Medicolegal Issues

Escalating Postsurgical Pain Not Addressed

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Cases reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

At age 19, an Illinois woman underwent radical open anterior and posterior synovectomy for a rare knee disease at the defendant hospital. Examination immediately after surgery revealed no complications and a normal neurovascular status. That night and into the next morning, however, the patient repeatedly complained of pain below her knee and in her foot, and her neurovascular status was abnormal.

She was given repeated doses of pain medication with increasing dosage. Two resident physicians were contacted by the nursing staff, but neither came to the hospital to examine the patient. The attending physician was never contacted.

Early the next morning, the patient was examined by the attending physician, who made a diagnosis of compartment syndrome and performed a fasciotomy. The patient required several debridements to remove necrotic muscle and tissue below her knee. She lost about 90% of the muscle in the affected leg and has foot drop and severe nerve dysfunction.

The plaintiff claimed that the nurses and resident physicians failed to recognize her condition and communicate it to the attending physician. According to the plaintiff, the delay in diagnosis and treatment of compartment syndrome led to extensive muscle and tissue death.

The defendants argued that the plaintiff did not complain on the night of the surgery as she claimed, and that compartment syndrome was diagnosed in a timely manner. The defendants claimed that fasciotomy performed by the attending physician was too conservative, permitting compartment syndrome to recur or persist.

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