Orthopedic Pressure Sore Under Cast Lawsuit

This is a medical malpractice case filed on by a woman against her orthopedist after pressure sores lead to the loss of a toe and a bone in her foot. It is the 18th medical malpractice lawsuit filed in 2017 in Maryland. It was filed in Maryland Health Claims Arbitration on January 13, 2017.

Plaintiff goes to defendant Orthopedic and Sports Medicine Center in Annapolis for treatment after she sustains an injury to her right foot a few days prior. Her primary care physician referred her for a non-displaced fracture of her anterior process of the calcaneus. Defendant doctor examines the plaintiff, and finds the injury as well as neuropathy, anemia, and prior cancer treatment. She places her in a fixed ankle walker and suggests she come for follow-up treatment.

Within a few weeks, plaintiff starts to develop a sore on the ball of her foot. She returns to defendant doctor for a follow-up. She shows the doctor the sore that had developed and changed in both size and presentation. Defendant doctor places her in a total contact cast.

A week later, plaintiff returns to have the ulcer checked. A new cast is placed. When she returns again, defendant doctor states that the ulcer has decreased in size and that it is not showing signs of infection. The plaintiff's daughter photographs the foot, as she does not think it looks smaller or free of infection. However, the woman is placed in a post-op shoe, told to follow-up in three weeks and change the dressing twice a day.

Plaintiff follows these instructions. When she returns, the records from her appointment with defendant doctor state there is no sign of infection and that the woman is doing well. Contrary to this, two days prior, she had gone to her primary care physician who referred her to a wound care specialist as she was concerned about the ulcer.

The wound care specialist finds a large wound with necrotic tissue. She conducts an MRI and a debridement procedure in an attempt to remove the necrotic tissue. Unfortunately, the ulcer does not resolve. The MRI shows "significant marrow edema at the distal 2nd metatarsal consistent with osteomyelitis". This requires amputation of the plaintiff's second toe and distal second metatarsal.

Plaintiff suffered the amputation and permanent injuries that she alleges she would not have suffered if defendants had provided the appropriate care, such as timely referral to physicians for treatment and appropriate assessments.

Comment on Lawsuit

This case, assuming the facts are as presented which is no guarantee, is not just about whether a patient had underlying medical issues. Almost every medical malpractice case involves a patient with some complicating health factors. What matters is whether the doctor responded appropriately to what was right in front of them.

Here, the plaintiff did exactly what she was supposed to do. She followed her doctor’s instructions, came to follow-up appointments, and raised concerns about her worsening condition. Her daughter even documented the foot ulcer when it seemed clear the doctor’s assessment did not match what they were seeing. Despite that, the doctor continued down the same path, recasting the foot, placing her in a post-op shoe, and delaying further investigation.

The defense will focus on the plaintiff’s health conditions—neuropathy, anemia, past cancer treatment—as if those facts somehow let the doctor off the hook. But that argument actually cuts the other way. A patient with a history like this needs closer monitoring, not less. The doctor knew this patient had a higher risk of developing serious complications. That is why the standard of care demands more vigilance, not excuses.

What is most troubling is the missed opportunity for a referral to wound care. A simple, timely referral could have avoided the worst-case scenario. Instead, the plaintiff was left to rely on her primary care doctor to raise the red flag and send her to someone who could actually help. By the time the wound was evaluated by a specialist, the damage was done, and the infection had progressed too far.

The loss of a toe and part of the foot is not a small matter, even if the defense tries to downplay it. It affects balance, mobility, and quality of life. The consequences here were avoidable. The law does not require perfection from doctors, but it does require reasonable, competent care. In this case, the failure to properly assess and manage a worsening wound led to a permanent injury that did not have to happen.

• Orthopedic malpractice cases related to the actual orthopedic treatment being sought is rare. Instead, it is something peripheral like informed consent or a radiology error. (This is an example case filed days before this lawsuit against Johns Hopkins.) Here, the claim is not the orthopedic treatment itself but the failure to properly manage the pressure sore.
• The defense to this case is going to be that her medical records clearly indicate a very complicated medical history and a poor ability to heal. So the real problem is her overall medical conditions. Accordingly, her pressure ulcer was unavoidable and not as a result of neglect of the orthopedic doctor. The problem with this defense is that the doctor knew or should have known of her prior medical history.
• The severity of the injuries seems to be an issue in this case. She has a problem with her gait. She lost a toe but not her big toe. But it is hard to get a gauge for the severity of the damages but the case is not impressive for a damages standpoint on paper. This is not to minimize the plaintiff's injuries which are awful. But there is a certain threshold of injury required to make the economics work in a medical malpractice case in Maryland. This is particularly true for a case in Anne Arundel County which is not knowing for being generous with malpractice victims.

• Anne Arundel County

• An orthopedic surgeon
• The Orthopaedic and Sports Medicine Center, P.A.

• Failure to order appropriate tests on plaintiff's ulcer at all times during treatment
• Failure to properly offload the foot to prevent ulcers
• Failure to provide appropriate re-check intervals
• Failure to refer plaintiff to professionals to treat the ulcer
• Failure to debride or treat the ulcer
• Failure to properly document the injury
• Failure to advise the plaintiff on proper care of her ulcer

If you sustained an injury due to negligence by a doctor, Miller and Zois can help you get the compensation that you deserve. We have a long history of results in medical malpractice cases in Maryland. Call us today and speak to a medical malpractice attorney at (800) 553-8082. You can also go online for a free case review.

• Information about failure to diagnose claims in Maryland
• What is the settlement value of bed sore cases? This is a little out of context because most of these are nursing home or hospital cases involving elderly patients (and an often despicable defendant in the nursing home).
• Some frequently asked questions and answers about pressure sore claims
• Some sample verdicts and settlements from medical malpractice cases in Maryland
• What you can expect when you bring a medical malpractice lawsuit in Maryland