Unfortunately, an 89-year-old with a hip fracture has an outlook in the coming months which is mediocre at best, even under good circumstances. I don't see any actual evidence of negligence on behalf of the surgeon. Even if we take for granted that the surgeon caused the bleed, it's not clear that it is negligent.
The defense hinted that they were going to make the argument re: life expectancy if it went to trial. The plaintiffs clearly knew this limited their case, given that they didn't even request policy limits in the settlement offer.
Oct 3, 2023·edited Oct 3, 2023Liked by Med Mal Reviewer
I think the only thing that could have been done differently is calling vascular when the bleeding first happened. May be true that vascular would have said "finish the nailing", but then at least that's on-record. However, not sure waiting to call rises to the level of negligence.
I've been involved in a few of these, and it's fairly apparent when "difficult to control bleeding" is nuisance ooze vs. major vessel injury. If it's the latter, I think it's good to get someone involved early. Even if you can initially control such bleeding with packing/pressure, you really do need to figure out from where it's coming.
Most orthopedic surgeons take call and take care of hip fractures on weekends despite any additional fellowships training they have. Hip fractures are really considered “bread and butter” in that there are so many that occur that we all share the load in taking care of them. Looking at the final fleuro shots the nail looks well positioned. Seems like a nightmare for everyone but I’m not convinced there was any mal practice here. In the same situation I would continue to fix the fracture as well while waiting for vascular. Otherwise you’re just standing there doing nothing or making things worse. This case takes all of 30 minutes when it’s going well.
With regard to the fleuro images not being saved - that’s on the radiology tech. I have them save everything on every case but that’s not standard. Many times the final A/P and lateral are all that get saved.
Oct 3, 2023·edited Oct 3, 2023Liked by Med Mal Reviewer
This is the trend I have observed as well, especially as getting ortho call to cover trauma has gotten very hard. Many groups are now refusing it as it increases problems with recruitment outside of major urban areas. I know a number of larger systems depending on locums for coverage. I suspect lawsuits are a factor for those groups in larger cities Im aware of that are now declining contracts trauma call. Edited to clarify that I work in the upper Midwest.
Suspect that the guide wire placement on the missing views may be why they went missing…That said, a hand surgeon shouldn’t be forced to treat hip fractures, tho orthopedic sub specialists often are-by hospitals/administrators; depends on who has ‘leverage’ -nb, retired now; practiced last 30 years post/fellowship in spine…after earlier years doing general orthopedics in the USN. So had leverage, because was not employed by the hospital-and went to several different/competing ones-and was “making” the hospital a lot of money. Then, and probably here, “hand” was typically not a big hospital earner, and, now doctors much more likely to be on hospital payroll.
Unfortunately, an 89-year-old with a hip fracture has an outlook in the coming months which is mediocre at best, even under good circumstances. I don't see any actual evidence of negligence on behalf of the surgeon. Even if we take for granted that the surgeon caused the bleed, it's not clear that it is negligent.
The defense hinted that they were going to make the argument re: life expectancy if it went to trial. The plaintiffs clearly knew this limited their case, given that they didn't even request policy limits in the settlement offer.
I think the only thing that could have been done differently is calling vascular when the bleeding first happened. May be true that vascular would have said "finish the nailing", but then at least that's on-record. However, not sure waiting to call rises to the level of negligence.
I've been involved in a few of these, and it's fairly apparent when "difficult to control bleeding" is nuisance ooze vs. major vessel injury. If it's the latter, I think it's good to get someone involved early. Even if you can initially control such bleeding with packing/pressure, you really do need to figure out from where it's coming.
Most orthopedic surgeons take call and take care of hip fractures on weekends despite any additional fellowships training they have. Hip fractures are really considered “bread and butter” in that there are so many that occur that we all share the load in taking care of them. Looking at the final fleuro shots the nail looks well positioned. Seems like a nightmare for everyone but I’m not convinced there was any mal practice here. In the same situation I would continue to fix the fracture as well while waiting for vascular. Otherwise you’re just standing there doing nothing or making things worse. This case takes all of 30 minutes when it’s going well.
With regard to the fleuro images not being saved - that’s on the radiology tech. I have them save everything on every case but that’s not standard. Many times the final A/P and lateral are all that get saved.
This is the trend I have observed as well, especially as getting ortho call to cover trauma has gotten very hard. Many groups are now refusing it as it increases problems with recruitment outside of major urban areas. I know a number of larger systems depending on locums for coverage. I suspect lawsuits are a factor for those groups in larger cities Im aware of that are now declining contracts trauma call. Edited to clarify that I work in the upper Midwest.
Suspect that the guide wire placement on the missing views may be why they went missing…That said, a hand surgeon shouldn’t be forced to treat hip fractures, tho orthopedic sub specialists often are-by hospitals/administrators; depends on who has ‘leverage’ -nb, retired now; practiced last 30 years post/fellowship in spine…after earlier years doing general orthopedics in the USN. So had leverage, because was not employed by the hospital-and went to several different/competing ones-and was “making” the hospital a lot of money. Then, and probably here, “hand” was typically not a big hospital earner, and, now doctors much more likely to be on hospital payroll.