Surgeries Progression
Patients who have undergone foot surgery at times experience a variety of complications and postoperative problems. Not all such complications and problems are the result of improper medical care, but, on occasion, legitimate grounds to investigate a potential medical negligence claim do exist. The following, therefore, is a summary of issues or themes that are common to the investigation of medical malpractice matters arising out of foot surgery.
WHO PERFORMS FOOT SURGERY?
Foot surgery can legitimately be performed by a variety of different types of doctors, including podiatrists, general orthopedic surgeons and orthopedic surgeons with a subspecialty in foot surgery. Generally, the standards of medical care that would apply to each are the same. However, it is helpful to determine whether the doctor, regardless of his specialty, is properly qualified to perform the particular surgery in issue. Establishing that the doctor is board-certified in his or her specialty usually ensures that he or she is sufficiently qualified and trained to perform most types of foot surgery. Also, it is important to determine, if litigation ensues and the surgery is performed at a hospital or surgical facility, whether the doctor has been granted privileges to perform the procedure in question. This can typically be accomplished by a request to the hospital for this information. Most hospitals maintain a list of such privileges granted to each surgeon.
ELECTIVE SURGERY:
Most foot surgeries are not life or death matters, but are “elective.” in nature. These “elective” procedures are often performed to correct perceived bony deformities of the foot, such as bunions and hammertoes, or, other conditions such as a Morton’s neuroma or “bone spur.”These conditions are relatively prevalent amongst the population and not all require surgical correction. Often surgery is limited to those cases where the patient experiences constant or frequent pain and where conservative measures to alleviate the problem are ineffective. In such cases, surgery may be warranted. However, foot surgeons who hastily direct a patient to surgery without attempting alternative, non-surgical treatments where the patient’s degree of discomfort is relatively minor, or, where the deformity is not significant, often face potential liability if the surgery results in a worsening of the patient’s condition. The basis for a claim under these circumstances is simply that the doctor performed unnecessary surgery. Another area of concern that is sometimes encountered is the performance of toe implant surgery in a patient who is either too young for such surgery or where there is a question as to whether the patient will truly benefit from the procedure. There are published guidelines and criteria to assist foot surgeons in determining whether a toe implant procedure is proper Adherence to such guidelines and criteria is essential, whereas a deviation from them may result in potential liability, especially if the patient experiences untoward problems. There are similar guidelines and criteria applicable to other types of foot surgery as well.
SURGICAL ERRORS:
Many normal and foreseeable complications can and do occur during foot operations, even when performed by the most skillful of surgeons, that are not the result of malpractice. However, situations can arise where errors occur during surgery that are neither normal or foreseeable and which may constitute malpractice. Common examples of these errors are excess bone removal, improper placement of implants and fixation devices (such as k-wire, pins or screws), and, over or under correction of a perceived bony deformity. If these errors result in a patient experiencing continued or unexpected postoperative pain or otherwise effect their usual activities, investigation may be warranted.
POSTOPERATIVE CARE:
This is an area of concern which should not be overlooked by either the physician or the patient. For example, following any type of surgery in which any type of implant or fixation device (such as k-wire, pins or screws) is used, it is prudent to obtain postoperative x-rays to ensure that there is proper alignment of the device and the bones of the foot, so that normal healing can best be achieved. The failure to do so may result in the patient experiencing slippage of the device, the development of a delayed union, mal-union or non-union, or, the displacement of bones in the foot. This may lead to serious long term consequences for the patient. Likewise, it is important for the doctor to be on guard against the possibility of postoperative infections in all surgical patients. When an infection is suspected, the area of concern should be timely cultured and treated with antibiotics. If the condition does not improve or worsens, consultation with a specialist in infectious diseases and/or readmission to the hospital for the delivery of intravenous antibiotics may be warranted. Another potential problem is a patient who experiences unusually abnormal postoperative pain and sensitivity. This may be the first sign of the development of reflex sympathetic dystrophy (“RSD”), a rare, but known complication associated with foot and other types of surgery. RSD can be a debilitating condition if it is not timely diagnosed and treated. Early diagnosis should result in the commencement of physical therapy, which has been shown to effectively halt the progression of RSD. In appropriate cases, referral to a specialist in pain management, who can administer other useful treatments, including nerve blocks may be justified.
DIABETIC PATIENTS:
Patients who are diabetic present a unique challenge to foot surgeons. Because of the very nature of the disease, diabetes can present special problems with respect to wound healing and the body’s ability to fight infections. For that reason, physicians should be particularly vigilant when caring for these patients by frequently checking for the development of foot ulcers and infections on each visit. Patient education regarding the development of foot ulcers and infections should be provided to diabetic patients, who often are unable to sense their development because of the peripheral neuropathy (loss of sensation) sometimes associated with diabetes. Foot ulcers and infections which go undiagnosed and which are not timely treated can lead to the development of severe infection and gangrene, and, as a result, may lead to amputation of the foot or worse.
OTHER AREAS OF CONCERN:
Consent, Steroids, Bills & Other Forms:
Informed Consent: Before most types of foot surgery are performed, the doctor is obliged to advise the patient of the material risks of the operation and should further have the patient sign a written consent form indicating that the risks were disclosed to the patient. This gives the patient an opportunity to decide whether or not to proceed with surgery in light of its possible risks and complications. This is particularly important in situations where the surgery being performed is purely elective in nature. The failure of a doctor to obtain a patient’s informed consent to surgery, particularly when one of the undisclosed risk materializes as a result of surgery and caused the patient harm, may be grounds for medical malpractice if a reasonable patient would not have undergone such surgery if the risk was disclosed in the first place.
Steroids: For a variety of reasons, a foot surgeon may administer steroids to a patient, typically by injection, to relieve pain or other symptoms. However, steroids are known to cause a variety of complications, including avascular necrosis and weakening of tendons, which can result in injury to a patient. A foot surgeon must take great care not administer steroids in excess. If this occurs, or if a doctor prescribes or administers steroids without good reason, and the patient develops harmful complications as a result of use of the steroids, the patient’s legal rights should be investigated.
Bills and other records: In conjunction with the investigation of any malpractice claim arising out of foot surgery, it is important to obtain the doctor’s billing records. Now and then the billing codes do not match the actual services rendered, or, may contain other diagnoses for which the patient was not treated. Such mistakes, whether they be deliberate or not, are often helpful in assessing the doctor’s credibility. Likewise, information contained on other forms prepared by the doctor’s office, such as disability or insurance forms, may also contain information that contradicts or is not contained in the patient’s chart, and, therefore, would be of assistance to a patient investigating his or her unfavorable medical care.
