Delay in Diagnosing Flesh Eating Bacterial Infection: $1 Million Settlement
Urgent care and emergency department doctors misdiagnose man with gout and failed to diagnose necrotizing faciitis
2023 Medical Malpractice Settlement Report
By William J. Thompson, Attorney
Hampden Superior Court, Springfield, Massachusetts
The plaintiff’s decedent died on 9/12/17 at the age of 58 from sepsis secondary to a bacterial infection (Fournier’s gangrene).
On 9/11/17, the patient presented to Urgent Care (UC) with left foot pain and fever of 101.8 degrees. The pain had started that morning, and was getting worse. He could not bear weight. He had no injury that he could recall. He had no history of gout. The doctor took an x-ray of the left foot was essentially normal. Laboratory studies including tests for Lyme disease and uric acid were normal. The doctor instructed the patient to present to the hospital for worsening symptoms, especially fever, chills, and redness, and documented a concern for septic arthritis. He prescribed Indomethacin and Tramadol and recommended crutches.
On 9/12/17 at 4:31 a.m., the patient presented to an Emergency Department (ED) with left foot swelling and throbbing pain scored 10/10. He reported increased swelling. He had a pulse of 128. The patient had eaten oysters, beer, and steak the weekend prior and the ED doctor diagnosed arthritis and gout. He prescribed Prednisone 60 mg per day. The patient was discharged to home at 5:55 a.m. in a wheelchair.
At 1:53 p.m., the patient returned to the ED for decreased mental status. It was noted he had a swollen tongue and numb arms and felt tingly and reported a pimple on his scrotum. Examination of his scrotum revealed necrotic tissue, potentially representative of Fournier’s gangrene. There was concern for sepsis as well and his left leg was cold, mottled, and the sole of his foot was purple and mottled. He was initially alert and oriented, but had an oxygen saturation of 88% on room air.
Thereafter, his condition deteriorated and he became hemodynamically unstable. A code blue was called. He was resuscitated and taken to the operating room. Scrotal debridement and packing was then performed. The findings included black skin on the scrotum with progression.
He coded again at approximately 5:30 p.m., and subsequently died.
Wound and blood cultures eventually grew out Group A Beta Hemolytic Streptococci. Autopsy findings included necrotizing fasciitis of the perineum and scrotum.
The plaintiff alleged the urgent care and emergency department doctor misdiagnosed the decedent with gout and failed to diagnose necrotizing fasciitis. The defense claimed there was no negligence, and the entry site was not the foot but rather the scrotum.
The case settled a few months before trial for $1,000,000.
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