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RISK MANAGEMENT
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partner, the lab results were returned indicating staphylococcus and
actinomyces meyeri infections. The patient was called and asked to
come to the surgeon’s office that day. She was emergently referred to
a plastic surgeon, who admitted her for IV antibiotics and several
debridements of the wound.
ALLEGATIONS
A lawsuit was filed against the orthopaedic surgeon, alleging that
he failed to timely and adequately treat the patient’s post-operative
infection. She claimed that function of her lower leg was impaired
as a result of the infection and the failed Achilles tendon graft.
The patient underwent subsequent surgeries with a plastic surgeon
to remove the original tendon transfer due to necrosis of the tissue.
Tissue from the patient’s wrist was transplanted to the original sur-
gical site to fill the void left by the removed tissue. The patient
claimed the subsequent surgeries resulted in the loss of sensation in
her fingers.
LEGAL IMPLICATIONS
TMLT consultants who reviewed this case were generally support-
ive of the orthopaedic surgeon. Infection is a known complication
of Achilles tendon repair. There also appeared to be some question
of patient compliance. However, all of the consultants had some con-
cerns about the lack of adequate documentation pertaining to justi-
fication of the antibiotics chosen.
The surgeon’s partner had also missed elements of the documen-
tation, and did not provide detail about why he chose amoxicillin
clavulanate. However, the only defendant in this lawsuit was the or-
thopaedic surgeon who performed the repair.
DISPOSITION
This case was settled on behalf of the orthopaedic surgeon.
RISK MANAGEMENT CONSIDERATIONS
Although infection is a known complication inherent in any sur-
gical procedure, there were several problems with the surgeon’s doc-
umentation that complicated the defense of this case.
It is recommended that all phone calls between the patient and
physician be documented, particularly calls in which medical advice
is given. There was no record of the patient’s call that triggered a pre-
scription for ciprofloxacin, or reason for the change in the treatment
plan. Documentation of the patient’s symptoms, description of the
20 San Antonio Medicine • June 2015
wound and any noted changes, and the physician’s reasoning behind
treatment not only creates a thorough chart, but in this case, it would
have provided additional information to the surgeon’s partner when
he saw the patient.
Implementing a protocol that requires all staff making entries in
the chart to initial or sign their entries will assist in identifying who
made the entry in case it needs to be verified at a later date.
It is recommended that physicians have a policy and procedure
manual for the practice to ensure that all personnel are operating
under the same guidelines, as expected by the physician. This may
include any routine instructions that are commonly given to pa-
tients, such as how to perform a wet-to-dry dressing change. It is
further recommended that important instructions to the patient
be developed into a handout that can be given to the patient and
to document that the handout was given. Patients often become
confused when instructions are given in the office, which can make
compliance difficult. Should a claim occur, the printed instructions
could be used as evidence to show precisely what information was
given to the patient.
It is appropriate for medication allergies to be consistently and
boldly documented on the front of the chart to prevent them from
being overlooked. All physicians in the same practice should stan-
dardize how allergy information is displayed if they cover for one
other. It was fortunate that the pharmacy caught the error before the
prescription was filled; however, the error made the patient lose con-
fidence in the practice. A patient and/or the patient’s family are more
likely to file a lawsuit if they perceive that the care they are receiving
is substandard.
The information and opinions in this article should not be used
or referred to as primary legal sources nor construed as establishing
medical standards of care for the purposes of litigation, including ex-
pert testimony. The standard of care is dependent upon the particular
facts and circumstances of each individual case, and no generalization
can be made that would apply to all cases. The information presented
should be used as a resource, selected and adapted with the advice
of your attorney. It is distributed with the understanding that neither
Texas Medical Liability Trust nor Texas Medical Insurance Company
is engaged in rendering legal services. © Copyright 2015 TMLT.
Texas Medical Liability Trust is a BCMS Circle of Friends sponsor at
the platinum level. BCMS does not endorse products or services.