APMA News - January/February 2018 - S3

SUPPLEMENT TO APMA NEWS

YOUR APMA / PAGE 3

ALL CLEAR FOR SURGERY
By Barbara Bellione, RN, CPHARM, ARM, director of Risk Management, PICA

You have determined your patient needs podiatric surgery and are ready to
proceed. But, is your patient really a candidate for surgery? This actual podiatric
malpractice claim illustrates the importance of thoroughly evaluating your
patient prior to surgery to determine if pre-operative testing/surgical clearance
is in order and ensuring appropriate pre-operative testing/surgical clearance is
completed prior to performing surgery.

he patient was 66 years old at the time
of treatment related to this case. He
was a long-term patient of the insured
podiatrist with a history of insulin-controlled
diabetes, hypertension, and peripheral artery
disease.
The patient presented to the podiatrist for
a diabetic foot exam and treatment of a painful soft corn on the left 5th toe. The podiatrist
instructed the patient on appropriate shoe
gear, padded the area, and instructed the
patient to return in one week. The podiatrist
stated in his progress note that he would
send the patient for a vascular exam to see if
the patient was a surgical candidate.
The patient returned one week later and
reported that changes in shoe gear and
padding had not decreased the pain in his
toe. Dorsalis pedis and posterior tibial pulses
were noted to be 0/4 bilaterally. The insured
discussed surgery with the patient and
documented in his progress note that the
patient was having a vascular exam in the
next few weeks.
The insured continued to treat the patient
conservatively over the next six months.
During that time, the patient developed a
painful corn on his left 4th toe. The insured
again discussed surgery with the patient. The
patient consented, and two months later, the
insured performed a partial excision of the
middle and distal phalanx of the 4th and 5th
toes, left foot.

The patient presented to the podiatrist's
office for his first post-op appointment a week
later. The patient's left 4th and 5th toes were
noted to be black and gangrenous. No signs
of infection were noted, and the podiatrist
diagnosed dry gangrene. He advised the
patient that he would likely lose the toes. The
podiatrist arranged for a referral to a vascular
surgeon the following day.
The patient underwent amputation of the
left 3rd, 4th, and 5th toes with subsequent

transmetatarsal amputation of the left foot.
The patient also underwent a femoral post
tibia bypass and an angioplasty to restore
adequate blood flow to preserve the skin graft
on the left foot.
The patient sued the insured podiatrist
alleging:
* performance of unnecessary surgery;
* failure to obtain vascular clearance prior
to performing surgery on a patient with a
documented history of vascular disease;
and
* failure to obtain sufficient informed
consent.
The case was reviewed for the defense
by several podiatric experts, none of whom
could support the podiatrist's treatment of
the patient. They concurred that the podiatrist should have ensured that a vascular
workup was performed prior to considering
surgery. The lawsuit was resolved through
mediation.
Thoroughly evaluate each patient prior to
surgery and obtain appropriate pre-operative
testing or surgical clearance, if indicated.
It is also important to implement a fail-safe
system, such as a pre-operative checklist,
to ensure that all pre-operative testing and
consultations are received and reviewed prior
to performing surgery.
For more information, contact the PICA Risk
Management department at 800-251-5727,
ext. 2107.

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Table of Contents for the Digital Edition of APMA News - January/February 2018