Facts

On April 14, 2009, the decedent, a 43-year-old husband and father of four children (three of whom are financially emancipated), was mowing his lawn, when a shard of metal penetrated his right anterior shin. He wrapped his heavily bleeding leg and proceeded to Roe clinic. He was seen there by an emergency room physician, who cleaned the wound, cauterized a bleeder, injected the area with epinephrine and Lidocaine, and sutured the wound closed. Antibiotics were not prescribed.

On April 16, the patient returned to Roe clinic with complaints of pain and swelling. He was seen there by a physician's assistant who noted swelling distant to the area of penetration. He was concerned for a possible clot, and so an ultrasound was performed to rule out deep venous thrombosis. The ultrasound was negative. The patient was given an injection of Ceftriaxone along with a prescription for Cephalexin. He was not hospitalized or seen by a physician.

On April 17, the patient again presented to Roe clinic with increased pain and swelling. He was hospitalized that afternoon and was seen by two orthopedic surgeons and a vascular surgeon on April 18. Based on the appearance on his leg, he was thought to have a superficial infection and IV antibiotics were initiated.

On the evening of April 18, the patient's condition rapidly deteriorated. He was seen by another surgeon, who took him to surgery urgently, with a diagnosis of necrotizing fasciitis.

Following surgery, the patient continued to deteriorate rapidly and expired in the early morning hours of April 29. The cause of death per autopsy was septic shock consequent to necrotizing fasciitis.

PLAINTIFF'S CONTENTIONS:
Plaintiffs conceded that is was a judgment call as to whether or not to begin decedent on antibiotics upon his initial presentation on April 14.

Plaintiffs argued that when the decedent presented again on April 16 with complaints of increased pain and swelling disproportionate to that one would expect with a simple penetrating wound, the standard of care required that he be hospitalized and seen by a surgeon very quickly. Had that been done, the diagnosis of necrotizing fasciitis would have been made, that the incision would have been opened and extensively debrided, and that decedent likely would have survived.

Plaintiffs conceded that by April 17, based on findings at autopsy, even had he undergone surgery, his survival was questionable.

DEFENDANT'S CONTENTIONS:
Defendant argued that the standard of care did not require beginning antibiotics on April 14; that the physician assistant exercised reasonable judgment; and that even if the decedent had been hospitalized on that date, the objective physical findings were not such that surgery was warranted.

Defense further argued that, as of April 17, had surgery been done on that date, it would have consisted of an above-the-knee amputation, which likely would have prevented the decedent from meaningful and gainful future employment in any event.

Damages

The decedent was earning $85,000 annually. In addition to MICRA, economic damages, assuming that decedent would work to his actuarial work life expectancy, totaled $1.5 million. According to the defense, economic damages approximated $1.2 million.

Result

The case was settled for $750,000 at mediation before Jay C. Horton, Esq. at Judicate West.