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ER Providers Fail to Meet Standard of Care

Failure to Identify and Diagnose Bleed in Lower Leg Results in Amputation and $700,000 Settlement

A man visited his local Emergency Room complaining of extreme pain in his lower leg. This plaintiff was an African American male, aged 36 years. He could not connect the pain with a specific injury. In leg amputation medical malpractice - Altizer Law, P.C.providing his medical history, he reported an embolic stroke several years before this ER visit. He also reported a recent history of DVT of the right leg that was being treated with an oral anticoagulent medication.

Upon physical examination of the painful leg, the ER physician made note of a “rock hard” calf muscle. He noted that the surrounding muscle segments were “soft.” The ER physician also noted palpable pulses in both legs and no evidence of neurovascular compromise. Blood tests were ordered. The blood tests indicated unusually low levels of hemoglobin, hematocrit, and red blood cells. Each of these levels should have indicated that plaintiff’s anticoagulant was not working properly and that there was an internal bleed. In addition, the INR was elevated, indicating that the patient’s blood was not coagulating properly. This also indicates an internal bleed. No diagnostic studies were conducted to determine the cause of the leg pain.

The ER physician prescribed valium, IV pain medication, and suspension of patient’s anticoagulant medications for 24 hours. The patient’s was then discharged. The diagnosis recorded was acute leg pain, acute muscle spasm and Coumadin coagulopathy.

Plaintiff returned to the same ER a few hours later. His complaint was that the pain had returned and that his ability to walk was limited. There were two important changes in his vital signs: elevated blood pressure and tachycardia. On this visit plaintiff was examined and treated by a Physician’s Assistant who was supervised by an attending ER doctor. The Physician’s Assistant noted diminished pulses bilaterally and a swollen gastroc muscle that was tense and tender, and a suspicion of compartment syndrome due to a spontaneous bleed in the left gastroc muscle. Intravenous pain medication and a muscle relaxer were prescribed. Upon reexamining the plaintiff, there was no pain upon flexion of the leg and foot. Based upon this observation, compartment syndrome was ruled out. The patient was then discharged. There is no indication in the records as to whether the attending physician did or did not examine the patient.

Three days later, and upon noticing coolness in the lower leg, swelling in the calf and knee, and pain, plaintiff called for an ambulance and was taken to another emergency room. During this visit, diagnostic tests were completed, including a CT-scan of the left leg. The CT-scan revealed a “ruptured left popliteal artery aneurysm. This ER physician obtained a consultation by a vascular surgeon, who discovered no pedal pulses in the left foot, diminished sensation in the calf and compartment syndrome. Plaintiff was then taken to emergency surgery for a fasciotomy and a repair of the aneurysm with bypass grafting.

Plaintiff’s recovery was complicated and difficult with incidences of vascular insufficiency due to a graft occlusion and wounds of the leg that persisted despite treatment. After roughly 18 months, the limb could not be salvaged and an amputation was performed.

Plaintiff’s attorneys argued that ER treatment on the first two visits standards of care were not met and that the nature of the symptoms was not fully investigated and diagnosed. Plaintiff’s expert witness argued that if the appropriate tests had been conducted, the aneurysm would have been observed and repaired in a timely fashion. Had this been the case, plaintiff’s leg would not have required amputation.

This medical malpractice case was resolved in mediation and plaintiff was awarded a $700,000 settlement.

Every failure to meet standards of care puts the patient at risk, as was the case here.

If you or a loved one has been harmed by the wrongdoing or negligence of a medical practitioner, you may be entitled to a financial award. When you call the trusted and experienced attorneys of Altizer Law, P.C. you can be assured that we will fight for you to recover the highest possible financial settlement or award under Virginia Law.