Failed Diagnosis of Sepsis Results in Amputation

Case Overview

This case takes place in North Dakota and involves a male patient who presented to Emergency Room with gout in his left foot. He was given the appropriate medication and discharged. Four days later he presented to another ER with worsening symptoms. He was again diagnosed with a flare up of his gout and no workup was ordered. The defendant doctor allowed the patient to leave and he later presented to a third hospital, where he was found to have sepsis. As a result, the patient required amputation of his left leg.

Questions to the Emergency Medicine expert and their responses

Do you routinely treat patients similar to the one described in the case? Please explain.

I've cared for patients suffering from gout flares as well as those suffering from acute bacterial arthritis (septic joints). Differentiating between which patient has a 'simple gout flare' vs. those who need extensive workups can be challenging early in the patient’s clinical presentation.

Do you believe this patient may have had a better outcome if the care rendered had been different?

Though, a second presentation for the same complaint within days of the first should automatically raise the suspicion of the treating team. The second presentation with worsening of symptoms and the patient’s overall clinical picture would warrant additional evaluation. The outcome of this additional evaluation would theoretically have allowed the treating team to identify the seriousness of the situation and possibly intervene sooner.

About the expert

This highly qualified Emergency Medicine expert has remained in active practice for over 20 years. He received his B.A. in Physiology at Southern Illinois University before completing his D.O. at the Philadelphia College of Osteopathic Medicine. He completed residency training in Emergency Medicine at the Joint Military Medical Center. He is double board certified in General Emergency Medicine as well as Emergency Medical Services. He has published 15 peer-reviewed journal articles which have appeared in such highly regarded publications as Academic Emergency Medicine. He is a Fellow of the American College of Emergency Physicians. This expert currently serves as a Clinical Professor of Emergency Medicine at a Texas-based University as well as Director of Emergency Medical Services at a major university affiliated hospital.

E-008958

Specialties:

Emergency Medicine