Case details
Wound infection known risk of excision, defense argued
SUMMARY
$0
Amount
Verdict-Defendant
Result type
Not present
Ruling
KEYWORDS
disfigurement, leg, scar
FACTS
On May 6, 2010, plaintiff Susan Goldburg, 58, a retail worker, underwent an excision of skin cancer on her right arm and leg. The excision surgery was performed by Elaine Woo Gallagher, a licensed nurse practitioner Contour Dermatology and Cosmetic Center in Palm Springs. She was assisted during the procedure by a medical assistant. Goldburg’s prior medical history was positive for multiple prior excisions for skin cancer and for frequent sinus infections requiring surgical intervention. On April 2, 2010, she presented to Dr. Timothy Jochen at Contour Dermatology and Cosmetic Center due to a concern about several lesions that she suspected could be skin cancer. A biopsy of the lesion on her right arm and leg was taken and both were positive for skin cancer. Goldburg later returned for a follow-up visit on April 30, 2010, and was advised to undergo excision of the right arm and leg lesions in order to obtain clear margins. However, the excision could not be done at that time since the biopsy sites had not fully healed. As a result, she returned the center on May 6, 2010, and underwent an excision of the skin cancer at that time. On May 8, 2010, Goldburg presented to a local emergency room with redness and inflammation of the right arm and leg at the excision sites. She was admitted to the hospital to rule out wound infections and was seen by a surgeon upon admission, who determined that she had a right leg abscess and cellulitis. A nasal swap taken at or about midnight was determined to be positive for Methicillin-resistant Staphylococcus aureus. A wound culture later taken of the right leg was also positive for MRSA. Goldburg sued Contour Dermatology and Cosmetic Center, APC. She alleged that the defendant’s staff failed to properly perform the excision on May 10, 2010, and that their failure constituted medical malpractice. Jochen and Gallagher were ultimately dismissed from the case for undisclosed reasons prior to trial. Thus, the matter proceeded against Contour Dermatology only. Goldburg claimed that at no time did she observe either the medical assistant or the nurse practitioner wash or sanitize their hands prior to putting on their sterile gloves. She also claimed that during the procedure the medical assistant, at the direction of the nurse practitioner, left the room with her sterile gloves on to secure the assistance of another medical assistant, and when she returned, the medical assistant made no effort to change her gloves before re-entering the sterile field. Goldburg further claimed that the second medical assistant participated in the surgery without taking the necessary sterile precautions. The plaintiff’s infectious disease expert testified that MRSA wound infections do not occur in the absence of negligence following skin cancer excisions. The expert opined that the most likely cause of the post-excision infection was a contaminated sterile glove and inadequate skin preparation. The expert also highlighted other breaches of the standard of care that could also have caused the infection, including the failure to wash or sanitize the hands, contact by one of the providers with an area of the plaintiff’s clothing, or skin that was colonized with MRSA followed by contact at the surgical site. Defense counsel contended that clean and sterile precautions were maintained throughout the surgery. Counsel also contended that post-surgery wound infections are a known risk of the procedure and that 80 percent of time, when a wound infection occurs, the patient has been shown to have been contaminated with staph aureus prior to the surgery. Both the medical assistant and the nurse practitioner denied the medical assistant leaving the procedure room during plaintiff’s excision surgery. They also contended they took proper sanitary procedures. The defense’s dermatology expert testified that the standard of care for an outpatient skin cancer excision is to use both clean and sterile techniques in order to minimize the risk of infection. The expert also testified that there is a known risk of post-excision wound infection of 1 percent to 3 percent in such a setting, despite the appropriate clean and sterile precautions. The defense’s infectious diseases expert testified that approximately 80 percent of post-surgery wound infections occur as a result of the patient being contaminated with staph aureus or a derivative of staph bacteria at the time of the procedure. The expert opined that Goldburg’s post-excision surgery nasal swap that was positive for MRSA was consistent with colonization prior to the time of the procedure. According to the expert, Goldburg’s leg excision site was contaminated with MRSA prior to the excision and there would not have been any way to know it. Thus, the infectious diseases expert opined that, at the time of the excision surgery, MRSA was unknowingly inoculated into the deeper tissues and soon thereafter, Goldburg began to manifest clinical signs and symptoms of a wound infection., Goldburg presented to a local emergency room on May 8, 2010, with redness and inflammation of the right arm and leg at the excision sites. She was subsequently admitted to the hospital and determined to have a right leg abscess and cellulitis. She was also found to be positive for Methicillin-resistant Staphylococcus aureus after a nasal swap was taken. On May 9, 2010, Goldberg underwent an incision, drainage and debridement of the right leg wound infection. A wound culture of the area in question was ultimately found to be positive for MRSA. As a result, Goldburg was given a PICC line, through which intravenous antibiotics were administered and she was discharged from the hospital on May 15, 2010. The PICC line remained in place for approximately one month and the wound vacuum was not removed until June 2010. Goldburg claimed that she was left with a lengthy scar to her right leg. She also claimed that she still suffers numbness and pain in her legs. She alleged that as a result, she suffers from emotional distress. Goldburg sought recovery of damages for her past and future pain and suffering.
COURT
Superior Court of Riverside County, Corona, CA
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