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ARTICLE ID 186983

$________ – MEDICAL MALPRACTICE – PLASTIC SURGERY – DELAY IN DIAGNOSIS AND TREATMENT OF COMPARTMENT SYNDROME FOLLOWING CALF IMPLANTS – ALLEGED LACK OF INFORMED CONSENT – MULTIPLE SURGERIES REQUIRED – RSD.

Schuylkill County, PA

When the male plaintiff was 30 years old, he took a keen interest in becoming a fitness trainer and amateur body builder. In an attempt to improve his appearance, he underwent surgery to install bilateral calf implants performed by the defendant plastic surgeon. The plaintiff alleged that the defendant negligently failed to diagnose and treat compartment syndrome which developed almost immediately after the surgery. The defendant’s professional practice group was also named as a defendant on a vicarious liability theory. The defendants maintained that the plaintiff’s condition was appropriately diagnosed and treated and that his injuries did not occur until after he left the care of the defendant plastic surgeon.

The plaintiff testified that, no matter how hard he trained, he felt that he had under-developed calves. He met with the defendant plastic surgeon on July 2, ________ and discussed calf implant surgery. The plaintiff testified that the defendant indicated that the procedure was straightforward with minimal risks and that he had performed the procedure before.

The plaintiff alleged that the defendant failed to disclose that the last time he had any involvement with calf implant surgery was eight years earlier, while he was a resident in training, and that he had never performed a calf implant surgery in private practice. The plaintiff contended that he met with the defendant on two subsequent office visits and was never told of the risks nor signed any type of document listing compartment syndrome as a risk of the calf implant procedure.

At a September 26, ________ meeting with the defendant doctor, the size of the plaintiff’s calf implants was discussed and samples were taped to the back of the plaintiff’s legs so that he could see what the “finished product” would look like. The plaintiff paid $________ in advance for the procedure and that surgery was performed by the defendant on October 18, ________. The plaintiff testified that he experienced intense pain and decreased sensation and numbness-tingling in his left lower leg within a short time after the surgery. He presented to a hospital emergency room with a few hours of the procedure.

Evidence showed that the defendant saw the plaintiff in the hospital at 7:00 p.m. on October 18, ________, and prescribed a stronger IV medication for pain. The plaintiff’s experts opined that the defendant was negligent in failing to recognize the signs and symptoms of compartment syndrome and in failing to perform a compartment pressure reading which would have revealed the condition.

The left calf implant was removed by the defendant on October 19, ________, at the plaintiff’s request, and he was discharged from the hospital on October 20, ________. On the morning of October 21, ________, the plaintiff presented to another hospital where the emergency room doctor immediately suspected compartment syndrome. Compartment pressure readings confirmed significantly elevated compartment pressures, according to evidence offered by the plaintiff. A decision was made to send the plaintiff back to the defendant plastic surgeon for additional compartment pressure readings and possible performance of a fasciotomy to relieve pressure.

The plaintiff argued that, even though the defendant was aware that the plaintiff would be returned to the local hospital via ambulance back into the defendant’s care at approximately 7:00 p.m.; the defendant did not perform surgery until after midnight. Records showed that the plaintiff was anesthetized at 23:35 (11:35 p.m.) and surgery, a mini-fasciotomy to relieve pressure, began at 00:05 (12:05 a.m.) October 22, ________.

The plaintiff testified that his pain, discomfort and symptoms worsened after the mini-fasciotomy was performed by the defendant. A non-party surgeon then took over the plaintiff’s care. On October 26, ________ the non-party surgeon performed a complete fasciotomy on the plaintiff’ left lower leg. On November 1, ________, additional surgery was performed, including an extensive skin graft and scraping and cutting away of dead muscle tissue. The plaintiff was discharged from the hospital on November 22, ________

The plaintiff subsequently underwent several surgeries for curled toes, hammer toes and lengthening of the Achilles tendon. In total, the plaintiff underwent eight additional surgeries following the October 18, ________ calf implant surgery performed by the defendant. He also required extensive physical therapy and rehabilitation. The plaintiff was ultimately diagnosed with RSD secondary to the development of compartment syndrome. He has been left with a 12.5 centimeter discrepancy in the size of his left and right calves. The plaintiff testified that he has tried numerous braces and assistive devices, but none have given him complete relief.

The plaintiff’s experts deemed him unable to work on even a part-time basis. The plaintiff was employed as a fitness instructor and personal trainer before the date of the surgery. At the time of trial, he was taking prescription medication for his RSD, constant pain, depression and anxiety. The plaintiff contended that his injuries and surgeries could have been avoided by immediate surgical intervention on the part of the defendant.

The defense maintained that the plaintiff was advised of the risks involved in the surgery prior to its performance. The defendant showed that the plaintiff’s medical chart included a typed note indicating that the risks of surgery were explained to the patient. The note was dictated but not read after the defendant’s initial meeting with the plaintiff on July 2, ________. There was also a consent form signed by the plaintiff at a July 22, ________ office visit. The plaintiff alleged that the consent form made no mention of specific risks involved in the surgery nor did it refer back to the July 2, ________ typed office note.

The defendant’s plastic surgeon testified that the implant procedure was properly performed by the defendant and that the doctor reacted appropriately in responding to the plaintiff’s pain and swelling by conservative treatment and removal of the implant. The defense contended that, following the mini-fasciotomy performed by the defendant on October 22, ________, the plaintiff’s muscles responded to electro-stimulation, indicating that no damage had occurred. The defendant contended that the mini-fasciotomy was timely performed by the defendant on an urgent but not an emergency basis.

The defendant argued that he saw the plaintiff at about 9:00 to 9:30 p.m. on October 21, ________ and that some time was necessary for additional pressure testing and to assemble a surgical team which began surgery just after midnight. If a medical emergency existed, the defendant argued that the plaintiff would not have been discharged from the second hospital back into the defendant’s care.

In addition, the defendant argued that on October 26, ________, four days after the defendant performed the mini-fasciotomy, a complete fasciotomy was performed and the non-party surgeon found that the plaintiff’s muscles were still viable and responsive and had not been injured at that time. It was the defendants’ position that the plaintiff’s injuries occurred sometime after he left the care of the defendant. The defendant’s neurologist opined that the plaintiff was capable of returning to work in a sales position or sedentary office job. The defendant presented video surveillance of the plaintiff walking and referring to upper body exercises he had performed at the gym.The jury found that the defendant was negligent and that his negligence caused injury to the plaintiff. The jury found for the defendant on the informed consent claim. The plaintiff was awarded $________ in damages. The award included $________ in past loss of earnings; $________ in past pain and suffering: $________ in future loss of earnings: $________ in future loss of earnings and $________ for permanent scarring and disfigurement. Post-trial motions are currently pending.

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