Inset: Judy Marsh (Michael Hill Trial Law). Background: The Ohio nursing home, Windsor House at Canfield, where Judy Marsh developed a fatal stage 4 pressure ulcer after staff allegedly neglected her (Google Maps).
An Ohio nursing home lied to the family of a 75-year-old woman about a "worsening" Stage 4 pressure ulcer that she later died from, documenting "consistently" how she had "no open areas" despite her muscles and bones being "exposed," a lawsuit says.
Staff at Windsor House at Canfield had been "encouraging" Judy Marsh, who was under a "required" two-hour turning and repositioning order, to turn and reposition herself in bed while "not actually turning her," along with refusing to change her soiled diapers, according to her family's legal complaint.
She had been placed in the facility in December 2024 following an 11-day hospital stay for pneumonia after her physicians recommended rehabilitation. "She had no pressure wounds on her body at that time," the complaint alleges.
By April 2025, Marsh was dead — with her demise being caused by "sepsis due to decubitus wounds" and E. coli in her pelvic bones, which were exposed by a Stage 4 pressure ulcer that led to osteomyelitis, a deadly and "difficult to treat infection" of the bone due to its exposure to the open air, the complaint says.
"Judy suffered from Multiple Sclerosis causing her to be generally weak, and Windsor House at Canfield documented she had very limited ability to reposition her body and needed assistance turning and repositioning," the complaint explains. "The treatment records show that Windsor House at Canfield relied on encouraging Judy to turn and reposition in bed … not actually turning her."
Before her death, staff at Windsor House allegedly failed to consistently follow the orders of Marsh's physicians and the wound care nurse. Additionally, nurses performed "wildly inaccurate skin observations and assessment," documenting that she had "no open areas" in spite of there being "large pressure wounds" on her buttocks — or not performing skin assessments at all, the complaint says.
"Windsor House at Canfield also continued to fail to timely change Judy's adult diapers when they were soiled, leaving her skin exposed to urine and feces which rested directly on the open wounds on her buttock, causing worsening breakdown," the complaint adds.
Marsh's wounds developed "leathery scab-like tissue" on top of them that deteriorated over time and led to the Stage 4 ulcer that "tunneled deep" into her buttocks and pelvis, exposing the bones of her sacrum and gluteal muscles.
"Windsor House at Canfield had been telling Judy's family that the pressure wound was improving with treatment when in fact, as can be seen from the photographs of the wound, it was steadily worsening to the point where it became a full-thickness Stage 4 pressure wound," the complaint concludes.
Marsh's family says she suffered a "continuous decline" until her death on April 6, 2025, including a refusal to eat and becoming "almost unarousable," per the complaint.
"This case reflects an avoidable and incomprehensible breakdown in basic care," said attorney Michael Hill, who represents the family, in a statement. "Our complaint alleges that a profit-driven business model led to chronic understaffing, and that Judy Marsh paid for that corporate decision with her life."
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