From our experience in speaking with countless patients, we believe that many surgeons who do a good job in the operating room leave much to be desired in post-operative care. Infections and wound care are frequent problem areas.
This was the situation facing a patient in a case that was recently decided by Houston’s Fourteenth Court of Appeals. The case is styled Babajide Ogulana, D.P.M. v. Derrick Cunningham, No. 14-18-00704-CV, In the Fourteenth Court of Appeals. You can read the opinion here.
The relevant health care that commenced all this happened after Derrick Cunningham, the patient, fell and broke his left ankle. He then went to a hospital emergency room, where a doctor placed a splint on his left ankle.
Six days later, he was admitted to Kindred Hospital, in Sugar Land, Texas, for treatment of a chronic wound on his other foot, his right heel. The day after he was admitted to Kindred, a wound care nurse assessed the patient and found splint and fracture blistering on his left foot. The wound care nurse documented these findings in the patient’s medical record.
While the patient was admitted to Kindred, he was followed and treated by a podiatrist, Dr. Ogulana. A podiatrist is a type of doctor who attended and graduated podiatry school, rather than medical school. Podiatrists are one of two types of physicians and surgeons who treat the foot, ankle, and related structures of the leg. Orthopedic surgeons are, of course, the other type.
The podiatrist at Kindred ordered a Controlled Ankle Motion (CAM) boot for the patient’s left foot. The idea behind this is to eliminate the friction and pressure that was apparently causing the blistering on the patient’s left foot. Unfortunately, there was almost a one-week delay to obtain the boot and even at that point it was too small.
According to the medical malpractice lawsuit, during this lengthy period of delay, podiatrist Dr. Ogulana didn’t monitor the patient’s left foot for skin breakdown. This inattentiveness occurred despite the patient’s known high risk of developing an out-of-control wound based on his medical history and other health conditions. For high-risk patients, medical experts generally agree and recognize that prevention is the most important part of wound care and that as soon as a wound developed they must be immediately treated.
In fact, the podiatrist didn’t even assess the patient’s left foot until he had been admitted at Kindred for two weeks. At that point, the podiatrist discovered severe wounds, one of which had developed during the patient’s hospitalization. Dr. Ogulana documented in the patient’s medical record that the splint was rubbing significantly on his ankle, causing significant rubbing around the blister site. He didn’t write wound care orders until the patient’s 18th day of admission at Kindred.
Less than a week later, the patient was discharged from Kindred with wound care instructions. He immediately followed up with an orthopedic surgeon and was scheduled for surgeries to repair his left ankle and foot. Unfortunately, though, the patient’s left leg was amputated below the knee because of gangrene and osteomyelitis (infection in the bone), related to his wounds and ulcerations.
After filing a medical negligence lawsuit against the podiatrist, the plaintiff (patient) served an expert report from a board-certified orthopedic surgeon. Expert reports are a requirement for plaintiffs in any healthcare liability claim in a Texas state court. They must be written by a qualified physician and identify the standard of care and conduct at issue that caused harm to the patient.
After receiving the expert report from the orthopedic surgeon, the podiatrist filed objections to the sufficiency of the report and a motion to dismiss, alleging, among other things, that an orthopedic surgeon wasn’t qualified to offer opinions about the podiatric standard of wound care.
On its face, I find this to be a rather absurd objection.
After all, orthopedic surgeons and podiatrists both treat the foot and ankle. That’s why it didn’t surprise me that the appellate court rejected the defendant’s argument, noting that the tort reform statute doesn’t focus on the defendant doctor’s area of expertise, but on the precise condition involved in the claim.
The court noted that the plaintiff’s expert orthopedic surgeon is board-certified, completed a fellowship in sports medicine/shoulder, and has participated in research on the ankle surgeries. In other word, he has experience and knows what he’s talking about when it comes to wound care prevention and treatment of the foot and ankle.
The court was also persuaded that the expert’s report specifically discussed the significant overlap between podiatry, orthopedic surgery, and internal medicine pertaining to wound care. Some of the expert’s words are repeating: “Podiatrists and orthopedic surgeons both frequently treat patients . . . with wounds. . . . one of my roles as the orthopedic surgeon is to engage in preventative measures that are designed to prevent my patients from suffering avoidable wounds from treatment I have proposed. It also includes providing the appropriate treatment to wounds at the first signs of wound development to prevent those wounds from becoming severe.”
The court’s opinion also outlined precedent from other Texas appellate courts, which have repeatedly recognized that the care and treatment of open wounds and infection are common to and equal in all fields of medicine. The court said this, in turn, physicians in every field of practice are qualified to testify on the subject of wound care.
If you’ve been seriously injured because of poor podiatric, surgical, or wound care, then contact a top-rated skilled Houston, Texas medical malpractice lawyer for help in evaluating your potential case.