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Allegheny County Court of Common Pleas
knee other-infection other-arthrotomy other-staph infection other-physical therapy
Medical Malpractice - Hospital, Emergency Room, Infection Control, Failure to Diagnose, Negligent Treatment
William Warnick v. UPMC Passavant
March 12, 2013
William Warnick (Male, 68 Years)
James B. Cole; Cole & Hens-Greco, P.C.; Pittsburgh, PA, for William Warnick
Michael K. Feeney; Matis Baum O'Connor; Pittsburgh, PA, for UPMC Passavant
On July 19, 2009, plaintiff William Warnick, 68, presented to the emergency room at UMPC Passavant hospital in Pittsburgh, with a chainsaw laceration to his left knee. The wound was 7-centimeters long, comprised of a 6-centimeter abrasion and a 1-centimeter laceration that was a little deeper. Warnick alleged that the emergency-room personnel administered no antibiotics, and the medical staff failed to appreciate that he was at a greater risk for infection due to his psoriasis. Moreover, he alleged that emergency personnel reportedly missed the fact that the chainsaw had partially cut his quadriceps tendon. Warnick claimed that he developed a severe infection, in the form of staphylococcal septic arthritis in his knee, which required surgery and physical therapy. Warnick sued UMPC Passavant, alleging medical malpractice. Warnick's expert in infectious diseases opined that when a patient with likely staphylococcal colonization of his skin presents with a deep contaminated wound, it is standard of care to defer closure for several days and provide an antibiotic to prevent development of overt infection. Had such steps been taken, the infection would not have occurred, said the expert. Warnick's expert in emergency medicine/infectious diseases testified that the extent of Warnick's injury and potential risk for infection were not fully appreciated by the hospital's medical staff, including the presence of the quadriceps-tendon tear. Because of the failure to more appropriately treat the wound and failure to administer antibiotics, these factors increased Warnick's risk of a poor outcome, said the expert. The defense's expert in emergency medicine cited a nationwide study on antibiotic prescription practices of emergency-room physicians, in which the study reportedly concluded that a small percentage of physicians prescribe antibiotics. The reason, according to the expert, was that the medicine has a significant risk of side effects: allergic reactions, complications with other medications, diarrhea, and clostridium difficile. The defense expert explained the process the hospital personnel undertook in treating Warnick. According to the expert, although Warnick had not noticed any contaminants in the wound, the emergency-room personnel documented that it was "contaminated mildly with grease." The medical staff cleaned the wound with antiseptic and antibacterial soap and injected 1-percent anesthesia into the surrounding area. Medical personnel further irrigated the wound with saline, scrubbed it with saline gauze and explored the wound to its base in a bloodless field to fully assess the extent of the wound. Three staples were then utilized to close the wound. The expert concluded that there was no damage to Warnick's quadriceps tendon, and that the hospital staff's treatment of Warnick met the standard of care. The defense maintained that as Warnick was being readied for discharge, he was given a special staple remover to take to his primary-care physician. It was specially designed to minimize tissue damage during staple removal, and was not a device that a physician's office would normally have available. Warnick's discharge instructions required him to follow up with his doctor "within 12 to 14 days for reevaluation and FOR STAPLE REMOVAL." However, Warnick took it upon himself to remove his own staples after just three days. He also never followed up with his primary-care physician for reevaluation as directed by the emergency-room personnel, according to the defense. Warnick testified that before he was discharged from the emergency room, either a nurse or a physician's assistant handed him the staple remover and told him that he looked "pretty handy," and that he could remove the staples himself, which would save him a trip to the doctor's office. Warnick's counsel also cited the medical records of his treating orthopedic surgeon and infectious-disease physician, in which Warnick told them how he was instructed by the UMPC staff to remove the staples himself.
On Aug. 17, 2009, Warnick returned to UPMC Passavant with a left knee infection, at which time he was diagnosed with staphylococcal septic arthritis. On Aug. 18, he underwent a left knee arthrotomy to drain and irrigate his knee, during which time a minor quadriceps tendon tear was repaired. Following a six-week course of intravenous antibiotics, Warnick treated with physical therapy for about six weeks. By Jan. 29, 2010, he had regained near full range of motion in his leg and was walking with a normal gait. Warnick's expert in infectious diseases causally related Warnick's infection to the hospital's alleged failure to treat him with antibiotics. Warnick, who testified that he was back to normal approximately a year later, sought to recover about $12,000 in past medical expenses and an unspecified amount in non-economic damages for past pain and suffering. The defense's expert in orthopedic surgery opined that if there was a quadriceps tendon tear as alleged by Warnick, it was so minor in nature that it could have gone without treatment of the tear for the rest of Warnick's life. The defense's expert in emergency medicine/infectious diseases testified that the staphylococcal infection Warnick suffered was not caused by the hospital's treatment; rather it was the result of Warnick's self-removal of staples. According to the expert, based on the gestation period of staphylococcal infections, it was not possible for bacteria in the wound on July 19 to take a month's time to manifest into a staphylococcal infection and be diagnosed on Aug. 17. The infection would have started a week later, at the latest, said the expert. The expert opined that the likely cause of the infection was Warnick's removal of the staples in a high-tension area of his knee without proper support, which likely reopened the wound and introduced it to new bacteria.
The jury found that the conduct of the hospital agents did not fall below the applicable standard of medical care.
Terrence W. O'Brien
This report is based on court documents and information that was provided by plaintiff's counsel and defense counsel.