Severe Infection Due to Delayed Follow-up Treatment in Correctional Facility

This case study examines the standard of care in a correctional facility where a postoperative patient developed a severe infection due to delayed follow-up and drain removal.

ByWendy Ketner, M.D.


Published on February 15, 2024


Case Overview

This case study involves an incarcerated adult who underwent a decompressive laminectomy. A lumbar drain was placed by the surgeon during the procedure, with explicit instructions for a follow-up visit within 3-4 days to remove the drain. However, nearly three weeks later, no follow-up had been conducted or scheduled.

The patient subsequently developed a severe MSSA infection, necessitating emergency hospitalization for approximately six weeks. This case seeks expert insight from a family nurse practitioner specializing in correctional medicine to review medical records and opine on the standard of care.

Questions to the Nursing expert and their responses


How frequently do you evaluate and manage postoperative patients in a correctional facility setting?

As a board-certified family nurse practitioner, I regularly evaluate post-operative patients several times a month within the correctional setting. Many of these patients have undergone some form of spinal surgery.


What are the pertinent protocols that should be followed if a postoperative patient requires surgical drain removal?

The protocols for managing post-operative patients, particularly those requiring surgical drain removal, are primarily based on the surgeon's recommendations. These include dressing management, follow-up schedules, and overall post-op care.

Additionally, there are specific correctional protocols that need adherence concerning follow-up timeframes, drain management, and post-op care. For instance, if a patient has a drain, they should be placed in a medically supervised cell with round-the-clock nursing care due to the high risk of infection. Nurses would monitor the drain multiple times daily and document output until its removal.


Have you reviewed cases similar to this one? If so, could you briefly describe your experience?

I have previously reviewed a correctional case where the attorney needed to determine if the standard of care was met for their client who lost a limb while under the care of a nurse practitioner. In that case, I reviewed over 3000 pages of medical records and provided an executive summary. I am prepared to apply similar diligence to this current case.

About the expert

This expert is a highly qualified family nurse practitioner with an extensive background in nursing, holding degrees from California State University, Chamberlain College of Nursing, and Grand Canyon University. They have served in various clinical roles, including labor and delivery departments and high-risk obstetrics case management, and have held teaching positions at West Coast University and a university in Kentucky. Currently, they direct a primary care residency program for a corrections department in California, making them particularly suited to provide insight into this case involving postoperative care within a correctional facility setting.

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About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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