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Patient's refusal of ultrasound led to diagnosis delay: defense
Saginaw County, Circuit Court, Saginaw
other-resection; foot/heel-foot drop (drop foot); arterial/vascular-artery
Medical Malpractice - Nurse, Hospital, Failure to Test, Delayed Diagnosis, Delayed Treatment, Orthopedic Surgeon
David Long v. Covenant Medical Center Inc. d/b/a Covenant Healthcare, No. 13-021595-NH
April 12, 2016
David Long (Male, 58 Years)
David J. Winter; David J. Winter, PLC; Plymouth, MI, for David Long
Ying Lum; M.D.; Vascular Surgery; Baltimore, MD called by: David J. Winter ■ Linda Castano; R.N.; Nursing; Detroit, MI called by: David J. Winter ■ Robert Corn; M.D.; Orthopedics; Cleveland, OH called by: David J. Winter
Covenant Medical Center Inc.
Jonathan C. Martin; Smith Martin Powers & Knier, PC; Bay City, MI, for Covenant Healthcare, Covenant Medical Center Inc.
Coverys for the hospital defendants
On Oct. 24, 2011, plaintiff David Long, 58, disabled, underwent a right total knee replacement. Long had a documented popliteal artery aneurysm behind his right knee and a history of deep vein thrombosis (DVT). The knee replacement procedure was performed by an orthopedic surgeon at Covenant Medical Center in Saginaw. Prior to surgery, in light of the patient's popliteal artery aneurysm, the orthopedic surgeon consulted with a vascular surgeon and obtained clearance to perform the surgery. In the early morning hours the next day, Long complained of tenderness in his right calf. A physician's assistant ordered a venous Doppler ultrasound of the right leg, but Long reportedly refused several of the vascular teams' attempts to conduct the study, which was ultimately performed at approximately 4 p.m. Shortly before the study was performed, a physician noted that Long's right leg was cool, with a normal pulse. The study's results showed an occlusion of the popliteal artery. That day, on Oct. 25, 2011, Long underwent a lower extremity bypass surgery which was performed by a vascular surgeon. A few days later on Oct. 30, 2011, Long complained of severe pain that stemmed from his abdomen. The cause of his abdominal pain was determined to be mesenteric ischemia, caused by decreased blood flow to his bowel. Long underwent a procedure that same day that included resectioning and removal of part of his bowel. Long's hospitalization lasted approximately six weeks. After several months had passed, Long's original bypass occluded and doctors at another hospital found that his lower right leg was in a hypercoagulable state. He ultimately underwent a second lower extremity bypass surgery. He allegedly suffered right-sided foot drop. Long sued Covenant Medical Center, Inc. d/b/a Covenant HealthCare, alleging medical malpractice. He had also sued the orthopedic surgeon and nurses, but they were dismissed because they were hospital employees. The matter proceeded to trial against Covenant Medical Center only. Long alleged that the orthopedic surgeon and the hospital's nursing staff failed to closely monitor him after his knee replacement surgery, failed to appreciate the signs and symptoms of a popliteal artery occlusion, and failed to intervene in a timely manner. Long claimed that, at the time of his initial hospitalization, he made complaints of unbearable pain, numbness and weakness, and his complaints were consistent with impaired blood flow caused by thrombus of the popliteal artery aneurysm. Plaintiff's counsel argued that a vascular surgeon should have been immediately consulted after the surgery and that a vascular surgeon would have detected a thrombosed popliteal artery without a Doppler ultrasound. Long maintained he was not responsible for his decisions to refuse the Doppler study because he was in a state of severe pain and was under the influence of narcotic pain medications. He claimed that a venous Doppler study was not necessary and was not the proper way to diagnose an arterial condition. The plaintiff's orthopedic surgery expert testified that there was evidence of thrombosis within Long's popliteal artery aneurysm prior to surgery and that the orthopedic surgeon should have recognized Long's condition was medically dangerous and required intensive post-operative monitoring. The plaintiff's orthopedic surgery expert opined that the hospital's failure to consult a vascular surgeon in the immediate postoperative period was a deviation from the standard of care. The plaintiff's expert in vascular surgery opined that, based on Long's complaints of unbearable discomfort in his lower right leg, his popliteal artery aneurysm became occluded either at the time of the knee replacement or within two hours thereafter. He testified that Long did not receive a proper diagnosis or treatment for a period of 36 hours, and the delayed diagnosis led to nerve damage, foot drop and a low-flow state which caused mesenteric ischemia and the need for a bowel resectioning. The plaintiff's nursing expert testified that the attending day shift nurse on Oct. 25, 2011 failed to notify the attending physician of Long's complaints of pain in his right lower extremity. She also testified that the nurse's efforts to obtain the Doppler ultrasound were inadequate. The defense asserted that the post-operative monitoring was sufficient and did not constitute a departure from the standard of care. The hospital maintained that its consultation with a vascular surgeon was timely and was obtained when signs of occlusion became apparent. Also, defense counsel contended that Long's refusal to permit the Doppler study until nine hours after he first complained of unbearable pain and numbness in his leg prevented a diagnosis prior to Long experiencing complete arterial occlusion. The defense's orthopedic surgery expert testified that there was no need to monitor the patient more closely because the hospital's routine post-operative monitoring orders after the knee replacement were sufficient and that the consulting vascular surgeon did not suggest more intensive monitoring was required. The expert opined that the treating orthopedic surgeon acted reasonably and within the standard of care in relying on the vascular surgeon's clearance of the patient for surgery. The defense's expert in vascular surgery testified that, based on normal pulses, color and temperature, the popliteal artery aneurysm did not become completely occluded until around the time the Doppler ultrasound was performed. The expert testified that, if Long had experienced a complete occlusion of the popliteal artery during the 36 hours as claimed, there would have been loss of muscle tissue in the lower extremity, which did not occur. He further opined that the foot drop was not likely to have been caused by the popliteal artery occlusion, but was likely a result of the original knee replacement surgery, or the fasciotomy performed by the vascular surgeon in connection with the patient's bypass. The defense expert opined that, if the patient had allowed the Doppler study to be performed earlier in the day, a developing thrombus could have been detected before complete occlusion occurred.
Long claimed a delay in diagnosing an occluded popliteal artery aneurysm resulted in nerve damage, foot drop and a low-flow state which caused mesenteric ischemia and the need for a bowel resectioning. Long sought recovery for past and future pain and suffering and past medical expenses. The defense argued that the occlusion was likely a result of the original knee replacement surgery, or the fasciotomy performed by the vascular surgeon in connection with his bypass, and was diagnosis was complicated by Long's refusal to allow an earlier Doppler study to be performed.
The jury found for the defendant and a defense verdict was entered.
Fred L. Borchard
4 male/ 4 female
This report is based on information that was provided by defense counsel. Plaintiff's counsel did not respond to the reporter's phone calls.