Virginia Lawyers Weekly//March 8, 2019
Virginia Lawyers Weekly//March 8, 2019//
Plaintiff fell from a ladder at his home on Nov. 14, 2013; several hours later he discovered that a roofing nail had punctured his abdomen during his fall. He presented to the defendants’ urgent care facility for evaluation about two hours later. Plaintiff told the defendant physician’s assistant, or PA, that his wound did not hurt or bleed when he pulled the nail out. The PA irrigated the wound with a mixture of Hibiclens, an antimicrobial soap, diluted with one liter of normal saline [diluted about 100 parts to 1] prior to plaintiff leaving the urgent care facility.
Two days later plaintiff presented to Centra Lynchburg General Hospital because of continued pain. He was diagnosed with cellulitis. Plaintiff’s condition improved somewhat with antibiotics before worsening again. He was ultimately diagnosed with fat necrosis in January 2014, which required surgery to excise the necrotic tissue.
Plaintiff alleged that this fat necrosis was brought on by the defendant PA’s use of Hibiclens to irrigate the wound. The package insert for Hibiclens stated that it should not be used on “wounds that involve more than the superficial layers of skin.” Plaintiff alleged that the Hibiclens caused a chemical burn which resulted in fat necrosis.
Plaintiff was supported by the testimony of a PA, Colleen Nakumara, who testified that defendant’s use of Hibiclens on a puncture wound violated the standard of care. Plaintiff’s causation expert, Dr. John Salmon, a pathologist, testified that the active ingredient in Hibiclens is meant to lyse cells which then caused the fat necrosis. He also testified that plaintiff’s fat necrosis would not have resulted from the impact of the fall or from infection.
The defendants presented standard of care evidence from a PA, Wilton Kennedy, as well as from an ER physician, Dr. William Moore, and a vascular surgeon, Dr. Jessee Davidson, III, who all testified that the use of diluted Hibiclens to treat puncture wounds fully complied with the standard of care. Dr. Moore and Dr. Davidson also testified regarding causation. They testified that there was no evidence to suggest that diluted Hibiclens in the concentration used by the defendant PA can cause fat necrosis and attributed plaintiff’s fat necrosis to infection, which often can lead to fat necrosis.
Following a three day trial, the jury deliberated for about an hour and returned a defense verdict. The case was not appealed.
Type of action: Civil/Medical Malpractice
Injuries alleged: Fat necrosis caused by irrigation of a puncture wound with Hibiclens
Court: Campbell Circuit Court
Case no.: CL16-1196
Name of judge or mediator: Judge John T. Cook
Special damages: $64,313.21
Demand: $2,100,000 sought in the ad damnum
Verdict or settlement: Defense Verdict
Attorneys for plaintiff: Jonathan S. Kurtin and Gordon H. Shapiro, Roanoke; James D. Fairchild, Forest
Attorneys for defendant: Walter H. Peake III and Mathew E. Kelley, Roanoke
Plaintiff’s experts: Colleen Nakumara, MS-PAC; William L. Kittrell. Jr., M.D., John M. Salmon, IV, M.D., FCAP; Mathew Foster, M.D.; Albert C. Weed, MD, FACS
Defendant’s experts: Wilton Kennedy, DHSC, PA-C; William N. Moore, MD, PhD, FACEP; Jesse T. Davidson, III, M.D., Vascular and General Surgeon
Insurance carrier: The Doctors Company