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Leg amputation was due to doctor’s negligence, per patient

Amount:

$8,350,000

Type:

Verdict-Plaintiff

State:

District of Columbia

Venue:

District of Columbia

Court:

District of Columbia, Superior Court

Injury Type(s):

other-infection; other-loss of consortium; epidermis-gangrene; amputation-leg (leg (above the knee)); arterial/vascular

Case Type:

Medical Malpractice – Surgical Error, Informed Consent, Delayed Diagnosis, Delayed Treatment, Failure to Detect, Orthopedic Surgeon, Orthopedic Surgery, Failure to Diagnose, Negligent Treatment, Post-Operative Care

Case Name:

Eloyd Robinson and Clara Robinson v. Rida N. Azer, M.D., Metropolitan Washington Orthopaedic Association and American International Orthopaedic Association, LLC,
No. 2015 CA 008980

Date:

June 15, 2017

Parties

Plaintiff(s):

Clara Robinson (Female, 64 Years), 

Eloyd Robinson (Male, 82 Years)

Plaintiff Attorney(s):

Patrick A. Malone;
Patrick Malone & Associates, P.C.;
Washington,
DC,
for
Clara Robinson, Eloyd Robinson ■ Kenneth M. Trombly;
Trombly & Singer;
Washington,
DC,
for
Clara Robinson, Eloyd Robinson ■ Daniel C. Scialpi;
Patrick Malone & Associates, P.C.;
Washington,
DC,
for
Clara Robinson, Eloyd Robinson ■ Daniel S. Singer;
Trombly & Singer;
Washington,
DC,
for
Clara Robinson, Eloyd Robinson

Plaintiff Expert(s):

Paul Collier; M.D.; Vascular Surgery; Sewickley,
PA called by:
Patrick A. Malone, Kenneth M. Trombly, Daniel C. Scialpi, Daniel S. Singer ■ Craig Lichtblau; M.D.; Physical Medicine; Palm Beach,
FL called by:
Patrick A. Malone, Kenneth M. Trombly, Daniel C. Scialpi, Daniel S. Singer ■ Arthur McTighe; M.D.; Pathology; Baltimore,
MD called by:
Patrick A. Malone, Kenneth M. Trombly, Daniel C. Scialpi, Daniel S. Singer ■ Jeffrey Shapiro; M.D.; Orthopedic Surgery; Great Neck,
NY called by:
Patrick A. Malone, Kenneth M. Trombly, Daniel C. Scialpi, Daniel S. Singer ■ Richard Matza; M.D.; Orthopedic Surgery; Waterbury,
CT called by:
Patrick A. Malone, Kenneth M. Trombly, Daniel C. Scialpi, Daniel S. Singer

Defendant(s):

Rida N. Azer, 

Metropolitan Washington Orthopaedic Association, 

American International Orthopaedic Association LLC

Defense Attorney(s):

David Lee Rutland;
Wharton Levin Ehrmantraut & Klein P.A.;
Annapolis,
MD,
for
Rida N. Azer, Metropolitan Washington Orthopaedic Association, American International Orthopaedic Association LLC ■ Tiffany D. Randolph;
Wharton Levin Ehrmantraut & Klein P.A.;
Annapolis,
MD,
for
Rida N. Azer, Metropolitan Washington Orthopaedic Association, American International Orthopaedic Association LLC

Defendant Expert(s):

James Black;
Vascular Surgery;
Baltimore,
MD called by:
David Lee Rutland, Tiffany D. Randolph ■ Robin Karns;
Life Care Planning;
Silver Spring,
MD called by:
David Lee Rutland, Tiffany D. Randolph ■ Andrew Panagos;
Physical Medicine;
Bethesda,
MD called by:
David Lee Rutland, Tiffany D. Randolph ■ Edward McCarthy;
Pathology;
Baltimore,
MD called by:
David Lee Rutland, Tiffany D. Randolph ■ William Andrews;
Orthopedic Surgery;
Lynchburg,
VA called by:
David Lee Rutland, Tiffany D. Randolph

Insurer(s):

Medical Liability Mutual Insurance Co. for all defendants

Facts:

On July 16, 2013, plaintiff Eloyd Robinson, 82, a security guard, presented for a total knee replacement of the right knee, which was to be performed by orthopedic surgeon Rida N. Azer, M.D. The knee replacement was reportedly not completed due to a crumbling of the femoral bone. Instead of replacing the knee, Dr. Azer used a temporary bone graft and then placed Robinson’s leg in a whole-leg cast. At post-operative visits on August 16 and August 19, Dr. Azer suspected and/or diagnosed a venous clot in the right calf. Upon Dr. Azer’s advice, Robinson presented to the hospital on August 19. Robinson was admitted. His leg was then amputated by a different surgeon on August 23. A pathologist subsequently noted that the leg had extensive gangrenous changes, including a “hard, black, reddish-black and mummified” heel and partial mummification of toes one and three. Robinson filed a lawsuit against Dr. Azer and his medical practices, Metropolitan Washington Orthopaedic Association and American International Orthopaedic Association, LLC, alleging medical malpractice. Robinson alleged that, at the time of the scheduled surgery, he had a number of indications of potential problems in achieving a satisfactory outcome from knee replacement surgery due to prior arterial flow issues in his legs. He had significant peripheral vascular disease. He claimed he had neuropathy in his right leg, as well as calcification of the popliteal artery, and a stent that had been placed to support blood flow to the lower leg. He also claimed he was taking Plavix on account of the stent. The stent had been placed in Robinson’s right superficial femoral artery in February 2011 due to a non-healing ulcer of the right great toe. According to Robinson, circulation to the leg below the knee depended on the viability of the stent. Robinson alleged that Dr. Azer failed to ensure that blood flow to the right limb was adequately preserved so that the leg tissues would heal and recover from the surgery. Robinson also alleged that Dr. Azer never documented any examination of the adequacy of the arterial flow in the right leg and, in fact, did not seem to be aware of all the components of a vascular examination of the leg. Robinson asserted that Dr. Azer apparently relied on warmth of the leg to determine whether there was good arterial flow, but warmth of the leg is not a good indicator of arterial flow. Robinson maintained that the total knee replacement should not have been done without approval from a vascular surgeon, who would have required various intraoperative measures to avoid harming arterial flow to the leg and who would have been available for post-operative surgical clearance. Further, Robinson argued that, while Dr. Azer obtained pre-operative clearance by a cardiologist, this clearance was not an adequate substitute for clearance from a vascular surgeon. According to Robinson, Dr. Azer’s failure to obtain pre-surgical clearance from a vascular surgeon was a breach in the standard of care. Robinson alleged that Dr. Azer’s use of a tourniquet for two hours at 350 mm and another two hours and ten minutes at 400 mm was excessive both in the pressures used and the duration. Robinson argued that this very likely contributed to occlusion of the superficial femoral artery. He argued that most prudent surgeons would not have used a tourniquet in this instance and Dr. Azer’s use of the tourniquet at these pressures and times was a breach in the standard of care. Additionally, Robinson argued that, if the femoral bone was crumbling as Dr. Azer maintained that it was, Dr. Azer was obligated to obtain a correctly sized femoral implant and finish the surgery. Robinson claimed the failure to finish the femoral implant left him with no knee. Also, Robinson argued that the leg cast itself contributed to insufficient blood flow to the limb and the failure to appreciate ischemic changes in the leg until it was far too late to reverse them. Robinson also argued that, while Dr. Azer claimed he was unaware of the stent in his leg, there was a note in Dr. Azer’s records from another doctor in November 2012 that the stent was visible on an X-ray of the right leg. Also, Robinson alleged that Dr. Azer failed to perform a thorough workup to see if the leg could withstand the proposed surgery, which was a breach in the standard of care. Robinson alleged that the history taken by a physician’s assistant for the July 2013 surgery failed to note anything about the circulation to the right leg and failed to note which leg had the stent. Robinson maintained that Dr. Azer should have performed an examination on admission to document the pulses in the leg and to also document the presence of the stent in the right leg, but failed to do so, which was a breach in the standard of care. Moreover, Robinson claimed he was discharged after the surgery without having been examined by a licensed physician, even though he had repeated observations from nursing staff of vascular insufficiency throughout the short time he remained in the hospital after the end of the surgery. He claimed he also had a low-grade fever at the time of discharge and 10/10 pain in the leg, which was only temporarily relieved by intravenous narcotics. He argued that he should have been kept in the hospital and seen urgently by a vascular surgeon. Robinson also alleged that the accuracy of Dr. Azer’s office notes during the post-operative period lacked any specific documentation of pulses to the leg or any other specific details of an actual examination. Robinson also alleged that Dr. Azer made a contradictory note that the wound had healed, but he was leaving the sutures in place. There was also a photograph taken by Robinson’s son at the time of the visit that allegedly showed the surgical wound had not healed properly. Moreover, there was eyewitness testimony that Dr. Azer did not even touch Robinson’s leg at several follow-up visits. Robinson further asserted that Dr. Azer failed to document any ischemic changes to the leg in notes at post-operative visits on August 16 and August 19, while other providers on his admission to the hospital on August 19 found a blackened, insensate, partially mummified foot and other signs of long-standing ischemic injury. Robinson argued that all of this evidence supported the conclusion that Dr. Azer’s post-operative examinations were inadequate, which was another factor leading to the need to amputate the leg. Robinson alleged that Dr. Azer’s failure to recognize any issue with arterial blood flow prior to the August 19 hospital admission delayed the vascular workup he urgently needed. He asserted that, by the time he got to the hospital on the evening of August 19, it was too late to save the leg. For the leg to be in the state it was at the time of amputation, Robinson asserted that the vascular compromise had been going on for a minimum of two weeks at the time of the amputation, and maybe as long as four weeks. Robinson acknowledged that he had been advised by Dr. Azer on Friday, August 16 to go to the hospital for a Doppler test, but claimed he was unable to obtain the Doppler because he was told by hospital employees that the hospital did not have staff there to perform it over the weekend. Robinson also claimed that Dr. Azer never told him there was any urgency in getting the test and, in any event, he did not have a venous thrombosis, as Dr. Azer suspected, so the test would have been of no consequence. The defense contended that Dr. Azer was not negligent and nothing he did or failed to do brought about the loss of Robinson’s leg. Dr. Azer testified in his deposition that he had asked Robinson to return to the vascular surgeon who performed the stent insertion for a pre-surgical consultation, but Robinson failed to do so. Azer also argued that he recognized the high-risk nature of the surgery and discussed this with Robinson, but Robinson was insistent that he proceed with the surgery. Dr. Azer additionally claimed that, when he saw Robinson on Friday, August 16, he advised Robinson to obtain a Doppler test at the hospital, but Robinson failed to do so. Dr. Azer argued that, if Robinson had obtained the Doppler as recommended, the vascular compromise would have been diagnosed and treated in time to avoid amputation.

Injury:

Robinson claimed he suffered vascular compromise in his right leg following surgery performed by Dr. Azer, resulting in the need for an above-the-knee amputation on Aug. 23, 2013. At the time of the amputation, Robinson was working and leading an active life. He claimed that, as an amputee, he is largely confined to his home, unemployed and much less active than he was prior to the amputation. Robinson sought non-economic damages only. His wife, Clara Robinson, sought damages for loss of consortium.

Result:

The jury found for Robinson and determined that his non-economic damages totaled $6.75 million and that his wife was entitled to $1.6 million for loss of consortium. Robinson did not ask the jury for economic damages.

Trial Information:

Judge:

Neal Kravitz

Demand:

$5 million

Offer:

$750,000

Trial Length:

7
 days

Trial Deliberations:

1
 days

Editor’s Comment:

This report is based on information that was provided by plaintiffs’ counsel. Defense counsel did not respond to a request for comment.