Failure to Diagnose Bacterial Infection

Negligence Resulting in Necrotizing Fasciitis

Malvin

Oct 29, 2024

14:52

A 57-year-old diabetic male laborer (DM) arrived at a general practice office with severe, throbbing pain in his right foot, rating it 8/10 on the pain scale. The patient also reported tenderness, swelling, and difficulty bearing weight following a workplace accident the previous day. During the incident, his steel-toed boot had hyper-flexed and dug into the top of his right foot.

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Per office protocol, a physician should have evaluated DM on this initial visit, but due to a high patient load, the physician assistant (PA) performed the assessment. The PA noted swelling, redness, and bruisingfrom the mid-foot to the toes. X-rays were normal, and DM was prescribed Toradol, Ibuprofen, and Vicodinfor pain and given crutches, a cold pack, and an open-toed shoe, with instructions to return in two days.

Two days later, DM returned, now rating his pain at 10/10 and reporting persistent swelling. Upon examination, the physician noted severe swelling, redness spreading up to the knee, a diminished pulse, decreased sensation, and signs of skin de-vascularization in the affected area. The physician diagnosed severe cellulitis with lymphangitis and directed DM to the ER immediately.

At the emergency room, DM mentioned a cut on his foot and a fever of 102°F the previous day. His white blood cell count was 20,000, and ER personnel identified a small laceration on the foot, likely sustained during the initial injury. A wound infection was diagnosed, and the patient was admitted to the hospital for immediate care.

Necrotizing Fasciitis Diagnosis and Complications

Surgical debridement revealed a sinus tract extending from the top of DM’s foot toward his ankle with liquefactive necrosis in the extensor digitorum muscle, indicative of necrotizing fasciitis. DM required an extended hospital stay, multiple debridement surgeries, and skin grafting. Despite treatment, he now suffers permanent mobility limitations, relying on a foot brace, orthotic shoes, and a cane, rendering him unable to return to work. This case settled for $450,000.

Understanding Necrotizing Fasciitis and Related Diagnostic Challenges

Necrotizing fasciitis, commonly known as flesh-eating disease, is a severe bacterial infection that spreads rapidly in the soft tissue. Early symptoms include swelling, pain, and redness at the infection site, often without clear signs of skin trauma. For patients with diabetes or other risk factors, these signs necessitate heightened vigilance and early intervention.

Key Failures in Infection Diagnosis and Follow-Up

1. Failure to Recognize Early Infection Signs

The patient’s initial severe pain and swelling warranted close observation and consideration of underlying infection, particularly given his diabetic condition.
 

2. Lack of Immediate Comprehensive Evaluation

Delayed or insufficient examination and a reliance solely on pain management without exploring infection risks led to oversight.

3. Inadequate Communication and Follow-Up Protocols

Not verifying a physician's initial assessment and prioritizing symptom review missed early signs of necrotizing fasciitis, delaying critical care.

Legal and Medical Implications

Failure to diagnose infections promptly, especially in high-risk individuals, often leads to high malpractice settlements, as seen in this case’s $450,000 payout. Such cases emphasize the necessity for thorough assessment and adherence to established protocols, particularly for diabetic patients, whose compromised immunity makes them more vulnerable to aggressive infections.

How Malpraq Can Help

If you or a loved one has suffered from an undiagnosed or improperly managed infection, our team at Malpraq can evaluate your claim and guide you in seeking the compensation you deserve. We are here to ensure medical accountability for your loss.

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