Man Dies From Pulmonary Embolism After Leg Surgery

Case Overview

This case takes place in Florida and involves an obese man who fractured his ankle, which was repaired through surgery performed by a podiatrist DPM physician. A few weeks after undergoing the operation, the patient presented to the podiatrist’s office for a follow-up visit. During the appointment, the man complained of persistent shortness of breath, which had persisted since the date of the operation. The podiatrist performed three checks of the patient’s heart during his exam, with each check revealing tachycardia. In addition, some swelling of the patient’s leg was noted and documented by the podiatrist. The defendant physician advised the patient to see his family doctor before clearing him for anesthesia, which would have been required to remove orthopedic hardware that had been installed in his ankle. Despite these worrying signs, the patient was not told to go the emergency room. As a result, the patient died from a pulmonary embolism within 48 hours of seeing his podiatrist.

Questions to the Pulmonology expert and their responses

As a pulmonary specialist, can you determine if this patient could have been saved / treated during the 3 day period between his final doctors visit and the massive PE?

The podiatrist DPM performed a prior surgical procedure on his ankle, but a podiatrist is not a trained medical doctor that can offer appropriate therapy in the event of a dangerous clotting risk. The surgery was performed on his ankle - this is not an anatomical location associated with deep veins thrombosis where the 'clot' likely originated. The patient was obese as well, which represents a risk factor in itself. The podiatrist could have advised an immediate ER visit but a legitimate alternative was to refer him to a primary care physician who is knowledgeable in initiating appropriate treatment for this risk. Regarding accepted standard medical care, a physician (not the podiatrist) would have ordered an emergency CT angiogram required to document the pulmonary embolism. An oxygen saturation might have displayed hypoxemia, but the oximeter is usually not a 'standard' medical device in a podiatrist's office. Again, there are specific medical approaches necessary for diagnosing a deep vein thrombus, and these necessitate special expertise for treatment. Even if the podiatrist referred the patient to an ER, another physician would have been responsible for treatment. The mortality rate for undiagnosed pulmonary embolism is high, but a podiatrist is not trained to treat or manage them.

About the expert

This expert is board certified in internal medicine, pulmonary medicine, and occupational medicine, with over 40 years of experience in simultaneous clinical and academic roles. He has held numerous prestigious positions including a professorship at the University of Cincinnati. He also formerly served as head of clinical studies at Cincinnati and the Coordinator of Research at the University of South Florida. He has been the director of several programs over his long career, and he is currently the director of a breath laboratory at a major university health center, and an attending physician at a major area hospital.

E-006714

Specialties:

Pulmonology