CAN 21 LAWSUITS FOR MALPRACTICE AND WRONGFUL DEATH BE WRONG?

July 1, 2012

A podiatrist who practices outside of Oregon has seen more than his share of lawsuits. Of the 21 total claims during his long career, 11 were filed in the last three years. At the moment, he is fighting eight medical malpractice suits and one wrongful death suit. Even for a doctor who performs 600 surgeries a year, nine suits at once is almost unheard of, according to one long-time litigator.

The patients’ stories are terrifying. One woman went to this doctor with a broken ankle. He operated four times over five years without success. Amputation below the knee was the only option left by 2011. “It changes everything” she said.

Another woman agreed to surgery — recommended by this podiatrist — to treat heel spurs. Eight surgeries over three years failed; in 2010, her leg was amputated below the knee. Before the surgery, she was an active grandmother with some pain, she said. Now, she has a prosthetic lower leg, uses a walker and a wheelchair and can’t manage normal activities much less playing with the grandkids.

Several of the lawsuits include the hospital where the surgeries were performed and its parent company as defendants. The company stands by its credentialing practices. Still, the podiatrist no longer performs surgeries at the hospital; he resigned his privileges six months ago after 26 years of practicing there. He also severed ties with another hospital owned by the same parent company; he had been affiliated with that facility for more than 30 years.

What gives?

According to the Oregon Medical Board, podiatrists “diagnose and perform medical, physical or surgical treatments related to the human foot, ankle and tendons directly attached to and governing the function of the foot and ankle.” A podiatrist must complete four years of college and four years of medical school; additional training is optional and can last anywhere between two and four years.

The educational requirements are more extensive for orthopedic foot and ankle surgeons: four years of college, four years of medical school, five years in an orthopedic residency, and a one-year fellowship devoted to the study of foot and ankle diseases, disorders and injuries.

The difference in training has fostered a kind of rivalry in which orthopedists feel more qualified to treat feet and ankles. Podiatrists have been the scrappy underdogs, whittling away at orthopedics’ piece of the pie.

For a long time, the medical community did not consider the ankle to be a part of the foot. As a result, podiatric practice was limited to the foot. No broken ankles or ankle replacements at all.

Podiatrists changed that, but questions about surgical skill when it comes to the ankle have persisted. State medical boards and legislatures have responded by finding some middle ground. In Oregon, for example, podiatrists must go through additional ankle-specific training before they can be “endorsed” to perform ankle surgery. Oregon statute specifically states that only those podiatrists whose licenses have been endorsed by the board may perform ankle surgery.

Several of the claims against the podiatrist we’re talking about are related to ankle surgeries. When ankle surgery goes wrong, the results can be life-changing: Below-the-knee amputation was the only option left to at least two patients. One patient wears a permanent ankle brace to prevent amputation.

Perhaps the key to this podiatrist’s legal troubles is the ankle?

The 65-year-old podiatrist at the center of our discussion was licensed to practice in 1973. During all these years, the state’s medical board — he doesn’t practice in Oregon — has never taken disciplinary action against him. And yet, since 1991, he has been named as a defendant in 21 lawsuits. Right now, the count is nine: eight medical malpractice suits and one wrongful death claim.

Medicine has changed since 1973, as has podiatry. This doctor, in fact, is responsible for sparking one major change in his field: the addition of ankle surgery to a podiatrist’s scope of practice. As a result, he is not especially popular with orthopedic surgeons.

The tension started in 1992 with the podiatrist’s application to perform ankle fusion surgery. Until then, ankle surgery was off-limits to podiatrists. At the request of the hospital, the medical board began grappling with the question of whether the scope of a podiatrist’s practice included surgery on the ankle.

About five years later, the board decided that the definition of the foot includes the ankle. The five years exacted a hefty toll, though, on the relationship between podiatrists and orthopedists.

The tension, according to the podiatrist’s spokesman, has yet to subside. The spokesman explained that the podiatrist had resigned his privileges at a hospital he’d long been affiliated with because he “was feeling pressured by orthopedic surgeons who were not happy that a podiatrist was performing highly technical surgeries such as ankle replacements. He elected to take his privileges to surgery centers where they welcomed the skills he has to offer.”

For the patients whose medical malpractice claims are pending, the explanation may not explain why they lost the lower parts of their legs following relatively routine surgery.

Source: The Columbus Dispatch, “Hilliard podiatrist facing 8 malpractice lawsuits,” Courtney Hergesheimer, July 9, 2012

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