Orthopedic Pressure Sore Under Cast Lawsuit

White v. The Orthopaedic and Sports Medicine Center, PA

This is a medical malpractice case filed on by a woman against her orthopedist after pressure sores lead to the loss of a toe and a bone in her foot. It is the 18th medical malpractice lawsuit filed in 2017 in Maryland. It was filed in Maryland Health Claims Arbitration on January 13, 2017.

Summary of Plaintiff's Allegations

Plaintiff goes to defendant Orthopaedic and Sports Medicine Center in Annapolis for treatment after she sustains an injury to her right foot a few days prior. Her primary care physician referred her for a non-displaced fracture of her anterior process of the calcaneus. Defendant doctor examines the plaintiff, and finds the injury as well as neuropathy, anemia, and prior cancer treatment. She places her in a fixed ankle walker and suggests she come for follow-up treatment.

Within a few weeks, plaintiff starts to develop a sore on the ball of her foot. She returns to defendant doctor for a follow-up. She shows the doctor the sore that had developed and changed in both size and presentation. Defendant doctor places her in a total contact cast.

A week later, plaintiff returns to have the ulcer checked. A new cast is placed. When she returns again, defendant doctor states that the ulcer has decreased in size and that it is not showing signs of infection. The plaintiff's daughter photographs the foot, as she does not think it looks smaller or free of infection. However, the woman is placed in a post-op shoe, told to follow-up in three weeks and change the dressing twice a day.

Plaintiff follows these instructions. When she returns, the records from her appointment with defendant doctor state there is no sign of infection and that the woman is doing well. Contrary to this, two days prior, she had gone to her primary care physician who referred her to a wound care specialist as she was concerned about the ulcer.

The wound care specialist finds a large wound with necrotic tissue. She conducts an MRI and a debridement procedure in an attempt to remove the necrotic tissue. Unfortunately, the ulcer does not resolve. The MRI shows "significant marrow edema at the distal 2nd metatarsal consistent with osteomyelitis". This requires amputation of the plaintiff's second toe and distal second metatarsal.

Plaintiff suffered the amputation and permanent injuries that she alleges she would not have suffered if defendants had provided the appropriate care, such as timely referral to physicians for treatment and appropriate assessments.

Additional Comments
  • Orthopedic malpractice cases related to the actual orthopedic treatment being sought is rare. Instead, it is something peripheral like informed consent or a radiology error. (This is an example case filed days before this lawsuit against Johns Hopkins.) Here, the claim is not the orthopedic treatment itself but the failure to properly manage the pressure sore.
  • The defense to this case is going to be that her medical records clearly indicate a very complicated medical history and a poor ability to heal. So the real problem is her overall medical conditions. Accordingly, her pressure ulcer was unavoidable and not as a result of neglect of the orthopedic doctor. The problem with this defense is that the doctor knew or should have known of her prior medical history.
  • The severity of the injuries seems to be an issue in this case. She has a problem with her gait. She lost a toe but not her big toe. But it is hard to get a gauge for the severity of the damages but the case is not impressive for a damages standpoint on paper. This is not to minimize the plaintiff's injuries which are awful. But there is a certain threshold of injury required to make the economics work in a medical malpractice case in Maryland. This is particularly true for a case in Anne Arundel County which is not knowing for being generous with malpractice victims.
Jurisdiction
  • Anne Arundel County
Defendants
  • An orthopedic surgeon
  • The Orthopaedic and Sports Medicine Center, P.A.
Negligence
  • Failure to order appropriate tests on plaintiff's ulcer at all times during treatment
  • Failure to properly offload the foot to prevent ulcers
  • Failure to provide appropriate re-check intervals
  • Failure to refer plaintiff to professionals to treat the ulcer
  • Failure to debride or treat the ulcer
  • Failure to properly document the injury
  • Failure to advise the plaintiff on proper care of her ulcer
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