care facility in their thorough charting, it seems they followed the proper sequence for treating patient’s ulcer and do not believe that (Ridgeview’s) actions or lack of actions led to her current problem. Despite the dramatic appearance of her large and extensive ulcer, this is not unexpected even in the very best of long-term-care facilities.”
Misiaszek also noted that Natalie was not eating, describing her as “extremely emaciated.” His records show that the nursing home said she had lost nearly 10 pounds in three months.
Central Park Lodges, the owner of the home, says it has a nation-wide program that teaches staff how to prevent bedsores. “We must constantly guard against this potential risk,” spokesperson Mary Nestor says.
In Natalie’s case, “an investigation was undertaken to assist us in continuous quality improvement,” Nestor says.
Many experts in pressure ulcers across North America consider them to be a sign of neglect in nursing homes, brought on by malnutrition, dehydration, and a lack of bathing and repositioning.
In the hospital, Natalie’s children sat in a ring around her bed. Her youngest son, Andrew Jr., stayed quiet, his anger silently growing. Noella was still weak from leukemia, so it was Martina who spent hours in the hospital room, sometimes resting on a pillow borrowed from a nurse.
Martina watched her mother, remembering her as a widow in Hamilton, going to work as a maid, a cook or a fruit picker to make extra money for her children. Every Easter, Natalie bought her daughters new dresses and her sons fresh shirts, and they all walked to church together.
Before that, when they were very poor and living in New Brunswick, Natalie read to her children each night from the only book she owned, a true romance novel. She sewed frilly dresses for Martina’s older sisters out of cotton flour bags, and she scrubbed her laundry to a pristine shade of white in water taken from the creek.
Natalie died on Dec. 24, 2002. She vomited black blood a day earlier and passed away overnight.
After they got the call from the hospital, Martina and her sister rushed to their mother’s room. She was wrapped in a white plastic sheet, her arms tied together. Martina pulled her out of the bindings.
They stroked her hair, said goodbye and told her they were sorry.
Ridgeview Long Term Care Centre never apologized.
Natalie’s records were sent to compliance officers at the Ministry of Health for a review.
In the ministry’s complaint records, Natalie Babineau’s neglect and death were summed up in one line: “Resident was hospitalized for an ulcer — police investigated the complaint.”
The ministry decided it was unable to verify whether the complaint was accurate. It made that decision without ever talking to Natalie’s family.
WHAT CENTRAL PARK SAYS
Natalie Babineau received care from two nursing homes, both owned by Central Park Lodges. The Star approached the company one month ago and in a telephone interview with chief spokesperson Mary Nestor detailed allegations raised by Babineau’s family. Nestor answered questions by letter and in a telephone interview:
THE BIG PICTURE
Natalie Babineau was one of 65,000 elderly people in Ontario’s 544 nursing homes. There is no minimum standard of care in Ontario homes. The regulation requiring 2.25 hours of care per day was dropped in 1996.
A Star investigation reveals:
A sampling of problems flagged in inspection reports: