Benjamin Gideon, Esq., returned an undisclosed, seven-figure settlement to a patient who lost her lower leg after doctors misdiagnosed multiple blood clots and delayed treatment for weeks. The following animations helped Mr. Gideon show what went wrong.
The Defendant's negligence included, but was not limited to: failing to consider all of his patient's signs and symptoms, failing to make a differential diagnosis, failing to obtain appropriate studies, and failing to obtain appropriate care.
Misdiagnosing the Blood Clot
The patient first entered a care clinic reporting pain in her right foot that was so severe, it would awaken her from sleep. She explained she did not experience any specific injury, and she had been using ice, elevation, and over-the-counter pain relievers with no relief. She also reported that her toes were cramped, her foot was cold to touch. She was examined by the Physician’s Assistant, who noted that she had redness on the top of her foot going back to her heel.
Instead of ruling out the worst case scenario first, the Physician Assistant misdiagnosed her as having gout. He provided her with 50 mg of Indomethacin and instructed her to follow up with her Primary Physician if symptoms did not improve.
Delaying Treatment for Weeks
Five days later, the patient returned to the same clinic reporting numbness and continued pain in her right foot with an intensity of 7 out of 10 on the pain scale. The Doctor noted that her foot had a “mottled” appearance and mild tenderness, but he discharged her with no follow-up ordered.
Thirteen days after her second visit to the clinic, the patient returned to the clinic to report that she had been taking her Indomethacin for gout with no improvement. She also noted that her right foot felt cooler than her left foot and she had an open wound on her big toe that was draining purulent material.
The Physician Assistant’s examination revealed bluish discoloration on two of her toes. He also noted an underlying blister draining sanguineous fluid from her toe. He was unable to feel a pulse in her dorsalis pedis artery and could feel only a faint pulse in her posterior tibialis artery. The Physician Assistant instructed her to go immediately to the emergency room.
What Was Really Happening?
In reality, multiple blood clots were choking off blood to her lower leg in her anterior tibial artery, peroneal artery, and posterior tibial artery. The animation below helped Mr. Gideon demonstrate how these three arteries connect back through the femoral artery to the heart, which delivers the oxygenated blood necessary for tissue to function and survive.
The next animation demonstrates how a blood clot can form, obstruct blood flow to the lower leg, and break off into tiny pieces that travel downstream to obstruct smaller arteries. The animation concludes by showing the location of each blood clot inside this patient’s leg.
These blood clots can dramatically choke off the flow of blood, oxygen, and nutrients to the lower leg. Without proper treatment, this decrease in blood flow compromises tissue in the lower leg and result in severe damage, as animated below.
What Should Have Happened?
The proper treatment for an arterial clot is an anti-coagulation medication, such as heparin, which is routinely administered. As animated below, the medication compliments the body’s own natural mechanisms to break down and dissolve blood clots. Had physicians administered this drug much earlier, the patient’s lower leg could have been saved.
Too Little Too Late
The patient was brought to the Emergency Room where she underwent thrombolytic therapy in an attempt to restore the flow of blood to her lower leg. Thrombolysis is a blood clot treatment used in urgent situations in which a clot needs to be dissolved much more rapidly - as animated below. Had physicians administered this drug earlier, the patient’s leg could have been saved.
A week after undergoing thrombolytic therapy, the patient needed to have three of her toes amputated. Following the amputation, her foot showed little improvement, remaining cold, mottled, and cadaveric without capillary refill. Two days after the first amputation, she underwent a below-the-knee amputation of her right leg. That was ultimately unsuccessful, and she would undergo an above-the-knee amputation a week later.
The visual presentation helped Mr. Gideon demonstrate to the Defense why his client deserved a seven-figure, undisclosed settlement for the gross medical negligence that resulted in extreme pain, suffering, and ultimately, the loss of his client’s leg. The Defense settled for a seven-figure, confidential amount.
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