Woman’s leg amputated after delayed infection diagnosis — $1.25M settlement

Type of action: Medical malpractice

Injuries alleged: Delay in diagnosis and treatment of necrotizing fasciitis infection resulted in septic shock and amputation of the right leg and hip joint

Name of judge or mediator: Judge Michael C. Allen (Ret.)

Date resolved: 9/7/2021

Verdict or settlement: Settlement

Amount: $1,250,000

Attorneys for plaintiff (and city): Lee Livingston, Charlottesville; Heather E. Zaug, Ashburn

Description of case: In her lawsuit, the plaintiff alleged that the defendant, an emergency medicine physician, failed to timely recognize and appropriately respond to her necrotizing fasciitis and sepsis during her visit to the emergency department. The defendant denied the allegations. Trial was scheduled to begin on Oct. 18, 2021.

On Dec. 11, 2017, the 39-year-old plaintiff presented to the emergency department with right knee pain. She reported that the pain was 10 out of 10 on the pain scale. She also said that her pain increased over the course of three days and that it radiated down her calf. Her right knee was tender and her leg was swollen from her knee to her ankle. She also had a rapid heart rate, low temperature and wide pulse pressure. The plaintiff’s lab studies were abnormal, revealing poor kidney function and her radiological images showed knee effusion.

Despite these signs and symptoms, the defendant failed to include infection on his differential diagnosis. Instead, he diagnosed the plaintiff with knee effusion, a knee sprain and leg edema. After he completed his assessment, the defendant ordered a knee immobilizer, crutches and pain medication, and he discharged the plaintiff from the hospital.

The plaintiff returned to the hospital via ambulance the following morning, approximately 12 hours after her discharge. She was diagnosed with severe sepsis, necrotizing fasciitis and septic shock. She received several liters of saline and was started on IV antibiotics. Unfortunately, serial debridements that were performed to attempt to salvage her limb were unsuccessful and the plaintiff had to undergo amputation of her right leg and hip joint. She also underwent several gastrointestinal surgeries including a colostomy. Her hospital course was complicated by a colon perforation, so a completion colectomy and an end ileostomy were performed. During the hospitalization, the plaintiff became progressively acidotic and anuric, so she also received continuous renal replacement therapy.

After several months in the hospital, the plaintiff was discharged to a rehabilitation center. She remained at the rehabilitation center for several months until she was discharged home.

The defendant designated two emergency medicine physicians, an infectious disease specialist and a general surgeon. The experts were designated to testify that necrotizing fasciitis can be difficult to diagnose. In addition, they were designated to testify that the plaintiff did not manifest signs and symptoms of infection on Dec. 11, 2017. Instead, she developed necrotizing fasciitis after discharge and her condition deteriorated the next day.

The plaintiff designated two emergency medicine physicians, a trauma surgeon, a physical medicine and rehabilitation specialist and a life care planner. They were expected to testify that the defendant breached the standard of care by failing to recognize the plaintiff’s signs and symptoms of infection including, but not limited to, rapid heart rate, low temperature, wide pulse pressure, disproportionate pain, swelling and redness, laboratory results that revealed hyperglycemia and poor kidney function and radiographic findings of extensive edema and knee effusion. In addition, the experts were expected to testify that the standard of care required the defendant to take appropriate steps to try to rule out infection and his failure to do so constituted a breach of the standard of care. Finally, the experts were expected to testify that the defendant breached the standard of care by discharging the plaintiff from the hospital instead of admitting her for further evaluation and treatment. As a result of the defendant’s alleged negligence, the plaintiff suffered, among other things, the amputation of her right leg and hip joint.

The parties reached a confidential settlement in the amount of $1,250,000.

[021-T-135]