Preventing Potential Claims of Negligence – Just Because You Can, Should You?
Ross E. Taubman, DPMPICA President and Chief Medical Officer
2012 APMA YOUNG PHYSICIANS’ INSTITUTEMay 18-19 Crystal Gateway Marriott Crystal City, VA
Case Presentation Number 1
• The Defendant (our Insured):– Graduated from Podiatric Medical School in
2002– 3-Year Residency Completed in 2005– Began practice in a rural part of a Southwestern
state in 2005– Not Board Certified– Only 3 Physicians in town – General
Practitioner, General Surgeon, our DPM
Case Presentation #1
• The Plaintiff (thePatient): First Visit in Early 2008– 59 year old diabetic male, employed as attorney
– Previous PVD diagnosis by two other physicians
– Charcot Arthropathy with chronic ulceration
– Failed conservative care lead to decision for surgery
Planned Procedure
• Tendo-Achilles Lengthening• Multiple Mid-foot Arthrodesis with
Osteotomy• Secondary Repair of Extensor Tendon• Partial Ostectomy X 3• Application of Multi-Plane External Fixator• Application of Bone Stimulator
What are the Potential Issues?• Diabetic Patient
• Diagnosis of PVD
• Medical Clearance with Laboratory Evaluation
• Rural Locations without Availability of Other Specialists
• Familiarity and Experience with Procedure
What Happened?
• Staff received abnormal Labs but failed to report to DPM
• Post-Operatively Wound failed to heal
• MRSA Infection which resulted in Osteomyelitis, BKA X 2, septicemia leading to Renal Failure and Myocardial Infection
• After all said and done:– Settlement with Plaintiff = $2,000,000
Case #1 - Lessons Learned
• Look in the Mirror
• Mind the Store
• Location, Location, Location
• Don’t Carry the Coffin Alone
Case Presentation #2
• The Defendant:– Graduated from Podiatric Medical School in
1997– 3-Year Residency Completed in 2000– Fellowship in Reconstructive Foot & Ankle
Surgery Completed in 2001– Began Private Practice in the Midwest 2001– ABPS Certified - RRA
Case Presentation #2
• The Plaintiff: First Visit Early 2004– 34 year old married female with two dependent
children
– Charcot-Marie-Tooth Disease
– Multiple prior back and extremity surgery
– Painful Cavovarus foot deformity secondary to CMT that failed conservative care leading to decision for surgery
Planned Procedure
• Midtarsal Arthrodesis with Internal Fixation
• Plantar Fasciotomy
• Application of External Ring Fixation
• Application of Bone Stimulator
What are the Potential Issues?
• Charcot-Marie-Tooth Disease
• Familiarity and Experience with Procedure
• Documentation and Informed Consent
• Scope of Practice
What Happened?
• Patient Developed Post-operative infection with ultimate Osteomyelitis which required BKA
• Allegations– Failure to Diagnose Infection –Defensible– Failure to Obtain Informed Consent – Indefensible– Battery and Practicing Outside the Scope of Practice –
Indefensible
• After all is said and done:– Settlement with Plaintiff = $850,000
Lessons Learned Case #2
• Take a Letter, Maria
• “Toto, We’re Not in Kansas Anymore”
• Look in the Mirror – AGAIN!
