Renal failure, sepsis, death follow podiatric surgery – $650,000 Settlement

On May 7, 2006, plaintiff’s decedent, Jane Doe, went to a local hospital’s emergency department with complaints of left calf pain and a recent onset of blisters around her left ankle. Her skin turgor was assessed as “poor” indicating dehydration. Three days earlier, Doe had undergone a podiatric surgical procedure known as a hammer toe release. The surgery went as expected and her podiatrist prescribed Keflex, an antibiotic, and Tylenol #4 for pain relief.

At the emergency department, Doe came under the care of a resident in training who was working at the emergency department under an affiliation agreement with an area teaching hospital that allowed third-year emergency medicine residents to rotate through the emergency department. Under the affiliation agreement, physician members of the defendant private emergency medicine practice who staffed the hospital’s emergency department were responsible for training the residents and were ultimately responsible for all aspects of patient care. The defendant physician was the private emergency practice member on duty the evening of May 7 and May 8.

The resident examined Doe and noted edema, erythema and blistering on the left foot and leg. She noted Doe was a diabetic and was taking blood pressure medication. The resident concluded that Doe had cellulitis and dehydration. Among other things, she ordered a whole blood count with differential and a basic metabolic panel.

The defendant physician’s progress note, taken at midnight, indicated he observed “blister swelling on ankle foot after having hammer toe surgery with calf pain.” On deposition, he testified he had no independent recollection of the decedent. He also testified he would have reviewed the patient’s entire chart by midnight, and he would have had access to all information it contained.

This would have included that the decedent was an African-American with a history of diabetes and hypertension; she had undergone recent surgery and was experiencing pain, swelling, redness and blisters in the surgical foot; she had vomited upon arrival at the hospital; her skin turgor was poor; and she was suffering from hypotension. The records documented no further involvement by the defendant physician.

The lab results were reported at 11:41 p.m. on May 7. The resident reviewed them three hours later. The labs revealed a white blood count of 11.8, band count of 25 percent and metamylocytes of 3 percent, indicating the decedent was septic. The basic metabolic panel indicated Doe was in acute renal failure consistent with sepsis.

Neither the defendant physician nor the resident specifically recalled discussing the lab results with each other, although the resident stated she “always” reviewed patient lab values with her supervising attending physician while the defendant physician said he believed the lab results were not brought to his attention. Neither the decedent nor her family members were informed of the lab values or their significance.

Doe was released from the hospital at 3:07 a.m. on May 8. She spoke to her podiatrist later that same day. He recommended that she continue her new antibiotic (Bactrim) and suggested she see him the following day. When the decedent did not seem to improve, some family members (including a niece who was a medical doctor) suggested she return to the emergency department that same evening.

The decedent refused, saying she would see the podiatrist the next day as scheduled. The next morning, the decedent could not be awakened. She was transported to the hospital and pronounced dead the morning of May 10. The cause of death was Systemic Inflammatory Response Syndrome (“SIRS”) secondary to an infectious process with organ failure and septic shock.
At the time of her death, the widowed decedent was 66 years old and retired. She regularly worked out at a health club and was active in her church and community. She left three adult children as beneficiaries. None of the beneficiaries relied on the decedent for financial support. The case settled during mediation for $650,000.

[08-T-148]

Type of Action: Medical malpractice
Injuries Alleged: Death
Name of Case: Confidential
Tried before: Mediator
Name of Mediator: Philip Blackburn
Special Damages: Medical bills – $69,263; funeral expenses – $6,385
Verdict or Settlement: Settlement
Amount: $650,000
Date: Aug. 11, 2008
Attorneys for Plaintiff: Jason W. Konvicka and Malcolm P. McConnell III, Richmond