Compartment Syndrome from DVT Misdiagnosis

Buddemeyer v. Kaiser Permanente White Marsh Medical Center

Venous DuplexThis medical malpractice claim against Kaiser was filed in Baltimore County after a physician misdiagnosed DVT as a groin strain, leading to compartment syndrome. It was filed in Health Claims Arbitration on February 12, 2018, and it is the 71st medical malpractice case filed in Maryland this year.

Summary of Plaintiff's Allegations

A man presented to Greater Baltimore Medical Center (GBMC) complaining of leg pain without a traumatic injury. A physical exam revealed mild right calf swelling and redness, so the man underwent a venous duplex imaging study of his right leg. The test results were positive for deep vein thrombosis (DVT) - blood clots in the deep veins of his right leg. Later that day, the man was discharged from GBMC with a 30-day supply of blood thinners to treat his DVT.

Three weeks later, the man went to Kaiser White Marsh for additional testing and a prescription refill. Again, the test results were positive for DVT and the doctor prescribed a three-month supply of a different blood thinner. After completing his medication regimen, the man returned to Kaiser for a D-Dimer blood test and an Ultrasound Doppler Study of the veins in his right leg. The results showed no evidence of DVT.

Nearly eight months after his first DVT episode, the man returned to Kaiser White Marsh with complaints of right thigh pain. He was discharged the same day with instructions for a groin strain. Even though the doctor's notes indicate concern for a clot because of his past medical history of DVT, the doctor did not prescribe any medications or perform any tests. Five days later, the man went to GBMC because he was still experiencing leg pain. He underwent a venous duplex, received a prescription for blood thinners, and was discharged the same day with instructions to make a follow-up appointment. Later that afternoon, the man went back to Kaiser White Marsh with complaints of right leg swelling. He was found to have extensive DVT and was advised to return to GBMC for an emergency procedure to break down the blood clots.

At GBMC the man was diagnosed with compartment syndrome and eventually, after a lot of unnecessary waiting, taken to the operating room for a fasciotomy. In other words, the blood clots were causing a buildup of pressure in the man's legs that was inhibiting blood flow, so a vascular surgeon cut open the muscle compartment to allow the tissue to swell, reduce pressure, and restore normal blood flow. The man remained hospitalized after the surgery, and five days later he underwent a follow-up procedure to wash out and close his wounds. He was discharged shortly thereafter, requiring extensive in-home nursing care.

Additional Comments
  • According to the claimant's expert witness, a family medicine doctor, the physician at Kaiser should have diagnosed the man with DVT when he returned with right thigh pain eight months after his first DVT. The standard of medical care dictates that DVT should be part of a patient's differential diagnosis when the patient has a known history of DVT and symptoms consistent with DVT. As such, the Kaiser physician should have ordered testing to definitively rule in or rule out DVT at that time. Had the Kaiser physician complied with the standard of care, the claimant's expert believes the man would not have suffered compartment syndrome.

  • Compartment syndrome is a rare but severe complication that can occur after leg trauma. Because compartment syndrome is so rare, there is limited information available about long-term outcomes for compartment syndrome survivors. Out of eighteen patients examined in this study, eight (44%) had long-term functional deficits. Only five patients (28%) fully recovered the strength in their thighs.

  • Here are a number of compartment syndrome stories and the settlements and verdicts the victims received.

Jurisdiction
  • Baltimore County
Defendants
  • Mid Atlantic Permanente Medical Group, P.L.L.C. d/b/a Kaiser Permanente White Marsh Medical Center
  • Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
  • Greater Baltimore Medical Center
  • A family medicine doctor
Hospitals Where Patient was Treated
  • Greater Baltimore Medical Center
  • Kaiser White Marsh
Negligence
  • Failing to notice and respond to the symptoms of deep vein thrombosis.
  • Failing to administer appropriate medications in a timely manner.
  • Failing to order and perform appropriate testing.
  • Failing to timely react to known surgical emergencies.
  • Failing to adequately communicate among health care providers.
Specific Counts Pled
  • As a direct result of the defendants' negligence, the claimant suffered past and future physical pain, loss of earnings and diminished earning capacity, and the need for future medical care.

  • The defendants' negligent conduct also caused injury to the claimant's marriage, including a loss of companionship and assistance.

Plaintiff's Experts and Areas of Specialty
  • Anupama Pani, M.D., family medicine
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