The research paid off in a rare result: In 2016, the jury issued a $30 million verdict for negligence, of which Mr. Denz and Mr. Bennett were personally liable for $20 million. The men’s own tax returns had bolstered the case against them. They claimed during trial they delegated daily responsibilities for residents to the home’s administrators, but they reported on their tax returns that they “actively” participated in the management. The jury did not find the nursing home responsible for her death later in 2009.

The appeal brought by Mr. Denz and Mr. Bennett challenges both the verdict and their inclusion. They argue that Tennessee courts should not have jurisdiction over them since they spent little time in the state and neither was involved in the daily operations of the home or in setting staffing levels. Their lawyers said jurors should never have heard from nurses who hadn’t cared directly for Mrs. Pierce.

“No way did I oversee resident care issues,” Mr. Bennett said in a deposition.

Deficient in the End

Whoever was responsible for Mrs. Pierce’s care, her family had no doubt it had been inadequate. Her son Bill Pierce was so horrified when he finally saw the wound on his mother’s foot, he immediately insisted that she go to the hospital.

Mrs. Hatfield said the surgeon had told the family that “he had never seen anything like it.”

“He amputated 60 percent of the leg, above the knee,” she said.

After the amputation, Mrs. Pierce returned to the nursing home because her family did not want to separate her from her husband, who was also there.

At the trial, the nursing home’s lawyers argued that Mrs. Pierce’s leg had deteriorated not because of the infection but because her blood vessels had become damaged from a decline in circulation. The jury was unpersuaded after nurses and aides testified about how Allenbrooke would add staffing for state inspections while the rest of the time their pleas for more support went unheeded.

Workers also testified that supervisors had told them to fill in blanks in medical records regardless of accuracy. One example: Allenbrooke’s records indicated that Mrs. Pierce had eaten a full meal the day after she died.