Facts

On Jan. 6, 2004, defendant dermatologist performed a 3 mm punch biopsy on the plaintiff’s right medial ankle. The defendant believed that the plaintiff may have a Kaposi’s sarcoma, a malignant tumor of the connective tissue, which can metastasize into systemic cancer. The plaintiff, age 61, denied that she received informed consent for the procedure.

Because of the plaintiff’s undiagnosed underlying venous stasis, the biopsy site did not heal and evolved into a 10+ mm ulcer, which ultimately required pressure casting and ultimate vascular surgery. The delay in healing was approximately two years.

PLAINTIFF’S CONTENTIONS:
The plaintiff contended that punch biopsy of the distal extremity was not indicated for several reasons. First, she claimed that the lesions observed by Dr. Ashley were easily recognizable as lesions of venous stasis and not characteristic of a rare malignancy. The plaintiff claimed that she informed the defendant of her vascular compromise and was not given informed consent.

Peter Lawrence, M.D., the plaintiff’s subsequent treating vascular surgeon, testified that the lesions were easily recognizable as benign lesions of venous stasis and that biopsy was contraindicated.

DEFENDANT’S CONTENTIONS:
The defendant contended that the lesions were consistent with potential malignancy, which required biopsy and histological examination. The defendant contended that he gave the patient informed consent and that the patient was non-compliant with wound care. Further, the defendant contended that regardless of the patient’s vascular compromise, biopsy was required.

Settlement Discussions

Prior to trial, the plaintiff made a C.C.P. Section 998 demand of $29,999.99. The defendant made a C.C.P. Section 998 offer of a dismissal in exchange for waiver of costs and malicious prosecution.

Damages

$30,000

Injuries

Two-year delay in healing of punch biopsy site resulting in pressure casting and multiple venous surgeries.

Other Information

The defendant agreed to waive cost and malicious prosecution in exchange for waiver of appeal.

Deliberation

one day

Poll

11-1 (standard of care), 10-2 (informed consent)

Length

six days