Scabies and freak hoist accident

A Tauranga rest home is under fire over the separate deaths of two former residents.
The son and daughter of 100-year-old Eileen "Anne" Harper say their mother lived with undiagnosed scabies for several months while she was a resident at Cedar Manor.
Mrs Harper died in September of secondary infections including cellulitis, an eye infection and pneumonia, after being discharged from Tauranga Hospital to another rest home.
In February, Lilian "Lu" Wilson, 87, died three days after a hoist used to carry her between her bed and wheelchair gave way at Cedar Manor on February 12.
Mrs Wilson's distraught family say she received a "horrific head injury" in her fall to the floor, as well as "massive bruising" to her left arm after the hoist's arm fell on top of her.
The families of both women have this week spoken out, saying they are still desperate to know how the tragedies could have happened.
The rest home defends its actions in both cases.
Philippa Bailey and Geoff Harper, Mrs Harper's daughter and son, are demanding answers.
Anne Harper moved into Cedar Manor about nine months ago from an assisted living facility, where she was getting care that included seven showers a week and was assisted with food and other needs.
After only a few weeks at the new home, the family say they became worried about its standard of hygiene and care, which Mr Harper felt was "vastly lower than what we had anticipated".
They eventually took their concerns to the Health and Disability Commissioner at the beginning of June, who referred the matter to the Bay of Plenty District Health Board to carry out an "issues-based audit".
But the DHB found that besides some identified "corrective actions", no further action was required.
Mr Harper questions this conclusion, given Mrs Harper was living with undiagnosed scabies during the time.
After several months at Cedar Manor, Anne Harper was admitted to Tauranga Hospital in early September, where it took eight days before a specialist dermatologist confirmed "diffuse crusted scabies".
She was treated with insecticide cream, and with antibiotics and antifungals, and then discharged to a Level 5 care rest home, where she died three days later.
"She was writhing in pain on her hospital bed, scratching at the undiagnosed scabies rash, in the end drawing blood," Mr Harper said.
"They had to put stockings around her hands to stop her from scratching. It was all avoidable.
"If she had been diagnosed months earlier and treated she'd still be with us."
The Harpers were also frustrated they did not receive the findings of the audit until last month, by which time Anne Harper had died.
In the case of Mrs Wilson, the incident occurred when an attachment on the hoist gave way.
"For many years I have cared for my mother, keeping her safe and tending to her daily to give her comfort in her ageing years," daughter Janice Warren said.
"We had three days at Tauranga Hospital where she died never regaining consciousness and never had a chance to say goodbye.
"I just find it so soul-destroying that I just want some closure."
Cedar Manor owner Bupa Care Services has defended its actions in the cases of both Mrs Wilson and Mrs Harper. In Mrs Harper's case, Bupa's quality and risk general manager Gina Langlands said Cedar Manor staff had "bent over backwards to try and resolve the concerns of this family and we were unable to do that".
She pointed out that in terms of treatment of Mrs Harper's persistent rash, staff were following the diagnosis of Grover's disease by Dr Neil Matson, the GP looking after her.
Dr Matson admitted to the delay in diagnosis.
"A dermatology referral was a possibility in private as the next option, as there is significant delay at hospital clinics," he said.
"Certainly I did briefly discuss with nurses that an option may be a trial of treatment for scabies. This condition can be difficult to diagnose but is easier to consider in retrospect.
"Scabies obviously has 'hygiene' considerations and perhaps subconsciously we underdiagnose initially."
The DHB said it was "normal" that Mrs Harper had to wait eight days to see a dermatologist at the hospital, and that her discharge summary showed she was in good shape.
But the Harpers remain unhappy, especially because they had asked Cedar Manor staff early on to rule out scabies.
Shortly after Mrs Harper's death the medical officer of health got in touch with Cedar Manor to advise that the rest home did indeed have scabies.
One resident was found to be infected and all staff and residents in the wing were given treatment on September 29 as a precautionary measure.
The family - several of whom also had to be treated - have made a fresh complaint to the commissioner with new information.
Bupa Care Services chief executive Dwayne Crombie rejected the suggestion that Mrs Harper "died of scabies"; "We simply can't accept that."
In the case of Mrs Wilson, the Department of Labour has investigated and forwarded its report to the coroner, who is still awaiting more evidence.
The department would not comment further to the Bay of Plenty Times.
Mr Crombie said staff at the home had followed the proper processes.
He said the hoist, which had a weighing scale attached, was provided by Active Rehabilitation Equipment and was already being used at the home before Bupa took over in 2007.
Another firm, BV Medical Limited, which Bupa contracted to inspect equipment, did not find anything wrong with the hoist when the company checked it last November.
After the incident Bupa located three more of the hoists among its other homes and took them out of circulation, and has also notified the DHB about them.
BV Medical Limited director Graeme Dixon said: "We were extremely concerned that it happened, and we conducted our own investigation, even though it wasn't our place to."
Active Rehabilitation Equipment refused to comment.
While the DHB did not conduct its own investigation, it did stay in close contact with Bupa and was "comfortable with the outcome of the reports", DHB planning and funding general manager Helen Mason said.
"We are confident that Cedar Manor acted appropriately and in a timely manner in regard to this tragic incident."
Since the tragedy, Cedar Manor had undergone two separate audits, which had independently shown the home was meeting appropriate standards of care.
Cedar Manor will this month again be audited against the Health and Disability Services Standards as a Ministry of Health requirement.
Mr Crombie said feedback from residents was overall positive, and he had no concerns about the level of care Cedar Manor was providing.
"If I wasn't, I'd say so. I think Cedar Manor has had a great reputation for many years."
In respect of Mrs Wilson's fall, Mr Crombie said: "Unfortunately, this happened.
"The family has a lot of reasons to be sad and unhappy, and I totally understand."
Mrs Wilson's daughter, Mrs Warren, said the Department of Labour had assured her that "changes have been made to the hoists".
"No consolation and no prosecution ... another misfortunate tragedy regarding elderly."