This is going to be long, so if you aren't into that sort of thing, go get your DNR GIF's & post away...this is still the Cliffs Notes version to this thing...lots more issues were discussed, but this is the nuts & bolts of the case I just sat through for 5 days
Civil Case...events happened all the way back in 2004.
Plaintiff is a 50 year old Paraplegic Man that has been paraplegic since 15 years old
Timeline4-5-04 - While at work, the plaintiff while in his wheelchair, reaches for an item that is too high, and ends up falling backwards out of his wheelchair when the back of the wheelchair breaks. Goes to his GP DR, who refers him to NKCBJ (Bone & Joint) where he has initial shoulder exam, which is negative. Schedules a follow up visit to NKCBJ for 4-22-04 to reassess Shoulder injury if it hasn't improved.
4-14-04 - While transferring from his bed to his wheelchair, his right shoulder gives out and the plaintiff falls to the floor directly on his right knee. He is paraplegic, but still has about 10% of pain sensation of a 'normal' person...says leg feels like a charlie horse that day. Sees some swelling.
4-15-04 - Makes an appointment with and sees his GP Dr, (who later becomes the defendant in this case) RE: Right knee. Examination shows swelling, but intact joint. Hip & Femur X-Rays are taken @ GP office. Defendant states there is "No acute fracture that I am able to elicit" on the X-Rays. Sends plaintiff home with instructions to use Ace Bandage & ice to treat swelling, and gives plaintiff the X-Rays to take with him to the same Orthopedic Dr that the Defendant referred him to RE his shoulder injury...Defendant testifies that he remembers the follow up visit being already scheduled for "Several days" after 4-15. No mention of extra care to plaintiff of injury, only to 'follow up' w/ NKCBJ
4-16 to 4-21-04 - Plaintiff sees increased swelling/bruising to his femur/right knee area. Attempts to call Defendants office 3-4 different days to talk to nurse, Dr, anybody. Finally gets through to Nurse on 4-21. Nurse call notes state plaintiff is concerned about blood clots, advises plaintiff to take aspirin to reduce clotting risk.
4-22-04 - Plaintiff sees NKCBJ...this is the appointment that was originally to have been follow up to shoulder injury, but femur is now main concern. The X-Rays taken on 4-15 @ GP office are shown to Orthopedic Surgeon, who elicits a fracture. Note taken at that time states the plaintiff will be admitted to the hospital for treatment which includes new X-Rays, checking for blood clots, blood work, UA, and bracing of the femur/knee is mentioned. There is NO mention of surgery in the initial Orthopedic Surgeons notes. X-Rays taken on 4-22 show a major, impacted fracture of the femur...basically 2-3 cm of bone impaled down into the knee joint between 4-15 & 4-22. At that time, Orthopedic Surgeons notes state that surgery will be required on this injury.
4-23-04 - approx 9-05Plaintiff has surgery on 4-23. Bone distender (I believe was the term) is used during surgery to pull the impacted portion of his femur back to correct length. Steel plate and 10 screws are inserted into femur. During healing a brace is used that locks the knee at a specific angle, starting w/ straight, and ending some months later w/ a nearly 90* bend. During his time wearing the brace significant skin wounds appear which warrant the use of a wound vac, which is basically a small vacuum that runs non stop, and vacates these wounds of infection. Fracture is noted as healed on 10-04. Wounds persist until approx 9-05.
TestimonyDefendantDefendant states that the fracture was not seen on initial X-Rays taken on 4-15, but given the swelling, he suspected there was 'internal derangement' of some sort, be it a sprain, ligament damage, or a hairline fracture. He knew the X-rays would be difficult to read b/c the plaintiff is a paraplegic (pp going forward) that does not have bones that are as dense as a walking person. Has received consult from Radiologists in the past on other cases, did not see a reason to consult on this case. Was afraid to put plaintiff in an immobilization brace b/c pp patients are susceptible to skin breakdown (very bad bed sores basically) b/c of their lack of sensation, esp when no fracture was elicited on the x-ray. States that even if a fracture was elicited on the x-rays he took on 4-15, his course of treatment would have been the same as it was...basically follow up w/ orthopedic surgeon.
Expert Witness #1Degree in Orthopedic Medicine + Law School degree + Business degree...has testified in 40 some cases before as an expert witness in this field. Found the X-Rays on 4-15 to show an acute fracture of the femur. Stated that the type of fracture in that x-ray is often fixed w/o surgery by using a Bledsoe brace. Thought that a GP Dr. should be able to elicit a fracture like the one seen, and thought that by missing the fracture, and failing to immobilize the leg on 4-15 he had failed to meet the standard of care. Says the X-Rays taken on 4-22 show a much more severe injury that now almost always requires surgery.
Expert Witness #2GP doctor for 30 years, now hospital admin. Testified in 33 cases as expert witness, 32 of which were for the defense. Testifies that even though the fracture was missed by the GP, the standard of care was met by giving plaintiff the x-rays and ensuring a follow up visit w/ ortho was made. Also testifies the standard of care in a patient that might have a fracture could include immediate visit to orthopedic specialist or immobilization of the area.
Orthopedic Surgeon that the Defendant was referred toDeposition only. Was a witness for the defense that was not issued a subpoena. Deposition stated that surgery was imminent from the time of the fracture. In direct contradiction to his notes taken on 4-22 described above. Thought that the Defendant met the standard of care by ensuring that the plaintiff had a visit scheduled to an Ortho for further evaluation.
You must rule for the plaintiff if you find all of the following to be true (I can't remember all the legalese used here, Trim, Limestone, Belvis, BSAC, whoever (eff there are a lot of lawyers here) feel free to modify if you GAF)
1) That the defendant missed the fracture on 4-15 x-rays
or
that the defendant failed to immobilize the leg on 4-15
2) That the defendant acted negligent by his actions in #1
3) That the negligence by the defendant caused damage to the plaintiff.
If you find for the plaintiff how much $$ do you award him? $145k in medical bills was the # that was thrown out, along w/ $225k in "Non economic injury" which included categories like loss of lust for life, loss of wages, loss of independence, etc...
How do you rule in this case?
