Case Resolution in Missed Diagnosis of Blood Clot Leading to Above Knee Amputation
Written By Thomas Hall
An Atlee Hall litigation team has successfully concluded a claim against an emergency room physician who carelessly missed the diagnosis of her patient’s impaired arterial blood flow in his left leg, resulting in the need for an above knee amputation four days later.
“Job One” for any emergency room physician is to make sure the patient does not have a life or limb threatening condition before clearing that patient for discharge to home. In this case, the patient reported pain and numbness in his lower leg. The emergency room doctor recognized that the symptoms could suggest blood clots in the veins of the leg, a condition called deep vein thrombosis, or DVT. The physician correctly ordered an ultrasound of the veins of the patient’s leg, but no ultrasound of the patient’s arteries. The arteries and veins in the lower leg are located far enough apart that performing an ultrasound of the veins will not detect any abnormalities in the arteries. The ultrasound of the veins was correctly interpreted as showing no blood clots in the veins of the patient’s leg. Rather than performing any further evaluation of the blood flow in the arteries of the affected leg, the emergency room physician discharged the patient to home, her only diagnosis being “pain in left leg”.
The patient’s pain worsened over the next three days prompting him to return to that same emergency room. At that time, a different physician correctly diagnosed that blood clots were occluding the flow of arterial blood, but it was too late to salvage the patient’s leg. He immediately underwent an above knee amputation.
The patient’s litigation team from Atlee Hall was able to demonstrate that, when faced with symptoms that could suggest blood clots in the arteries of the patient’s leg, and having no other diagnosis to explain those symptoms, the emergency room physician should have conducted a further evaluation of the patient’s arterial blood flow. A five-minute test, for no cost, and which presents no risk to the patient whatsoever, called an ankle brachial index, is performed by comparing the blood pressure in the patient’s arm with the blood-pressure in the patient’s leg. If those blood pressures are out of proportion, it confirms an arterial blood flow problem. This simple test was not done, nor was the more expensive ultrasound of the arteries ordered once it became clear that there was no problem in the patient’s veins.
The patient, who was 69 years old at the time of this incident, still struggles with problems of mobility. His recovery in this case will allow him to obtain a better prosthesis which will allow him the ability to once again drive his car and to greatly expand the distances he is able to walk.
If you or a loved one has suffered a significant and unexpected outcome as a result of a medical issue, Atlee Hall is here to help. Contact us here: https://atleehall.com/contact/ or call 717-740-8636.