Case details
Surgeon appropriately decided to close wound, defense argued
SUMMARY
$0
Amount
Verdict-Defendant
Result type
Not present
Ruling
KEYWORDS
arm, hand
FACTS
On Sept. 8, 2013, plaintiff Gregory Swift, 28, a college student with a history of heroin abuse, had relapsed and injected heroin into his left, non-dominant arm. He subsequently developed redness, swelling and pain, and he could not move his fingers. As a result, Swift presented to an emergency room on Sept. 11, 2013, and Dr. Harish Hosalkar, an orthopedic surgeon, was consulted. Hosalkar determined that Swift had the potential to develop compartment syndrome and took him immediately to the operating room. As the infection initially started in the hand, Hosalkar first performed a carpal tunnel release in order to try to protect the median nerve. He then began a fasciotomy to determine the extent of the infection and see what damage was done to the tendons. As a result, Hosalkar opened the top compartment of the arm to clean out the infected tissue and it was determined that it was not a deep infection. He then made sure that Swift’s muscles and nerves were not dead, and determined that everything was healthy and viable. Thus, Hosalkar felt that he had opened Swift’s arm early and was able to eradicate the infection without any compartment syndrome occurring. After he cleaned the area, Hosalkar closed the skin loosely at the incision site and placed a Jackson-Pratt drain to allow the superficial infection to properly drain. Following the procedure, Hosalkar planned to follow up Swift during his admission to the hospital to see if there was any swelling or compartment syndrome occurring. If there was, he would have opened the site again. However, five days after the operation, Swift felt he was not properly cared for and became frustrated. As a result, he left the hospital against the advice of physicians and went home. Swift eventually went to another hospital with complaints of a tight forearm. His compartment pressures were measured by an orthopedic surgeon, and Swift was found to be fine. A plastic surgeon then opened the site of the prior procedure, and Swift’s muscles came out of the wound. Swift was then left to heal. However, Swift claimed that his left hand ultimately became non-functional. Swift sued Hosalkar and Hosalkar’s medical office, Harish S. Hosalkar M.D. Inc. Swift alleged that Hosalkar failed to properly treat his left arm and that this failure constituted medical malpractice. The trial ultimately continued against Hosalkar only. Plaintiff’s counsel contended that Swift had compartment syndrome at the time he saw Hosalkar and that the release and fasciotomy should have been left open by Hosalkar. Counsel also contended that closing the skin did not allow the infection to drain and increased pressures in Swift’s arm, causing an ischemic nerve and muscle injury that resulted in a non-functional hand. The plaintiff’s orthopedic surgery expert opined that the decision to close the wound after the fasciotomy in order to treat the compartment syndrome that was compounded by the infection was well below the standard of care. The expert further opined that, instead, Hosalkar should have left the wound open to drain and heal by secondary intention. Defense counsel argued that there was no compartment syndrome at any time of the fasciotomy. Counsel contended that the compartment pressures measured by the subsequent orthopedic surgeon were normal and that Swift’s non-functional hand was due to the progressive infection of the tendons in his hand. The defense’s upper-extremity, orthopedic surgery expert opined that the decision to close the wound was appropriate because Swift’s muscles and nerves appeared complete and healthy, and were not protruding out of the compartment after Hosalkar did the fasciotomy. The expert also opined that because the infection was superficial, it was appropriate to utilize a drain through the incision, but close the wound to prevent other infections. The expert further opined that Swift had minimal drainage, that there was no clinical evidence of an infection, and that Swift would have healed normally if he had remained, as instructed, at the hospital. In addition, defense counsel contended that Swift left the hospital before he finished his course of antibiotics, which probably allowed the infection to continue and caused a tendon injury in Swift’s hand, rather than a nerve injury in Swift’s arm., Swift claimed that he was ultimately left with sensory complications and motor deficits, resulting in an inability to use his left hand. He claimed that as a result of his left hand being essential non-functional, he is limited to having to use it as only a helper hand. Swift was getting his college degree, but had previously worked doing manual labor jobs. However, he claimed that he is now precluded from doing any manual labor jobs due to his disability and that his ability to earn has decreased. The plaintiff’s neurology expert opined that Swift had global numbness in his palm and fingers of his left hand, and in both the ulnar and median nerve distribution. The expert also opined that the exam evidenced that Swift’s left hand was not functional and that, together with a lack of sensation in the hand, made Swift susceptible to injury. Thus, plaintiff’s counsel asked the jury to award Swift $800,000, including between $500,000 and $700,000 for Swift’s loss of earnings. Defense counsel contended that Swift underwent nerve conduction velocity studies and EMG studies, both of which indicated that Swift only sustained minor sensory deficits in the ulnar nerve. Counsel also contended that the minor sensory deficits would have only affected Swift’s sensation on the outside of his left ring finger and that all other objective nerve testing was normal. Accordingly, defense counsel argued that Swift never had compartment syndrome and that Swift did not suffer a true nerve injury. The defense’s neurology expert opined that the nerve conduction studies and EMG study confirmed that Swift only had a minor sensory deficit on the outside of his ring finger and that Swift otherwise had normal neurological findings. The defense’s orthopedic expert opined that Swift’s lack of function in his hand was due to the fact that Swift did not aggressively engage in physical therapy and that, therefore, the tendon of the hand scarred down from the infection. The expert further opined that if Swift had engaged in physical therapy, the tendons would not have become weak or scarred.
COURT
Superior Court of San Diego County, San Diego, CA
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