Delay in treatment of diabetic wound brings $900,000 settlement

2008 Trial Lawyers Report

Death from infection from delay in treatment of diabetic’s wound ulcer

The plaintiff’s decedent was a 70-year-old diabetic woman who died from sepsis on 11/01/02. The plaintiff claimed that the sepsis was the result of the defendant’s failure to recognize, diagnose and treat an evolving and worsening right heel ulcer that the defendant did not competently manage over a period of several weeks.

The defendant began treating the plaintiff’s decedent in October of 2001. On 4/19/02, she was seen by the defendant for complaints of a right heel ulcer that had been present for 1-2 weeks. The defendant diagnosed her with a cellulitis and prescribed Keflex 500mg, 3 times a day for 10 days, warm soaks, and bacitracin to her ulcer. On 5/23/02, she followed up with the defendant for complaints of frequent nosebleeds. The medical record for this visit contains the notation “right heel ulcer also,” but the defendant did not note anything about examining the heel or following up on treatment.

Approximately three weeks later, on 6/17/02, the plaintiff’s decedent again sought treatment from the defendant for complaints of right heel redness, swelling, and burning. The defendant noted that her heel had a 4x4cm area of blackened eschar (dead tissue). He prescribed Santyl ointment and saline dressings. Three days later, on 6/20/02, she was again seen by the defendant who noted that her heel was unchanged.

The plaintiff’s decedent followed up on 7/1/02 with the defendant who noted that her heel ulcer persisted at the same size and that black eschar was present. He also noted that he would continue to treat her with the Santyl ointment and saline dressings. On 7/11/02, the defendant found that the ulcer has increased to a 6 x 7 cm blackened area, and he referred her to a wound clinic.

The plaintiff’s decedent was seen by the wound clinic on 7/24/02. The evaluation revealed a 3.4 x 4cm, full thickness, Stage 3-4 ulcer of her right heel. The examination also revealed redness of the foot and ankle as well as 2-3+ bilateral lower extremity edema. Pedal pulses were not palpable on either leg but were audible with a Doppler. The wound clinic ordered non-invasive vascular studies, dry dressings, a vascular surgery consult, and Keflex.

The plaintiff’s decedent was seen a vascular surgeon who found a large area of necrosis on her right heel, and noted that her non-invasive vascular studies were consistent with right superficial femoral artery occlusion with severe ischemia of the right lower leg. His impression was that a right above-the-knee amputation might be necessary.

The plaintiff’s decedent underwent a right above-the-knee amputation on 09/10/02. The amputation site became infected, and she had to undergo an incision and drainage of her right stump. Cultures of the stump were positive for MRSA. She was treated with antibiotics, however her condition worsened and she ultimately died from sepsis.

The plaintiff claimed that the defendant was negligent in not arranging a vascular consult sooner. In a diabetic patient with a non-healing right foot ulcer that had not responded to conservative treatment, the standard of care required a prompt referral for vascular studies or a vascular surgery consult.

The defendant was prepared to present expert testimony that he was not negligent and that he complied with the standard of care at all times in the performance of his duties. It was reasonable to treat the foot ulcer conservatively initially, and when it did not respond to treatment he referred the patient to a wound clinic in a timely way. The defendant further contended that the unfortunate outcome was not connected to his care and treatment, and indeed happened over two months after he last saw the patient.

The case settled prior to trial for $900,000.

Lubin & Meyer attorneys represented the plaintiff in this diabetic wound infection lawsuit.

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