Grounding pad burn

[Blackmateria]

---

Members don't see this ad.

Please feel free to delete if this is inappropriate. Had a patient who I did a left RFA on, the day of the RFA just as ablation was starting he began to complain of right leg pain. I immediately stopped the ablation and had staff check grounding pad. It was adherent to the leg, but patient developed a penny size burn on this thigh. We switched bovie sites and completed procedure with no issues. Wound was dressed with neosporin and he agreed to follow up with PCP for wound care. Patient is not upset. Saw him one month later, his back pain is greatly improved and burn is healing, however he states he spent 200 to 300 dollars in doctor visits for the burn and doesn't feel it's right that he covers it, he wants us to cover it in some way. I am W2 at an ortho group, they are urging me not to do this at it would create an admission of guilt and "open up to a lawsuit". Patient is a "reasonable" white collar type. Any suggestions from people in similar situations?

 

[BobBarker]

You are a w2 employee. It is not your decision. You leave this to your practice admin.

 

[lobelsteve]

Notify carrier/risk management.
Complications happen, and this was recognized and handled appropriately.

 

[RoloTomassi]

How/why would this happen?

 

[Ducttape]

apparently no one entirely knows why.

it could be the contact is not that good, so that part of the pad will actually damage the dermis rather than have the current pass through the patient on to the pad as it heats up and does not dissipate through the skin.

there is some thought that, in patients with PVD, that there is vasoconstriction around the pad site and this prevents heat from dissipating and thus burning the patient.

there is also some thought that patients who have less fat will have less dissipation at the pad site, and if the pad location is in an area with insufficient fat subcutaneously, there is a higher likelihood for burn.


oh, and lotions are bad. so dont say "it rubs the lotion on its skin"

 

[Blackmateria]

apparently no one entirely knows why.

it could be the contact is not that good, so that part of the pad will actually damage the dermis rather than have the current pass through the patient on to the pad as it heats up and does not dissipate through the skin.

there is some thought that, in patients with PVD, that there is vasoconstriction around the pad site and this prevents heat from dissipating and thus burning the patient.

there is also some thought that patients who have less fat will have less dissipation at the pad site, and if the pad location is in an area with insufficient fat subcutaneously, there is a higher likelihood for burn.


oh, and lotions are bad. so dont say "it rubs the lotion on its skin"

Do you always shave the leg before placement? This guy was not that hairy, but I wonder if it played some role.

 

[Agast]

Pad has to be nicely adherent, so it could be a combination of hairy skin and bubbly placement

Or maybe a product defect. I think in the future if there is a burn, don’t throw the pad away so you can eyeball it later

 

[lobelsteve]

If the pad isn’t fully adherent and prep seeds under it that will cause a burn. Likewise, if a patient gets sweaty, I think that would do it too.

 

[strike5858]

If the pad isn’t fully adherent and prep seeds under it that will cause a burn. Likewise, if a patient gets sweaty, I think that would do it too.

So what happens if you don’t report this and the patient does sue? Can malpractice insurance refuse to cover?

I remember when I first started out of fellowship a patient I did a procedure on developed an unrelated infection and I reported it to my carrier. They are still making me pay a premium on my malpractice insurance even though nothing came of this.

 

[lobelsteve]

Why would you report an unrelated infection? The reason to report is the patient complaint and seeking remuneration.

 

[strike5858]

In that instance I was fresh out of fellowship and that Patient developed sepsis with no clear source. I had done an injection a couple weeks prior.

 

[Ducttape]

i wouldnt have reported it.

the most common causes of sepsis include benign things such as cuts and bruises.

its too late now, but unless you found a nidus at the injection site, it is much more likely that the patient was infected from some other nonsterilized skin source, and i would not have reported the injection.


unless you didntprep it and blew your nose on to the not so sterile field and used days old previously used needles.....

 

[strike5858]

In hindsight I agree, I didn’t know any better at that time.

I guess I’m trying to get a better understanding of when we should report. Obviously if a patient bluntly threatens law suit or is requesting reimbursement in the grounding pad situation noted above we should notify.

but let’s say the patient for a burn from grounding pad and it was managed appropriately. Patient the burn healed without any issues. Patient is happy would you guys still report this incident to the malpractice insurance?

 

[buddababa]

but let’s say the patient for a burn from grounding pad and it was managed appropriately. Patient the burn healed without any issues. Patient is happy would you guys still report this incident to the malpractice insurance?

this isn't malpractice, so i wouldn't report

 

[RoloTomassi]

A lawsuit really doesn't have legs unless there's potential damages. In this case if the burn caused significant permanent disfigurement and the patient was an underwear model, maybe. I would only report if the threat is legit (you start getting records requests) and there are potential damages.

Example: med mal firm wanted my opinion on an egregious cord stick by another doc resulting in hemiplegia. They asked about the permanency of deficits, otherwise would not even bother.