Allegation:
Negligent surgical excision of a plantar fibroma resulting in a severed medial plantar nerve and permanent injury.
Case Details:
A 49YOF was seen by podiatry for a rapidly growing, large painful lump in the arch of her left foot and diagnosed with a plantar fibroma. The podiatrist performed surgery to excise the plantar fibroma. The patient complained of pain in her foot at her post-op visit due to a severed medial plantar nerve. The patient sued the podiatrist for medical negligence. The judge dismissed the case during trial due to lack of admissible evidence, but the plaintiff filed a successful appeal and was granted a second jury trial. There were several instances in her second trial that her testimony contradicted her testimony in the first trial. The podiatrist’s testimony was consistent with his documentation in the patient’s medical records, making him more believable to the jury.
Expert Testimony:
Plaintiff’s expert witness testified that transection of the medial plantar nerve was unexpected and considered malpractice. During cross examination defense counsel brought forward his prior testimony from another case in which he claimed that severing of the plantar nerve was a known complication and not malpractice, which damaged his credibility.
Resolution:
A defense verdict was entered in favor of the podiatrist at both trials.
Risk Reduction Strategies:
The following documentation strategies can help enhance patient safety and reduce your liability risk:
- Document all informed consent discussions in the patient medical record including the nature of the procedure, the potential risks and benefits, alternative treatments available, and level of the patient’s understanding and participation in the process.
- Create an accurate record of what occurred during a patient encounter to demonstrate the thought process, rationale and medical decision making. Should a question arise about a visit or a decision, thorough documentation can support defense of the care provided.
- Review office notes that have been dictated or transcribed for accuracy before submitting. Be alert to systems that have autocorrect functions or words that are easily misinterpreted and may alter the content from what was intended.
Conclusion
Complete and accurate documentation of all communications and interactions with patients is critical in the defense of negligence claims, and in fostering quality and continuity of care.
Additional resource: for informed consent forms, informed consent checklist and refusal of treatment forms see https://riskmanagement.proassurance.com/sample-forms
For more information see https://picagroup.com/
