Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A hypothetical case of medical malpractice. This can be you. 

Howard Smith, MD
Physician
April 28, 2024
Share
Tweet
Share

A patient presents to the emergency room of a major local hospital with ulcers on the heels of both feet. The patient is more than 40 years old, smokes, and has hypertension but is not a diabetic.

It is determined that the patient has peripheral artery disease. The patient is admitted to Dr. X’s service. Dr. X is a vascular surgeon with a special interest in endovascular devices for peripheral artery disease. However, Dr. X, for whatever reason, is out of the country. Dr. Y is covering.

The patient is clueless about these behind-the-scenes circumstances.

A week later, Dr. Y performs a conventional femoral popliteal bypass on the right leg, presumably, to prevent amputation. A week after that, Dr. X returns and operates on the left leg, replacing a supposedly blocked portion of the left femoral artery with a state-of-the-art endovascular device, presumably to save the leg.

After both surgeries, a “family meeting” is arranged at the hospital. Neither Dr. X nor Dr. Y is present. A vascular surgery resident, a podiatrist, and the hospitalist are in attendance. Their purpose is to obtain consent for a left below-the-knee amputation. This is the leg upon which Dr. X inserted the endovascular device into the left femoral artery. The right leg, upon which Dr. Y performed a femoral-popliteal bypass of the right femoral artery, does not raise concern.

Questions arise. Why is the right leg fine and the left leg not? Why is a femoral-popliteal bypass performed on the right leg and not on the left? What about wound care? Their only answer is that dressings are regularly changed, and there is no infection in either heel bone.

If so, why not save the left leg with a second revascularization procedure rather than amputating it? These doctors know, but never admit, that the endovascular device inserted by Dr. X is not functioning. The left leg is in jeopardy; the right leg is not.

When questioned about a transfer to another local hospital in the same health care system, which has a reputation for limb salvage second to none, they answer: The family must make those arrangements if such a transfer is desired.

The patient wants the transfer and refuses the amputation. The doctors assure the patient that because there is no infection, there is still time to reconsider.

The patient is sent from the ICU to a nursing station and is now under the care of another hospitalist, who cooperates. For six days, wound care becomes noticeably better, and arrangements for transfer to the aforementioned hospital are underway.

Unfortunately, the patient is switched to another nursing station where another hospitalist is in charge. The ulcers on both feet are unattended and, unbeknownst to the patient, the transfer is stopped. Finally, maggots are seen infesting the decubitus on the left side.

Why else would maggots infest a wound if not for the lack of wound care?

The patient develops a life-threatening septic shock and consents to a below-the-knee amputation performed by Dr. X. After the amputation, Dr. X revises the stump, which results in a left above-the-knee amputation.

ADVERTISEMENT

Following these surgeries, the parade of transfers to nursing stations continues. In the meantime, an infection in the wound where Dr. X first inserted the endovascular device goes unnoticed. Finally, Dr. X debrides this abscess and removes the device. Three months after admission, the patient is discharged to a rehabilitation and nursing facility, where he or she resides today.

At a post-operative appointment with Dr. X, the truth comes out. The endovascular device is not functioning. Dr. X obstructs the transfer because “it would have made no difference.” Furthermore, a narrative is underway to make it appear that the patient contributes to these problems by rejecting an amputation. However, no one of sound mind would grant consent for amputation when told that there is no infection, that there is still time to consent, and that a transfer to the other hospital known for limb salvage is being arranged.

While residing at the nursing and rehab facility, the ulcer on the right heel receives wound care. However, previous months of no wound care have a price, and an x-ray is suspicious of infection in the heel bone. At long last, an appointment is made with the wound care clinic at the same hospital reputed for limb salvage, and surgical debridement is scheduled.

After partial excision of the heel bone, the right leg is salvaged. This speaks volumes about potential salvage of the left leg had only doctors been diligent about transfer to this facility because, at the time, there was no infection.

For the reader’s convenience, two important journal articles are cited. In Circulation Research, there are 230 million similar patients worldwide, and many undergo limb-salvage procedures. In Annals of Vascular Surgery, after 14.5 months, 67 percent of patients who undergo revascularization surgery have complete wound healing; 12.2 percent die; 1.8 percent have other complications; 17 percent require a second revascularization procedure, but only 2 percent require amputation.

Is this amputation the background risk or medical malpractice? Using the risk management tool in my earlier articles, I prove malpractice with 95 percent confidence. However, who better to answer this question than ten prominent medical malpractice plaintiff attorneys? Yet, despite professing commitment to duty, patient safety, and advocacy, none agree to represent this client. As each points out, they work on a contingency basis. This does not mean there is no merit. It simply means this case is just not worth their time or effort to litigate. Their only advice is to seek another opinion.

If I, as a physician, should ever not help a patient, for whatever reason, I would never leave that patient swinging in the breeze as do these lawyers to this client. Society expects me, as a physician, to consult with a colleague, who can help. What society expects of lawyers remains to be seen.

Howard Smith is an obstetrics-gynecology physician.

Prev

Dismantling the mythical dichotomy of physician career options

April 28, 2024 Kevin 0
…
Next

EHRs and physician well-being [PODCAST]

April 28, 2024 Kevin 2
…

Tagged as: Malpractice, Surgery

Post navigation

< Previous Post
Dismantling the mythical dichotomy of physician career options
Next Post >
EHRs and physician well-being [PODCAST]

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Howard Smith, MD

  • The hidden cost of malpractice: Why doctors are losing control

    Howard Smith, MD
  • Why no medical malpractice firm responded to my scientific protocol

    Howard Smith, MD
  • The shocking silence of top law firms on frivolous medical lawsuits

    Howard Smith, MD

Related Posts

  • Medical malpractice is a lot like running a marathon

    Christine Zharova, Esq
  • From medical humanities student to physician

    Nicholas Bellacicco, DO
  • Medical malpractice: Don’t let the minority define us

    Shah-Naz H. Khan, MD
  • A medical student’s physician inspiration

    Uju Momah
  • For students with test stress, medical schools leave a void  

    Steve Blatt, MD
  • Why a gap year will make this medical student a better physician

    Yoo Jung Kim, MD

More in Physician

  • Bureaucracy over care: How the U.S. health care system lost its way

    Kayvan Haddadan, MD
  • ER threats aren’t rare anymore—they’re routine

    Patrick Hudson, MD
  • Love on life support: a powerful reminder from the ICU

    Syed Ahmad Moosa, MD
  • Why we fear being forgotten more than death itself

    Patrick Hudson, MD
  • From basketball to bedside: Finding connection through March Madness

    Caitlin J. McCarthy, MD
  • The invisible weight carried by Black female physicians

    Trisza Leann Ray, DO
  • Most Popular

  • Past Week

    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • ER threats aren’t rare anymore—they’re routine

      Patrick Hudson, MD | Physician
    • JFK warned us about physical fitness. Sixty years later, we’re still not listening.

      Alexandre Bourcier, MD | Conditions
    • The silent threat in health care layoffs

      Todd Thorsen, MBA | Tech
    • Why true listening is crucial for future health care professionals [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love on life support: a powerful reminder from the ICU

      Syed Ahmad Moosa, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • ER threats aren’t rare anymore—they’re routine

      Patrick Hudson, MD | Physician
    • JFK warned us about physical fitness. Sixty years later, we’re still not listening.

      Alexandre Bourcier, MD | Conditions
    • The silent threat in health care layoffs

      Todd Thorsen, MBA | Tech
    • Why true listening is crucial for future health care professionals [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love on life support: a powerful reminder from the ICU

      Syed Ahmad Moosa, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...