Patient Loses Legs Due to Delayed Treatment of Sepsis

Joseph O'Neill

Written by
— Updated on September 28, 2017

Critical Care Expert WitnessThis case takes place in Louisiana and involves a male patient who presented to the ER with complaints of severe flank pain. The patient’s medical history included a recent diagnosis of kidney stones. On examination, the emergency room physician suspected that the patient was suffering from a significant obstruction of his urinary track that would require immediate treatment. After undergoing a range of imaging studies, lab tests, and physical examinations, the patient was given a number of medications for pain and treatment of other symptoms. The patient was also admitted to the hospital. After several hours in the hospital, the patient was again seen by doctors, who discovered that he was lethargic with worrying vitals and complaints of severe 10/10 pain. Over the course of a day, the patient’s condition continued to deteriorate, with his blood pressure and oxygen saturation falling significantly. The patient was again given medication for pain and treatment of symptoms. After several more hours had passed doctors noted that the patient’s condition had continued to deteriorate significantly, at which point he was diagnosed with sepsis. As a result of his sepsis, the patient developed gangrene in his feet, which eventually required the amputation of both of his legs below the knee. It is alleged that the treating physicians failed to diagnose and treat his sepsis in a timely matter, and that he would have experienced a better outcome had care been given sooner.

Question(s) For Expert Witness

  • 1. How often do you treat patients presenting with this clinical picture?
  • 2. What investigations should be carried out to rule out the possibility of sepsis?
  • 3. What are the complications of delay in treatment?

Expert Witness Response E-001199

I have treated hundreds of patients over the past decade with sepsis and septic shock, and this case is a very common situation for my practice. Urosepsis is a condition that must be diagnosed clinically based on the appropriate constellation of clinical signs and symptoms, combined with laboratory (WBC, urinalysis, etc.) and imaging (CT scan vs. intravenous pyelogram) results. The critical determinants of malpractice in this case are whether this patient was adequately treated for his urosepsis in a timely manner. Specifically, the Surviving Sepsis (SCCM) campaign recommends appropriate empiric antibiotic therapy within one hour of severe sepsis or sepsis shock. In addition, early adequate fluid resuscitation is considered standard of care in sepsis, severe sepsis, and septic shock. The literature has shown that increases in morbidity and mortality result from delays in antibiotic and fluid therapy. From the synopsis above, it appears the patient did not receive timely antibiotic therapy, and likely did not receive appropriate early volume resuscitation for his sepsis either. This case is indeed an example of the breach of standard of care in the appropriate early and aggressive treatment of septic shock.

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