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Breech Of Standard Of Care

Been the victim of Medical Malpractice or fighting a malpractice suit? Discuss it here.

Breech Of Standard Of Care

Postby Humph » Fri Nov 25, 2016 5:28 pm

5 months ago my husband fell off ladder at home and had tibial plateau fracture.  Orthopedic surgeon did open reduction with internal fixation the next morning in the OR. In the ER she informed us of the type of injury and said this is a bad break. We are 60 miles away from Birmingham AL, a city with very good medical care and several well known orthopedic surgeons.  I asked her if this type of surgery was within her scope of experience.  She said yes.  I asked her if she felt confident it was within her ability to manage.  She said yes. I asked how she would address the risk of embolism which is known to be a concern with orthopedic surgery. She said she would start anticoagulation therapy after surgery.  She did not.  I asked her about this again after surgery but she did not order this for him.  He was on bed rest for 6 days following 3.5 hr orthopedic surgery with a turnoquet in place.  She discharged him from the hospital.  Our internist happened to stop by and ordered ultrasound to check for deep vien thrombosis.  The found 2 important leg viens completely occluded with a diagnosis of DVT. He stayed in the hospital 2 more days to begin anticoagulation therapy.  We saw the surgeon in her office monthly to take xrays and evaluate healing of the fracture. Each visit she took xrays and said that everything was fine.  After 5 months he has a lot of pain, a disfigured leg that is bowed, he walks with 2 canes, has a very pronounced limp, and can barely bear weight on the operative leg.  He is an OR instrument sales rep.  One of the orthopedic surgeons saw him in the OR in Birmingham.  The Dr commented that my husband did not look like he was progressing well after his accident.  He offered to take xrays which were done on the spot.  He said "this is a train wreck" and began to point out the problems he saw on xray.  He asked for the xrays from the hospital and her office visits.  We provided this.  He consulted with us and showed us that each visit in her office showed by xray the progression of what is now non union.  He was suspicious of a dark shadowy looking area where the compression fracture is located.  He said it looks necrotic.  He did an aspiration of fluid from that area and the path report came back with a serious infection.  We are awaiting the 2nd path report to confirm the first following an additional knee aspiration 1 week later. We have not gone back to our original orthopedic surgeon.  The new surgeon says that my husband will need to have surgery for complete revision of the first surgery which was done 5 months ago and will also need total knee replacment. This should be done right away.  But the presence of infection must be addressed first.  It will require extensive medical(iv antibiotics) and surgical(OR debridement of the tibial plateau and all affected areas)with possible gangrene and also possible amputation to prevent organ failure.  My husband was off for 3 months short term disability after his initial surgery.  He was unable to bear weight for 3 months.  He has been back to work for 2 months but is finding he is not able to carry trays of instruments, catalogs, etc into the OR which is a key part of his job.  He is not able to stand and participate in the cases during evaluations of his instruments.  He is 62 years old and will possible go on long term disability with his company in order to get the additonal treatment for the infection and the "train wreck" repair done by the first orthopedic surgeon.  From what we know now, would a mal practice atty take this case.  Best case scenario is additional surgery, treatment is successful and he has recovery of 6 months with lost income during that period and unknown residual impairment.  Worst case is extensive medical surgical treatment, no insurance due to loss of employment, amputation of leg. I have had concerns from the beginning that she did not deliver the standard of care and that this caused him harm.  Now it appears she failed to detect the non union and lack of healing on his post op office xrays and the evidence of a problem with infection.

ANSWER: And the question is, do you have a malpractice case?
Humph
 
Posts: 42
Joined: Fri Feb 28, 2014 2:04 am

Breech Of Standard Of Care

Postby Chayne » Sun Nov 27, 2016 1:31 am

Two important items of advice.  Firstly, when he sees that new ortho, try to get as much info a possible re the reasons for the poor surgical result but don't give the doc the idea that you are thinking about a lawsuit. He will probably clam up. Just say you don't understand what happened. Could the surgeon have handled it differently? Shy away from tipping him that you are not only looking for solution to the medical problem but also someone to help in your futurue lawsuit.

Next, I don't buy what that lawyer told you. He is just looking for an excuse to not take the case. He should have been honest and say that for the work and cost involved, it wasn't worth it to him.  So shop for other lawyers. Miss. is well known as a good place for plaintiffs and I don't know why AL wouldn't also. Lots of big plaintiffs cases in the deep south but maybe the pendulum has turned, people are generally soured on lawsuits, I don't know. But keep looking. That atty certainly isn't the last word on the subject.
Chayne
 
Posts: 44
Joined: Mon Mar 17, 2014 7:08 pm

Breech Of Standard Of Care

Postby Boine » Thu Dec 01, 2016 8:40 am

5 months ago my husband fell off ladder at home and had tibial plateau fracture.  Orthopedic surgeon did open reduction with internal fixation the next morning in the OR. In the ER she informed us of the type of injury and said this is a bad break. We are 60 miles away from Birmingham AL, a city with very good medical care and several well known orthopedic surgeons.  I asked her if this type of surgery was within her scope of experience.  She said yes.  I asked her if she felt confident it was within her ability to manage.  She said yes. I asked how she would address the risk of embolism which is known to be a concern with orthopedic surgery. She said she would start anticoagulation therapy after surgery.  She did not.  I asked her about this again after surgery but she did not order this for him.  He was on bed rest for 6 days following 3.5 hr orthopedic surgery with a turnoquet in place.  She discharged him from the hospital.  Our internist happened to stop by and ordered ultrasound to check for deep vien thrombosis.  The found 2 important leg viens completely occluded with a diagnosis of DVT. He stayed in the hospital 2 more days to begin anticoagulation therapy.  We saw the surgeon in her office monthly to take xrays and evaluate healing of the fracture. Each visit she took xrays and said that everything was fine.  After 5 months he has a lot of pain, a disfigured leg that is bowed, he walks with 2 canes, has a very pronounced limp, and can barely bear weight on the operative leg.  He is an OR instrument sales rep.  One of the orthopedic surgeons saw him in the OR in Birmingham.  The Dr commented that my husband did not look like he was progressing well after his accident.  He offered to take xrays which were done on the spot.  He said "this is a train wreck" and began to point out the problems he saw on xray.  He asked for the xrays from the hospital and her office visits.  We provided this.  He consulted with us and showed us that each visit in her office showed by xray the progression of what is now non union.  He was suspicious of a dark shadowy looking area where the compression fracture is located.  He said it looks necrotic.  He did an aspiration of fluid from that area and the path report came back with a serious infection.  We are awaiting the 2nd path report to confirm the first following an additional knee aspiration 1 week later. We have not gone back to our original orthopedic surgeon.  The new surgeon says that my husband will need to have surgery for complete revision of the first surgery which was done 5 months ago and will also need total knee replacment. This should be done right away.  But the presence of infection must be addressed first.  It will require extensive medical(iv antibiotics) and surgical(OR debridement of the tibial plateau and all affected areas)with possible gangrene and also possible amputation to prevent organ failure.  My husband was off for 3 months short term disability after his initial surgery.  He was unable to bear weight for 3 months.  He has been back to work for 2 months but is finding he is not able to carry trays of instruments, catalogs, etc into the OR which is a key part of his job.  He is not able to stand and participate in the cases during evaluations of his instruments.  He is 62 years old and will possible go on long term disability with his company in order to get the additonal treatment for the infection and the "train wreck" repair done by the first orthopedic surgeon.  From what we know now, would a mal practice atty take this case.  Best case scenario is additional surgery, treatment is successful and he has recovery of 6 months with lost income during that period and unknown residual impairment.  Worst case is extensive medical surgical treatment, no insurance due to loss of employment, amputation of leg. I have had concerns from the beginning that she did not deliver the standard of care and that this caused him harm.  Now it appears she failed to detect the non union and lack of healing on his post op office xrays and the evidence of a problem with infection.

ANSWER: And the question is, do you have a malpractice case?
Boine
 
Posts: 40
Joined: Mon Mar 17, 2014 1:58 am

Breech Of Standard Of Care

Postby Oratun » Sat Dec 03, 2016 7:34 pm

: maybe.  What I can tell you is that the injury and disability would probably meet the damages threshold of most lawyers depending on the ultimate outcome. The question of liability is always difficult. The story you tell is compelling but the ortho will defend herself vigorously by saying that what she did and how she did it was all "within the standard of care".  I won't attempt a substantive opinion on the subject because the fact is, and the law requires, that only another orthopedic surgeon can opine on whether an orthopedic surgeon was negligent.  What I can say is, you should certainly start contacting medical malpractice firms in your area. Birmingham has several I am sure. When you find a firm that is interested, they will then gather all the records and films and pay an outside ortho to review the entire case. If the expert review indicates there was malpractice, the firm will then offer to represent your husband in a lawsuit against the ortho, on a contingent fee basis. Walk away from any firm that asks for money from you. If they aren't willing to front the expert fees, filing, copying, etc up front costs, they don't believe enough in the case. Be mindful of the statute of limitations. Could be as little as one year. Check that by googling,................"alabama statute of limitations medical malpractice"  Good luck.

---------- FOLLOW-UP ----------

We are seeking an additional opinion from another ortho surgeon in Birmingham of equal stature to the one who alerted us to the problems.  He has the records and films and we have an appointment to see him next week.  We will ask him about the standard of care provided by our original ortho and his opinion of treatment options going forward.  We feel this is prudent given the seriousness and need for consultation going forward. We do not expect that either of these surgeons would be willing to testify even with their candid comments to us regarding how poorly his fracture was originally managed. I spoke with a mal practice atty in Birmingham prior to our learning about the infection. He said that the cost of getting an expert to testify that there was a breech in standard of care and that it caused him harm would likely not meet the damage threshold that you spoke of. This is not because of the seriousness of the injury-disability but due to the fact that it is very difficult to get a mal practice conviction in the state of Alabama.  He said that it would require getting an ortho from out of state and that juries in Alabama do not convict based on out of state testimony.  He also said that insurance companies have discovered this over the last 15 years and do not settle since there is such a low incidence of conviction in the state of Alabama.  He seemed very frustrated as a mal practice atty working in those conditions.  My husbands condition is deteriorating and I feel we will experience a spiral of more and more serious outcomes. Even with good care and outcomes(which is very much a question regarding outcomes)he will likely lose his job and insurance. Loss of income and mounting medical bills will be a disaster for us. At age 62 this will be the premature end of his career. My follow up question is regarding meeting the damage threshold.  Are you aware of anything unique in getting a settlement in the state of Alabama or if going to trial in getting a conviction.  Thank you
Oratun
 
Posts: 51
Joined: Tue Jan 14, 2014 7:22 pm


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