Allegation:
The patient brought allegations against the podiatrist for failure to obtain informed consent for additional procedure and negligent management of a surgical complication resulting in need for further surgery.
Case Details:
A 54 YOF presented to podiatry with complaints of right heel pain and left great toe pain. The patient received a plantar fasciitis injection to the right foot. An x-ray revealed a hallux valgus deformity with degenerative changes of the left 1st metatarsophalangeal joint (MPJ) with increased intermetatarsal angle. The patient underwent six MLS laser treatments to the left, 1st MPJ over the next three months without relief and decision was made to proceed to surgery. The podiatrist performed a left 1st metatarsal ostectomy and cheilectomy. During surgery, it was discovered that the patient had a large bone cyst, which was removed, but the bone cyst defect collapsed and the only available option during surgery was placing an implant because bone cement, bone graft, or a plate with screws were not available at the surgery center. This resulted in loss of bone beyond what was anticipated and a 16mm implant being placed but shortening occurred.
Post operatively, the insured discussed the cyst encountered with the patient and discussed surgical correction with a bone graft for lengthening as well as distraction with an external fixator. The second procedure would require additional prolonged non-weight-bearing recovery period, inability to wear high-heeled shoes, and lifelong pain and discomfort. The patient elected not to have the second surgery before getting a second opinion. The patient never returned to the insured nor underwent any additional care.
Expert Testimony:
There was very strong defense expert support for the podiatrist’s surgical decision making and handling of the surgical complications.
Resolution:
A defense verdict was entered in favor of the podiatrist.
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.
- The informed consent discussion and signature form should include each potential procedure- If there is a high incidence of certain complications which may require additional procedures intraoperatively, discuss these with the patient ahead of time and list all possible procedures on the consent form, or separate forms.
- Include in your office note thought process, rationale and medical decision making and the patient’s agreement / disagreement and understanding of the plan of care.
Conclusion:
Even when there is an appropriate diagnosis and appropriate procedures are performed, a claim can be brought against you. Contemporaneous documentation is important especially if a claim is brought against you years later. Should a question arise about a visit or a decision, thorough documentation can support defense of the care provided.
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