Med Mal Case: Missed Femur Fracture

[bbc586]

Lady comes into the ED one week after knee replacement with nausea and vomiting, and her knee still hurt.

Workup included labs and EKG.

Seen at an ortho clinic a week after that, diagnosed with a femur fracture.

Expert Witness Case #29

Ms. P was a 73-year-old woman in 2017 when she underwent a right knee replacement. She had an uneventful surgery, and was discharged home. She presented to the ED one week after the surgery with nausea and 8/10 right leg pain. Labs and an EKG were ordered.

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[WilcoWorld]

a) How do we know the fracture didn't happen during the 10d of rehab b/w ED visit and diagnosis? I hope the ED chart included a detailed exam or at least documentation of ambulation.

b) What was the harm of the allegedly delayed diagnosis?

 

[nexus73]

I was surprised by the blog authors comment this would settle in the low 6 figures. How is this worth $100K+? 10 days of delayed fracture diagnosis? What are the damages?

 

[wamcp]

I was surprised by the blog authors comment this would settle in the low 6 figures. How is this worth $100K+? 10 days of delayed fracture diagnosis? What are the damages?

Does it cost more than 100k for legal fees if the insured chooses not to settle and still defends successfully?
I assume that is the justification

 

[DarkHorizon]

I don’t understand the point of this lawsuit. Sure, an XR should have been ordered if the patient really complained of Knee pain and was having severe pain with ROM and tenderness to palpation and there was any history of recent trauma/falls. At the very least, the surgeon should have been notified.

However, a week long delay in diagnosis of a distal femur periprosthetic fracture is highly unlikely to cause any permanent disability. Sure, the diagnosis may have been delayed (questionable) but it really wouldn’t change anything from outcome standpoint. You still would do the same surgery.

 

[skougess]

This is kind of a difficult case to evaluate unless you were actually at bedside during the patient encounter. A patient with a secondary complaint of 8/10 knee pain a few days after knee surgery doesn’t necessarily warrant radiologic investigation in a vacuum.

 

[thegenius]

a) How do we know the fracture didn't happen during the 10d of rehab b/w ED visit and diagnosis? I hope the ED chart included a detailed exam or at least documentation of ambulation.

b) What was the harm of the allegedly delayed diagnosis?

It appears there really wasn't any overt harm as mentioned near the bottom of the report.

This is a stupid case. I hate how expert witnesses can look at a chart and determine what should be the standard of care or not.

 

[emergentmd]

This is Bull $hit. I am sure this didn't happen in a good Med Mal state but some other left wing sue happy state.

I am embarrassed for the expert witness.

I get drug seekers coming to the Er complaining of pain all over. Am I supposed to do a full body scan each time just in case that guy goes home and breaks something?

I have 20 yrs Trained at one of the top level 1 burn/Trauma centers, attending at a level 1 referral center, worked at large community hospitals, Medical director of large hospital and my expert witness is this is crap.

 

[thegenius]

totally agree
I don't think this is going to go that far. Apparently it's still in litigation