Patient suffered necrotizing fasciitis after orthopedic surgery – Defense Verdict

On July 30, 2008, plaintiff, a 350-pound, 22-year-old man with pre-existing venous stasis issues, was in a single-vehicle motorcycle accident and admitted to the hospital for a broken left tibia and fibula, and other trauma injuries. The patient underwent closed reduction internal fixation and rodding of the left leg that night. On Aug. 4, 2008, the defendant orthopedic surgeon was called by the hospital’s physical therapy and nursing staff with a report of purulent drainage and two areas of necrotic tissue on the back of the patient’s left leg. Concluding that these findings were consistent with fracture blisters, the defendant orthopedic surgeon ordered daily dressing changes and a wound care consult, which occurred on Aug. 7. On that date, the wound care specialist noted foul smelling drainage and black eschar at the site of the wound on the back of the patient’s calf.

Despite these findings, the patient was discharged under the supervision of a home health nurse, who documented drainage from and black eschar over the wound each time she performed dressing changes on Aug. 8, 11, 12 and 15. The patient returned to the defendant’s office for follow-up on Aug. 14, and an outpatient wound care consult was ordered for a determination on whether to debride the wound or allow it to heal unimpeded. Upon presentation for the outpatient wound care appointment on Aug. 19, a substantial amount of infected and necrotic tissue was discovered beneath the patient’s black eschar and satellite wounds were observed. The patient received intravenous antibiotics and underwent emergency debridements of his left calf on Aug. 19, 21 and 23. He received a skin graft to the back of his calf in October 2008 and spent 21 months following up with outpatient wound care to address his wound healing issues.

Plaintiff filed suit in Winchester Circuit Court, alleging defendant orthopedic surgeon breached the standard of care by failing to take appropriate steps to diagnose and treat necrotizing fasciitis. Plaintiff further alleged that defendant orthopedic surgeon’s failures to do so between Aug. 4 and 14, 2008, caused him to require more aggressive debridement and more loss of muscle tissue than he otherwise would have suffered, thereby making it impossible for him to work in his prior capacity as a heavy equipment mechanic. Defendant denied the allegations and the case was tried on Dec. 3, 2012.

Plaintiff’s liability experts, John Schaefer, M.D., an infectious diseases specialist from Norfolk, and Kenneth Lippman, M.D., an orthopedic surgeon from Baltimore, testified that defendant breached the standard of care by failing to order an infectious diseases consult, an x-ray, a wound culture, or a number of other diagnostic tests on each and every day that the defendant orthopedic surgeon saw the patient after Aug. 4, 2008. Drs. Schaefer and Lippman testified that if such interventions had been instituted, the diagnostic tests would have revealed necrotizing fasciitis, and the amount of tissue lost on the back of the plaintiff’s calf would have been eliminated or significantly lessened.

Defense liability experts William Petri, Jr., M.D., an infectious diseases specialist from Charlottesville, and Robert Afra, M.D., an orthopedic surgeon from Encinitas, Calif., testified that the defendant orthopedic surgeon met the standard of care by involving wound care specialists at all appropriate junctures, procuring home health nursing to monitor the patient’s wounds, and remaining vigilant for signs and symptoms of infection. Dr. Petri and Dennis Chong, M.D., a physical medicine and rehabilitation physician from Seattle, further testified that the patient did not have necrotizing fasciitis between Aug. 4 and 14, 2008. Instead, his signs and symptoms were consistent with any number of alternate etiologies, and the patient did not demonstrate a progression consistent with necrotizing fasciitis during the time he was under the defendant orthopedic surgeon’s care.

After a five-day trial and deliberations for five hours, the jury returned a verdict for defendant and his practice.

[12-T-198]

Type of action: Medical malpractice – personal injury
Injuries alleged: Failure to diagnose and treat necrotizing fasciitis
Court: Winchester Circuit Court
Tried before: Jury
Judge: John E. Wetsel Jr.
Date: Dec. 7, 2012
Demand: $1,500,000
Offer: None
Verdict or Settlement: Defense verdict
Insurance carrier: The Doctors’ Company
Attorneys for defendant:  Richard L. Nagle and Travis W. Markley, Fairfax