Potential Defendant is an Interventional Cardiologist.
Case involves a 67 y/o diabetic with PAD/PVD, CAD, renal insufficiency, s/p CEA, left leg stent. In February 2025, client began having right leg pain. On 2/12/25, Defendant M.D. completed a right lower extremity arterial angiogram and atherectomy for an 80% stenosis of the popliteal artery at Outpatient Facility. On 3/5/25, he presented to Defendant M.D.'s office with leg swelling and redness, WBC 19.1, and rising creatinine with reduced GFR. Defendant M.D. documented possible cellulitis but failed to admit client. He was given scripts for Bactrim, Lasix, nephrology referral. Venous ultrasound, right venogram, but no CT or MRI. On March 7, 2025, client underwent a right BKA for sepsis with necrotizing RLE cellulitis with abscess.
Potential Deviations?
1. Failure to hospitalize
2. Failure to Order CT or MRI of the RLE to evaluated for deep tissue infection
3. Inappropriate antibiotic selection of oral Bactrim
4. Inappropriate meds given acute renal dysfunction. Lasix, Bactrim & Tramadol can worsen kidney function.
5. Failure to obtain cultures
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Do you believe there might have been medical error?
After the post op follow up, it is obvious that the clinical picture and the labs scream impending sepsis. I can not with full confidence tie the intervention and the infection, but even if there is a slight possibility, there is evidence of end organ failure, and a severe infection. The patient is diabetic. Patient should have been hospitalized, IV fluids and IV antibiotics.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Two things. There could be a causation from the procedure, with hospital stay and AV puncture. Also DM has always the higher risk of infection. Ischemic PVD worsens the infection risk. It may have been better even to use perioperative antibiotics. Secondly. During the office visit, the clinical picture is worsening. GFR is coming down, so using diuretics was probably not the right choice. There is WBC of 19, so again most likely PO antibiotics won't do it. Rapid hospitalization may have saved the leg.
What makes you a good expert for this case?
I have dealed with many peripheral angiograms, and had my share of infections. I do an aggresive and broad spectrum antibiotic therapy. At the same time I do have a very low threshold for ICU admission for these patients. I believe I am quite experienced in this field.
How often do you encounter cases similar to this one in your practice?
Rare. But I see them. So far I remember only one patient who lost a leg, but his medical issues were much more complicated, intubated and cardiogenic shock. But I have not a patient who lost an extremity to an infection due to early and rapid sepsis protocol.
Do you believe there might have been medical error?
Patient’s presenting post procedure with concerns of infection skin changes on the intervened leg. Leukocytosis and AK I patient should’ve been hospitalized both for the infection concerns with AKi. Also giving lasix for aki , which may be associated with sepsis or possibly contrast induced the property was not the right strategy. Also confused why venogram was done, in addition to a Venus duplex.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Inappropriate management and delayed treatment contributed to the limb loss. again would need to know more detail.
What makes you a good expert for this case?
Board certified interventional, cardiology, cardiology, vascular medicine. In practice for 13 years. 10 years of that I did vascular procedures. Take care of Cardiology and critically ill impatient in the hospital
How often do you encounter cases similar to this one in your practice?
I don’t Gucci Vascular patients in the past couple of years as I’m focusing more Cardiology interventional structural heart. But I do comanage many Vascular patients with my colleagues and very rarely. Would we see anybody ending up with this complication. But see a lot of patients with PAD. And I also see a lot of patients overly treated in the community.
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