Malpractice? Need some advice please
 

I'm 37 and lead a VERY active life, work a very physical job, and playing with cars is my only hobby that doesn't involve physical exertion.
August of 2013 I was playing volleyball and rolled my ankle. It swelled quickly and I was in some pretty big pain. Managed to drive myself home and my wife took me to our urgent care center.

They took xrays and said it is just a sprain. I don't remember even being offered pain meds or an anti inflammatory. They put one of those simple half casts on me and sent me on my way.

Fast forward to this spring and I see my PCP about my knee as it had really been bothering me, always stiff and sore, getting up from a chair or out of a car I needed a minute before I could walk at a normal pace. Dr does some xrays and says that it looks ok but go see a specialist as something isn't right. Meet with the specialist/surgeon and he does a quick look at my knee and then glances at my ankle and says "WTF is this!" He takes a few xrays and and a CT scan and tells me that:
1) I have a "huge chunk" of bone floating around in my ankle
2) one ligament is fully torn and another has been stretched to the point of not doing its thing
3) cartilage and bone have been eroded by the chunk of bone floating around
4) my knee pain was likely from misalignment of the tibia and fibula causing patella tracking issues

I had surgery in May to remove the bone and repair the ligaments and clean up some cartilage and smooth the rough area of bone where it has eroded. I did physical therapy as directed. My ankle bothers me now more than ever and my knee still sucks (but is a little better)

Dr says I'll probably need more surgery as he couldn't get to all of the cartilage during that first procedure.

This has cost me thousands. I'm never going to regrow that bone or cartilage. I can't do some of the things I love to do and more physical activities, even walking, causes pain.

My initial visit with the urgent care center should have caught this, right?
What do I do now?

Well for one thing, don't piss around on Pelican OT, instead call a lawyer. That statute of limitations aint gonna wait for us to chime in.

You had an injury doing a risky activity by your own choice.

Perhaps the first visit xrays showed normal findings as the bone had not separated yet. That said U/C's do often call everything a "sprain" at first from my experience. Doing MRI's and expensive imaging on every guy who walked in w/ an ankle sprain for palliative care is not practical.

Did you followup with your PCP thereafter for a real evaluation? Urgent care sort of doesn't count as a real evaluation IMO, that's basically just an emergency/get me out of pain until I can get to a real doctor sort of place to go.

What was the time interval between the time you saw your PCP and when you saw the specialist/orthopedic?

Life is risky, things happen, it was YOUR injury not the doctor's. Ask yourself are you looking to blame someone who was trying to help you for the result of YOUR injury vs taking ownership?

The human body is imperfect and in many instances has a limited capacity to repair itself even with the best healthcare/surgery.

Getting old sucks.

Time been injury and PCP visit was just over a year.
Time between PCP and specialist was less than two weeks.

UC made me feel like it was a waste of time for me to even be there. They showed no concern that it might be more serious nor did they tell me to follow up with anybody.

When you are seen in prompt care, they do the initial eval to get the ball rolling. They aren't orthopedic doctors...

Sounds like they did an xray, which will NOT show ligament tears/tendon tears/etc... All an xray shows is fractures, which they reported you did not have (accurate, yes?).

You mention a "loose bone." That could be anything from a small chip - means little. to a complete fragment that was pulled off... Which is it?

Usually prompt care will tell you "if your symptoms aren't better see your primary doctor..."

Thats the legal way of covering yourself, in case the patient doesn't follow up and something is missed... Its SOP.

Sorry you had a bad ankle. Doesn't sound anywhere near malpractice... unless that original xray showed a clear fracture... Any problems that develped could also have occurred/worsened after the prompt care visit...

Focus on healing yourself... alluding to malpractice will take you down the wrong road...

(Simply an opinion/not medical advice or legal advice and shoudnt be misconstrued as such from a random stranger on the net...)

It appears that you didn't either.

It was a fragment. Surgeon referred to it as "a huge chunk of bone"

Why would I? I was seen by a doctor and told I was fine.

Were you completely asymptomatic during the year between the U/C visit and the PCP visit?

My wife went thru a similar deal, diagnosed as an ankle sprain, felt better after basic care for a couple weeks, but always was a bit sore, nothing that restricted her activities (was running 8-10 miles 2-3x per week on it), almost a year went by, started hurting again while training for a half marathon. Had an MRI, found a similar chunk of bone pulled off by a ligament. Orthopedic determined it was non-operable, wore a boot for 4 months and has been fine since. Unfortunately they don't do repeat MRI's to verify the bone reattached unless there is persistent symptoms.

Based on this and your story I think the ankle may tend to lack symptoms despite major problems sometimes??

Yes! My knee was what brought me to my PCP. My ankle might bother me for a week and then be fine for a while.

I had nothing other than the initial extreme swelling and bruising to make me think it was broken.

Well then it's tough to make a case for any malpractice. Given that you had no symptoms there was no real reason to have imaging of the ankle done and if the initial xrays were read by a radiologist who found no problems then the urgent care had no reason to think anything was wrong beyond a sprain. Tough break.

I'd be quite surprised to learn that the paperwork the UC clinic sent you home with doesn't explicitly recommend a follow up visit with your PCP.

If you truly love your active lifestyle, you learn to deal with the pain. I had very similar ankle issue (still have a chunk of bone floating around the doc couldn't get to). It's been around 15 years now; I still play volleyball/softball/tennis/basketball...some days just hurt more than others.

Just wait till that ankle starts developing arthritis...

I've got two blown disks in my back and a tweaked shoulder. The disks in my back were misdiagnosed for close to 10 years. If you've been active your whole life, you start to accumulate broken bits. I'm 45, and I recall my late thirties well. You need to start being a bit more careful, stay flexible, keep your core strength up....and buy a 5 gallon bucket of ibuprofen from Costco. :D

I don't think suing it worth your time. Move on.

The practical analysis is:

1. Are you willing to pay a lawyer $300/hour out of your pocket to pursue a claim?

2. Can you find a lawyer who will take the risk himself (i.e., contingency fee)?

I suspect the answer to both is "no."

+1

Hmm. Every time I've been to an ER or Urgent Care they give me a paper to sign saying I will make an appointment with my regular doc. They didn't do that?

How are you going to prove the stuff that was wrong with your ankle didn't happen in the year between your UC visit and the time you saw your doc?

Having a valid case will also rest on the initial XRay showing an anomaly that the emergency physician missed. Is that the case?

The thought of pursuing this was spurred by my last two adventures. Hiking in the Appalachians a couple weeks ago and wading while salmon fishing last weekend had me in pain. I got to thinking about my new limitations, the pain, the fact that I had to sell my manual trans jeep because it was painful to use the clutch.

Would things be different if I had had my ankle dealt with right after the injury? I don't know. Surgeon says arthritis is inevitable because of the erosion.

Thanks for the input guys.

I don't know. I'm not a radiologist.
I know it won't show the torn tendons but I would think the fracture should've been visible.

That depends on where the fracture was. If it were a talar dome lesion, it would be difficult to see on plain films. It also would hurt. Where did that piece of bone come from?

If you injured it and did not have problems that sent you to a doctor for a year, and they were in your knee, not your ankle, a lawsuit is not likely to be fruitful. Today is the four year anniversary of some old rummy running a stop sign crushing my car, fleeing the scene, had to be chased down. First serious injury I have ever had. My back is ****ed forever; can't play golf with Dad, can play catch with the grandkids for about 10 minutes and I have to go lie down, can't sleep for more than about 6 hours before I have to get up and walk around. The settlement is going to net me about $13,000, after everyone else gets paid. Drunky up and died a few years ago, so I can't even go give him kick in the neck so he can see how I feel every day.

Turn the page, do your rehab

Can't offer any legal advice, but some generalities:

Malpractice is only with gross negligence. You have to demonstrate the practitioner exhibited gross negligence. Not just that there was a bad outcome, or even that a mistake was made.

That standard (of gross negligence) is different for different specialists. So if a doc-in-a-box misread an x-ray, that's different than if a radiologist or podiatrist/orthopedist (in this case) misread that same x-ray.

You need to see that original x-ray to see if something really was missed or not--by the original practitioner as well as the radiologist who later read it. Not all fractures necessarily show up on initial films. Almost always a radiologist will dictate (on the official report) something to the effect of: "no acute injuries/fractures noted...clinical correlation recommended...if persistent symptoms after 1-2 weeks then repeat imaging." What happened in the days and weeks after your injury? Did you have any symptoms? Why didn't you follow-up with your regular doctor and/or specialist if you were still having problems?

Best of luck with the ankle and knee. Degenerative arthritis is not fun to have.

OK I'll be more direct; most of the advice written thus far in this thread is crap, and uninformed crap to boot. I am a lawyer - here's my advice - consult with a medical malpractice lawyer, and do it now. There are limitations on how long you can wait to file a claim. These limitations vary from state to state (PA is 2 years, and the "discovery" rule applies).

All good med-mal lawyers work on a contingent fee basis. You pay nothing unless you win, then you pay a percentage of the winnings to the lawyer. The law firm takes the economic risk; not you. Their take is typically 30% to 40%, depending on a settlement or trial. These are fair numbers, because you are guaranteed ZERO if you try to do this without a lawyer. Also, all med-mal lawyers will give you an initial consult, for free - they will talk to you.

As to the merits of the case, the ONLY way to know if you have a good case is to talk to a lawyer. Not the people on a car forum OT section. You might have a very good case (I do not know your specific facts); it sounds half decent to me - definitely worth pursuing by talking to a med-mal lawyer. The lawyer has relationships with doctors who assess your medical records and help to decide whether malpractice has occurred. THIS IS THE ONLY WAY TO KNOW.

If you truly have lost quality of life due to bad service from an urgi-care type of place, pursue it. The stuff about you choosing to go there, or you choosing to partake in the activity that harmed you, etc is all nonsense. Yes, people get hurt, and you paid for care but apparently didn't get it properly administered. The medical center holds itself out as providing quality medical care, and they must abide by whatever the proper legal duty of care standard applies. Also, the med mal standard certainly IS NOT gross negligence.

Well, as a doc and someone with experience with litigation, I would suggest your comments are awefully aggressive...

This attitude is partly why we have the malpractice premiums we do, and why docs are fleeing from high malpractice states... Also explains why some lawyers have the reputation they do...

The OP was seen for an injury... and xray was done... and he was feeling pain free since. He didn't have any pain or reason to see someone for the ankle since...
Sees an orthopod and has a "now found" ankle abnormality that may or may not have occured a year ago...

Forget the fact that he was pain free...

Forget the fact that he didn't feel an urgent need to follow up...

Forget the fact that 1 year passed...

Forget the fact that there is no evidence to suggest that the alledged delay caused injury...

Forget the fact that there is no proof of permanent damage...

By all means. See a lawyer. If the info is dramatically different than what was presented, perhaps there is a case...

80-90% of med-mal cases which actually goto trial are won by the provider. And those are cases that have been vetted, with serious injuries or death. Thats because in the majority of cases the docs did what they could, and were within the standards of practice...

I have supported patients who were screwed by other docs. More than willing to testify...

This isn't one of those cases. Telling the guy to see a lawyer is doing him a diservice, and not shining the brightest light on lawyers...

To the OP, focus on your health, and get better... Did you get surgery on your knee, or your ankle... the original note isn't that clear. Sounds like you went in for knee pain, and then had knee surgery?

Honestly, if I were you I would delete this entire thread. You mentioned the clinic by name, and subseuently accused them of malpractice. Not a wise thing to do on the net... You also have documented in perpituity that you had no pain for a year (that will come up in discovery - heaven forbid). Now, this is all based on what was posted. If the original xray showed an acute fracture which was displaced, and that was missed or not communicated, then all bets are off. But thats not what was posted...

Based on the fact that you showed up, seems to have worked just fine:)

To the OP. I was hit by a car when I was 19 and the impact of the significant trauma to my leg didn't manifest through the rest of my body until my mid 40's. I was a college athlete, etc.

DO NOT do what I did, which was to to try and work the pain away, gut it out, no medicine, etc. Find the right folks, get the right care and carefully manage the meds to get back to the things you enjoy.

Best.

Take two asprins and sue me in the morning.

I am offended!

Don't miss the irony that the above advice also came from a car forum OT section.

I would take linderpat's advice with a large grain of salt. He writes like a true applicant attorney.

Of course this is your position, doctor. I have no dog in the hunt, I do not practice this type of law. Also, I never said he has a case. He asked whether he did or not, and I said the only way to know is to ask a lawyer that does this type of work to evaluate. Are you suggesting that medical malpractice should go unchecked? Also, the real disservice is telling a guy to suck it up, if there was in fact harm caused by another.

And Noah, not sure what an applicant attorney is, but I guess I'll take that as a complimentSmileWavy

Certainly nothing wrong with seeing if you can find a contingency med mal atty to bite on this. As Bluto said, "It don't cost nothing."

Open up the yellow pages, give a few a call, let us know how it works out.

What is pursuing a malpractice lawsuit going to change? It won't repair your foot or knee ... I would only blame myself for being careless not to follow up and immediately look ahead. I would never go back and remind myself on a regular basis of bad events that took place in the past by starting a lawsuit.

Like others have said, you aren't a spring chicken any more. Get used to some aches and pains an physical limitations starting to creep up. It would happen sooner than later anyway, especially with high demands towards your physical abilities.

Also, give it some time. Your body can do amazing things if you give it time. Attitude is half the battle and by looking forward, you will get there quickly.

G

As a doc, I would have to agree that it would be tough to prove (based on what has been offered here) that the initial injury directly caused the bone fragment and was missed at the time of X Ray. You were pain free for a year. How can you prove that some other small twist or turn of the ankle didn't do the damage? If there's not evidence of a fracture or avulsion on the initial XRay, you will have a tough time making that case.

A bit disappointed in the lawyer's comments, but not surprised. As has been said above, at some point our society is going to have to decide what is really worth suing over and what isn't. This attitude that you should just call a lawyer and throw something up against the wall to see if it sticks is going to kill our country.

I'm sorry your knee hurts, I'm sorry you had to have surgery to try and fix it. I just doubt you have much of a case to prove malpractice here.

The system isn't perfect, but it does have some built in safeguards.

As in this instance.

He can call lawyers, but that's a completely different thing than actually finding one to risk his own time and money to file a contingency suit.

I think it's unlikely.

Contingency lawyers like to see two things: (1) Clear liability, and (2) significant damages (like someone died, lost a limb, permanently disabled, significant brain damage, etc).

If both are present, any contingency lawyer would take the case.

If neither are present, almost all will not take the case.

+1. In the malpractice world the risk side of the risk/reward equation is pretty high, and any good malpractice attorney is selective. Case needs both liability and damages, or needs to be a huge slam dunk on the other side if one side has problems. Here, I see large damages issues, forgetting liability, on which I can't comment.

an error in diagnosis does not constitute malpractice.

The urgent care centre stated that nothing was broken. So they did their part however if I was them I would have recommended going to see a specialist as a follow up. There is nothing wrong with a second opinion and I have done that in the past thinking the next doc might be better. In some cases he was.

In terms of lawsuit I don't think you have a leg to stand on(pardon the pun). The slowness with which you followed up was not good.

I am not a med professional. More physio? Another specialist?

People in the third world would love access to the care we take for granted. It seems every time we suffer a setback, SOMEONE has to pay. It's embarassing. America needs to HTFU.