Facts

On Jan. 31, 2012, plaintiff John Doe, 56, a diabetic, felt a popping sensation, pain and wetness on the top of his right foot when he stood up after working two hours from a kneeling position. When he removed his work boots, he noticed a bruise and small cut on top of his right foot. The following day, plaintiff's employer sent him to Roe Medical Group, an occupational clinic, where a physician's assistant examined him. Before the examination, plaintiff filled out a comprehensive medical questionnaire, indicating that he had a history of diabetes.

The physician's assistant diagnosed cellulitis and right dorsal foot strain, prescribed painkillers, and instructed plaintiff to return for a follow up appointment on Feb. 3. When plaintiff returned to Roe Medical Group on Feb. 3, the supervising doctor, who diagnosed severe cellulitis with lymphangitis of the right foot, saw him. The doctor instructed plaintiff to go to the emergency room immediately for consult and treatment. At the hospital, plaintiff was diagnosed with necrotizing fasciitis, commonly known as the flesh eating disease.

PLAINTIFF'S CONTENTIONS:
Plaintiff contended that despite the history of diabetes, obvious signs of a bruise and an open wound, the physician's assistant only performed a cursory examination. Plaintiff also contended that defendants, by and through their employee, the physician's assistant failed to properly examine, diagnose and assess plaintiff's condition and failed to call in the supervising physician. Plaintiff claimed that proper treatment would have required referral to a specialist, or, at the very last, initiation of antibiotic treatment. Plaintiffs argued that prompt treatment and antibiotic therapy would have confined the infection to the surface and prevented it from developing into a fulminating infection and necrotizing fasciitis.

Plaintiff argued the doctors who owned and operated the occupational medical clinic failed to supervise the physician assistant, especially in light of his prior history of discipline.

DEFENDANT'S CONTENTIONS:
Defendants claimed the physician's assistant was properly supervised and that his assessment, diagnosis and treatment recommendations were within the standard of care. Defendants argued necrotizing fasciitis was a rare condition and there was no reason to suspect plaintiff's injury was more than a bruise and foot sprain. Defendants claimed that plaintiff could return to his work and did not have significant disabilities.

Settlement Discussions

Prior to mediation, plaintiff made a CCP 998 demand for $450,000, and plaintiff's wife demanded $175,000. Defendants did not make any settlement offers prior to the mediation but implied the $250,000 MICRA general damages cap was on the table and the purpose of the mediation was to resolve plaintiff's economic damages.

Damages

Plaintiff worked most of his life as a machinist, and claimed $250,000 for future lost wages because he did not believe he could ever return to work. Plaintiff's workers' compensation carrier paid the medical expenses and paid plaintiff for temporary and permanent disability. Plaintiff's wife of 32 years claimed loss of consortium.

Injuries

Two of the three surgeons at the hospital recommended amputation of plaintiff's right foot, but the third doctor recommended surgical intervention. In the first six days after plaintiff was admitted in the hospital, he underwent three excision and debridement of muscle procedures to remove the dead tissue. Two months later, plaintiff underwent a split-thickness skin graft to his right foot. Plaintiff claimed residual right foot pain, scarring and a deformity of his foot and toes that will require him to wear a foot brace and orthopedic shoes for the remainder of his life. Plaintiff also claimed he has altered gait and weight distribution because of the foot injury, which lead to chronic back pain. Plaintiff also claimed severe anxiety and depression because of his physical disability, physical appearance and inability to provide for his family.

Result

The case settled for $475,000.