A daughter's outrage

Agitated and restless, 77-year-old Jean Dwyer seemed distressed as she lay in her bed at a Norwell nursing home last fall, but, with a mind weakened by dementia, she was unable to explain what was wrong, her daughter said.

As Kathy Caulfield fretted by her mother's bedside nearly every day for a couple of weeks, she said doctors called in a hospice worker, who told her that Dwyer's organs were shutting down and that she was near death.

It wasn't until the nursing home sent Dwyer to South Shore Hospital's wound clinic on Oct. 19 that Caulfield said she discovered the true source of her mother's pain: a gaping wound on the elderly woman's ankle that left her bone and ligaments exposed.

"It was horrifying. . . . I had never seen anything like this in my life," said Caulfield, a third-grade teacher and mother of two from Hanover.

Dwyer's organs were not shutting down, but a raging infection from the sore had spread into her bloodstream and her right leg had to be amputated to save her life, Caulfield said.

"I could not believe the betrayal," she said.

Caulfield said she visited her mother nearly every day at the nursing home, but no one told her about the festering wound and she didn't see it because it was always covered by a sock or bedcovers. "Her Social Security was paying for these people to take care of her, and they're not."

Caulfield said she reviewed her mother's medical records after her mother's leg was amputated and discovered that the nursing home staff had falsely reported that they rotated her mother in her bed on days when Caulfield had been in the room visiting and knew no one had moved her.

A medical malpractice suit filed last week in Plymouth Superior Court on behalf of Dwyer accuses the nursing home, Southwood at Norwell Nursing Center, and two doctors, Perry R. Hearn and Veemal M. D'Souza, of "carelessness, unskillfulness, negligence, and improper care" that caused Dwyer to lose a limb.

In a separate case earlier this year, Hearn was accused by the US attorney's office of overcharging the Medicare and Medicaid programs between 2000 and August 2005 by allegedly sending bills that falsely asserted he had treated nursing home patients, when they had actually been treated by nurse practitioners or physician assistants on his staff. In January, he agreed to pay the government $150,000 to settle the allegations, without admitting liability.

Timothy M. Burke, a Needham lawyer who represents Dwyer, said he doesn't know whether any of the allegedly false bills submitted by Hearn involved Dwyer, but the suit accuses both Hearn and his associate, D'Souza, of failing to provide her with sufficient care.

"It's a tragedy, in the sense that you have somebody who was not just elderly but who was unable to speak, who was totally dependent on the staff at the nursing home," Burke said. "And, even with a family advocate there, it still wasn't enough to overcome the lack of attention that was obviously not paid her."

Southwood's administrator, Richard Starr, said he did not believe that Dwyer's ankle wound was neglected or mistreated at the nursing home and contended she suffered from circulatory problems. "It isn't unusual for someone with circulatory problems to have amputation," said Starr, declining to comment on the suit. The Starr family also runs the Queen Anne Nursing Home in Hingham and has been in the healthcare business since 1954, Richard Starr said.

But Caulfield said, "No doctor ever said that she had circulatory problems."

Bradley M. Henry, a lawyer with the Boston personal injury law firm Meehan, Boyle, Black & Bogdanow, said it's common for bed sores to develop into what is called decubitus ulcers. But he added: "Generally people receiving proper care should never progress to an ulcer down to the bone. They are the kind of wound that almost in and of itself are evidence of neglect."

Neither Hearn nor D'Souza, who have family medical practices in Carver and Norwell and are affiliated with South Shore Hospital, returned repeated calls from the Globe.

However, Richard C. Bardi, a lawyer who represented Hearn in the January settlement with the government, said that the case "had nothing to do with care and treatment he granted to his patients."

"He always provided quality care to all of his patients and is well regarded by his colleagues," Bardi said of Hearn. Bardi blamed the billing errors on Affiliated Professional Services, a Wareham-based company that submitted the bills on behalf of Hearn and paid the government $100,000 as part of the January settlement.

However, the company's lawyer, Mark Shub, insisted that Hearn and his staff were to blame for any errors.

Dwyer grew up in West Roxbury and raised her three children in Scituate. She lost her husband when the children were teenagers and worked full time as a secretary to put them all through college. Dwyer suffered a stroke at age 64 and never fully recovered. She had been working full time as a secretary at a South Boston printing company founded by her father until she was stricken.

After caring for her mother at home for years, Caulfield said she reluctantly put her in Southwood in 2003, when her worsening dementia required more care.

Since Dwyer's release from the hospital after her amputation, she has been living comfortably in another nursing home in Scituate and is able to get out of bed and sit in a wheelchair, Caulfield said. But, she added, her mother sometimes tries to stand up, unaware that she now has only one leg.