The next day, the defendant surgeon examined the woman and noted that the toes on her left foot were bluish and felt cold, and that the plaintiff had faintly palpable bilateral femoral pulses but no palpable pulses in the popliteal or posterior tibial or dorsalis pedal area. Doppler ultrasonography showed intact posterior tibial pulses bilaterally but no dorsalis pedal pulse on the left.
The surgeon developed a plan that included repeat ultrasonography of the woman’s left leg in two weeks. He also told her that it would be fine for her to leave the next day for a vacation in Maine.
The following day, because her condition was worsening, the patient went to another surgeon with severe left foot pain and discoloration. She was hospitalized immediately and underwent an angiogram. The imaging revealed a thrombus in the proximal superficial femoral artery with a complete occlusion of the popliteal artery above the knee.
She was operated on twice during the next two days in an attempt to restore meaningful blood flow to her leg. The surgeries were unsuccessful, and she was transferred to another hospital for possible leg salvage. Attempts were unsuccessful, and the woman underwent amputation of her left leg above the knee.
The plaintiff alleged negligence by the NP in failing to admit her to the hospital when she reported the cool leg and foot, and by the first surgeon in failing to hospitalize her when she had an obvious lack of blood flow to the leg and foot. The plaintiff claimed that her foot and lower leg could have been saved if she had undergone surgery at any time before the day she was hospitalized.
The defendants denied any negligence and claimed that clots forming in the small vessels of the leg made saving the leg impossible.
A $2 million settlement was reached.
No Investigation of Elevated Hemoglobin and Hematocrit
Over the course of several years’ treatment of an elderly man with a medical history that included colon cancer, hypertension, type 2 diabetes mellitus, and Parkinson’s disease, the defendant primary care physician had ordered various tests. On several occasions, the patient’s hemoglobin and hematocrit values were elevated. The defendant physician ordered no further testing to investigate these findings.
When the man presented to the defendant with cyanosis in one of his fingers, he was referred to a vascular surgeon to be assessed for possible peripheral vascular disease. The surgeon ordered a number of tests, including a transesophageal echocardiogram, and started the patient on warfarin. During the procedure, his blood pressure became extremely elevated. He was admitted to the ICU, where he was noted to have difficulty speaking and swallowing. CT showed that he had experienced a cerebral infarct.
It was determined during the man’s hospitalization that he had polycythemia vera, which causes the blood to be abnormally thick and poses an increased risk of stroke. CT performed the day after this discovery revealed a hemorrhage in the brain stem. The patient’s condition deteriorated, and he died a few weeks later.
The plaintiff claimed that the decedent’s elevated hemoglobin and hematocrit should have been investigated earlier. The defendant claimed that the decedent’s stroke was unrelated to the elevated hematocrit or to polycythemia vera and that earlier treatment of the blood disorder would not have prevented the vascular injury that occurred.
According to a published account, a $250,000 settlement was reached.