Allegation:
Patient alleged negligent surgical excision of benign, right calf mass resulting in severed tibial nerve and permanent disability.
Case Details:
A 54 YOM presented to podiatry with complaints of a painful right calf lump. The patient reported that it had been present for a year and was increasing in size. An MRI was ordered which revealed a 3.3 x 4.3 cm solid mass. The radiologist’s impression stated, “this is a sarcoma until proven otherwise.” The podiatrist recommended surgical removal of the mass. The patient had a past medical history significant for removal of a schwannoma in 1995. The insured’s consent discussion with the patient included the risk of nerve damage, in addition to other specifically identified significant risks. During the surgery to excise the mass, the insured severed the tibial nerve. It could not be reconnected due to retraction of the nerve ends. The surgical pathology report confirmed the mass was not a sarcoma, but that it was another schwannoma. Six days post-op, the patient was referred to a neurologist for nerve conduction studies. The patient claimed he now has an abnormal gait, nerve damage, and suffers from complex regional pain syndrome (CRPS).
Expert Testimony:
Defense of the case was challenging as the treating neurologist, and external experts could not support the podiatrist’s decision to proceed to surgery without first obtaining a biopsy of the mass. The informed consent discussion regarding nerve damage, and documentation of that discussion, in this case was not enough to defend the case because the surgery was unnecessary and could have been avoided if a biopsy had been completed prior to surgery.
Resolution:
The case was settled prior to trial.
Risk Reduction Strategies:
The following strategies can help enhance patient safety and reduce your liability risk for surgical patients:
- Conduct a thorough history and physical exam and document a patient’s medical history prior to initiating treatment or surgery.
- Ensure timely ordering of consults and tests when there is clinical suspicion for a condition or complication that requires further evaluation, i.e.: biopsy, imaging, intraoperative complication requiring surgical assist.
- Maintain a consistent assessment process for all procedures and evaluate patients against established protocols for patient selection.
Additional resources: Prevention of Surgical Errors; Santos G, Jones MW. Prevention of Surgical Errors. [Updated 2023 May 29]. In: StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK592394/
For more information see https://picagroup.com/
