Plaintiff saw Defendant, a board certified Interventional Cardiologist, for complaints of high blood pressure. Defendant Doctor notes in his SOAP notes that Plaintiff has been wearing 30-40 mmHg compression stockings for an unknown period of time prior to establishing with Defendant Doctor, but Plaintiff have no knowledge of ever wearing compression stockings. After initial testing was completed, Defendant Doctor recommended Plaintiff to receive venous ablations in both of her lower legs even though she did not complain of any pain or aesthetically unappealing varicosities in her legs. She did not receive pain medication when the venous ablations were completed, a male technician performed the procedure both times without Defendant Doctor being present in the room. Since the procedures she has experienced pain, heaviness, exhaustion, and swelling of both legs. She had a second opinion with another cardiologist who informed her that the venous ablations were unnecessary, she was unable to continue treatment due to her lack of insurance coverage at that time. Records have been requested and received from Defendant Doctor, but the venous imaging were not provided in the initial production nor were they provided in response to a follow-up letter. The venous imaging would objectively establish venous reflux to establish medical necessity for the ablation procedures.
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Do you believe there might have been medical error?
I do venous ablations. If the patient is asymptomatic, there is no indication for this procedure. Also it appears that the doctor documented that the patient wore compression stockings even though she did not. The doctor did this so insurance companies can approve. And the most problematic issue is that the doctor did not do it, but the tech. This appears to be a malpractice case.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The procedure itself is painful, and if not done in an indicated manner, may cause life long pain and swelling. Also if needed, those veins can not be used now for any upcoming cabg. The procedure can also cause a lot of complications such as thrombus, PE and infection. It should only be done when it is indicated.
What makes you a good expert for this case?
I have done more than 5000 procedures of venous ablation. I also train other doctors for this procedure.
How often do you encounter cases similar to this one in your practice?
I encountered quite a few, when the patients suffer from post op infections and pain. Also thermal injury to the nerves can cause lifelong neuropathy, which is mostly untreatable.
Do you believe there might have been medical error?
Venus ablation therapy is indicated for patients who have symptomatic venous insufficiency manifested by pain, swelling, skin changes or ulcerations. It does not appear Patient had any of these problems. Furthermore by the guidelines and most insurance companies, the requirement includes a course of compression stockings as conservative management first and if that fails, then consider a anblation. In this scenario it does not appear. The patient was symptomatic, nor did they ever wear stockings, and those may have been written in the record to obtain insurance coverage for the procedure. Therefore does not seem to be indicated. It also appears there was incorrect documentation. In this case it seems to have led to significant side effects. There’s also a concern that the procedure was not performed by an MD , this is a little unclear, but that would also be inappropriate
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If the patient is experiencing chronic swelling since the procedure and they never had any symptoms prior to the procedure, then it does appear side effects of occurred. It’s unclear if this potential was ever discussed with the patient.
What makes you a good expert for this case?
I treated patients, chronic venous insufficiency, and performed ablation procedures for 10 years of practice before I stopped doing it about 2 to 3 years ago. I’m also RPVI certified and was previously certified and vascular medicine. I also am aware from experience in my practice and from in medical conferences that a lot of unnecessary Venus procedures are performed.
How often do you encounter cases similar to this one in your practice?
These days I do come across patients who have seen vein specialists and undergo procedure procedures when they are not necessary
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