Case details
Plaintiff had vascular issues prior to toe amputation: defense
SUMMARY
$0
Amount
Verdict-Defendant
Result type
Not present
Ruling
KEYWORDS
gangrene amputation, osteomyelitis epidermis, toe
FACTS
On June 19, 2015, plaintiff Aaron Brown, 35, a disabled diabetic with end-stage renal disease and neuropathy, presented to Vallejo Foot & Ankle Clinic, in Vallejo, with a new ulceration on his left, little toe. Brown had begun at-risk podiatric care at Vallejo Foot & Ankle Clinic on Dec. 21, 2013. He was treated by two podiatrists, Dr. Paul Weiner and Dr. Ryan Thomas, who provided Brown diabetic foot care approximately every two months. During that time, Weiner treated two small ulcerations on Brown’s left, fifth toe, which both healed with conservative treatment that included antibiotic ointment and a bandage. In April 2015, Weiner performed non-invasive, diagnostic testing on the arteries and found that Brown had developed decreased blood flow to his left foot. Weiner referred Brown to a vascular surgeon, who performed an arterial duplex and noted narrowing of the vessels and calcifications. The vascular surgeon did not recommend any intervention at that time. Brown presented to Weiner on June 19, 2015 to have a callus removed from his left, fifth toe (the little toe). Brown also complained of pain to the left subtalar joint. During the callus removal, it was discovered that Brown’s toe had a new ulceration, which Brown was allegedly unaware about. Weiner debrided the wound and dressed it with antibiotic ointment and a bandage. He also ordered an X-ray to evaluate Brown’s feet. Brown returned to Vallejo Foot & Ankle Clinic on June 26, 2015, with complaints of pain to his feet and ankles. He was seen by Thomas, who noted that the ulceration had doubled in size since the last visit. However, Brown was allegedly still unaware he had the ulceration. Thomas reviewed the X-rays and noted arthritic changes. Thomas debrided the ulceration and dressed it with an antibiotic ointment and a bandage. Thomas also ordered laboratory tests to rule out inflammatory arthritis. On July 13, 2015, Brown presented to Thomas for a follow-up visit and the ulceration was determined to have reduced in size by approximately 50 percent. Thomas also reviewed the laboratory test results and noted that Brown had elevated inflammatory markers. In addition, Thomas again debrided the ulceration and dressed it with an antibiotic ointment and a bandage. Brown returned to Vallejo Foot & Ankle Clinic on Aug.17, 2015 and saw Thomas. Brown reported that he was dropped from the kidney transplant list due to the open wound on his left, little toe. Thomas subsequently had Weiner come into the room to discuss the issue with Brown. They discussed options to heal the wound quicker and ordered an X-ray to check for bone involvement on the wound. They also debrided the ulceration once again, and dressed it with an antibiotic ointment and a bandage. After developing foul smelling discharge from the toe, chills, and a fever, Brown presented to John Muir Health, Concord Medical Center, in Concord, on Aug. 24, 2015. He was subsequently found to have acute osteomyelitis and gangrene. He ultimately underwent an amputation of the left, little toe along with a portion of the metatarsal. Three weeks later, Brown returned to John Muir Health, Concord Medical Center; underwent an angiogram; and was noted to have severe blockages in the arteries supplying blood to his left foot. Brown sued Weiner; Thomas; and the podiatrists’ medical office, Vallejo Foot & Ankle Clinic. Brown claimed that Thomas and Weiner were negligent in the care of the wound on his toe. He also alleged that the podiatrists failed to diagnose his infection during his last visit on Aug. 17, 2015. The plaintiff’s podiatry expert opined that Thomas and Weiner should have cultured the wound, utilized biologics, and referred Brown to a specialist. The expert also testified that the documentation was below the standard of care. Defense counsel contended that Thomas and Weiner met the standard of care at all times. The defense’s podiatry expert opined that Brown’s care was appropriate and that the wound had decreased over the course of the four visits. The expert also opined that there was no reason to change the treatment, as the same treatment had been successful in the past. In addition, the expert opined that the loss of the toe was due to impaired blood flow and neuropathy. The defense’s vascular surgery expert opined that the loss of the toe was due to the natural course of Brown’s disease, as Brown was found to have severe arterial disease after the amputation. The expert explained that the condition was likely present during Thomas’ and Weiner’s care of Brown and that the condition caused Brown to have an inability to prevent an infection or heal the ulceration., Brown was found to be suffering from acute osteomyelitis and gangrene. He ultimately underwent an amputation of the left, little toe along with a portion of the metatarsal. Brown claimed the loss of the toe impacted his ability to balance, walk, and engage in recreational activities that he once enjoyed, such as softball and going out with friends. Thus, Brown sought recovery of non-economic damages for his past and future pain and suffering. Hie also sought recovery of past medical expenses, which were stipulated to total $18,000. (Brown did not make a claim for lost wages, as he was disabled at the time of the incident.)
COURT
Superior Court of Solano County, Solano, CA
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